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E - Guideline On The Management of Acute Respiratory Distress Syndrome PDF
E - Guideline On The Management of Acute Respiratory Distress Syndrome PDF
1)To ensure that all patients in ICU with ARDS are correctly identified and receive
the best evidence based treatment.
Definition
Onset of ARDS (diagnosis) must be acute, within 7 days of some defined event,
which may be sepsis, pneumonia, or simply a patient’s recognition of worsening
respiratory symptoms. (Most cases of ARDS occur within 72 hours of recognition of
the presumed trigger.)
Bilateral opacities consistent with pulmonary edema must be present but may be
detected on CT or chest X-ray. Ultrasound may also be used to define lung
pathology and the presence of non cardiogenic extra vascular lung water
Respiratory failure can be “not fully explained by cardiac failure or fluid overload,”
in the physician’s best estimation using available information.
General Measures
1 All patients should have 100% compliance with the Ventilator Care bundle
6. Ventilation
The tidal volume required must be written every day at the top on the ICU
observation chart in red. It is the responsibility of the ICU consultant 1 to ensure that
this is done
NDMR
All patients who meet the above criteria will be given a cisatracurium infusion. This
will be titrated to a train of four (TOF of 2 twitches). Paralyses will continue for as
long as they meet prone ventilation criteria.
Prone ventilation
All patients who do not have specific contraindications to prone ventilation will be
prone ventilated. They will be placed prone as per unit guidelines. They will remain
prone ventilated for at least 16 hours.
Prone ventilation will be stopped when any of the following criteria are met:
2) If the pH remains less than 7.2 for >24 hours then consideration should be given
to using extra corporeal CO2 clearance
3) If the pH is < 7.1 for 4 hours or more with no other therapy (nebulisers etc)
available to reduce it, then extra corporeal CO2 clearance should be considered.
4) All patients being considered for extra corporeal CO2 clearance should initially
be discussed with our regional ECMO centre.
1) Increase FiO2
Recruitment maneuvers
1) All patients will have ‘inspiratory hold’ recruitment. This will be performed by
using the inspiratory hold function on the ventilators.
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References