RT Book, Section
A1 Biesterveld, Ben E.
A1 Williams, Aaron M.
A1 Alam, Hasan B.
A2 Feliciano, David V.
A2 Mattox, Kenneth L.
A2 Moore, Ernest E.
SR Print(0)
ID 1175136765
T1 Respiratory Failure
T2 Trauma, 9e
YR 2020
FD 2020
PB McGraw Hill
PP New York, NY
SN 9781260143348
LK accesssurgery.mhmedical.com/content.aspx?aid=1175136765
RD 2024/04/16
AB KEY  POINTSThe  Lung  Injury  Score  (LIS)  is  based  on  the  chest  x-ray,  hypoxemia,  positive  end-expiratory  pressure  (PEEP),  and  respiratory  compliance,  and  each  component  is  scored  from  0  to  4.The  Berlin  definition  of  acute  respiratory  distress  syndrome  (ARDS)  (2012)  includes  timing  (within  1  week  of  a  known  clinical  insult),  bilateral  opacities  on  chest  x-ray,  respiratory  failure  not  explained  by  cardiac  failure  or  fluid  overload,  and  mild,  moderate,  or  severe  hypoxemia.A  consistent  histopathologic  feature  of  ARDS  is  neutrophil  infiltration  of  the  pulmonary  microvasculature,  interstitium,  and  alveoli.With  ARDS,  it  is  not  unusual  to  see  greatly  diminished  lung  compliance  on  the  order  of  10  to  30  mL/cm  H2O.The  current  standard  of  care  for  ARDS  is  lower  tidal  volume  ventilation  and  the  use  of  incremental  inspired  oxygen–PEEP  combinations  to  achieve  oxygenation  goals.PEEP  is  used  in  ARDS  to  allow  for  adequate  oxygen  delivery  to  tissues  while  reducing  the  concentration  of  inspired  oxygen  to  nontoxic  (below  0.6)  levels.The  most  common  type  of  extracorporeal  life  support  ([ECLS];  or  extracorporeal  membrane  oxygenation  [ECMO])  is  venovenous,  where  blood  is  withdrawn  from  and  returned  to  the  venous  system.Inhaled  nitric  oxide  (iNO)  is  a  selective  pulmonary  vasodilator  with  no  systemic  side  effects.Any  use  of  “rescue”  steroids  for  late  ARDS  must  be  individualized  and,  optimally,  delivered  before  disease  day  14.The  mortality  of  ARDS  in  several  randomized  controlled  trials  over  the  past  two  decades  has  decreased  to  20%  to  25%.