ARDS: NCLEX Priorities
ARDS: low tidal volume ventilation, prone positioning, PEEP, refractory hypoxemia.
Acute Respiratory Distress Syndrome is non-cardiogenic pulmonary edema. NCLEX tests low-volume ventilation and prone positioning.
Berlin criteria
Acute onset (<7 days). Bilateral infiltrates on CXR. Not explained by HF. P/F ratio <300 (mild), <200 (moderate), <100 (severe).
Causes
Sepsis, pneumonia, aspiration, trauma, transfusion (TRALI), pancreatitis.
Ventilator strategy
Low tidal volume (4-6 mL/kg ideal body weight). Plateau pressure <30 cm H2O. PEEP titrated to oxygenation. Permissive hypercapnia.
Prone positioning
Improves V/Q matching. >12-16 hours/day in moderate-severe ARDS. Improves mortality.
Refractory hypoxemia
Neuromuscular blockade, inhaled NO, ECMO in severe.
Frequently asked
Why low tidal volume?
Reduces volutrauma. Mortality benefit (ARDSNet trial).
Steroids in ARDS?
Controversial. Dexamethasone has shown benefit in COVID-ARDS specifically.
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