ICU SAQs · ARDS & lung protection
Defining and recognising ARDS (the Berlin definition)
A core Second-Part question on the Berlin definition of ARDS — its four diagnostic criteria, the three severity bands and their prognostic implications, the under-recognition problem highlighted by LUNG SAFE, and the immediate application of lung-protective ventilation.
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Prompt
A 58-year-old woman is admitted with H1N1 influenza pneumonia. On 15 L/min oxygen via reservoir mask her PaO2 is 62 mmHg, FiO2 0.85, and her chest radiograph shows bilateral diffuse alveolar infiltrates. She is clinically euveolaemic with a normal echocardiogram. Define the syndrome she has, classify its severity, and outline your immediate ventilatory management.
Question
A 58-year-old woman is admitted with H1N1 influenza pneumonia. On 15 L/min oxygen via reservoir mask her PaO2 is 62 mmHg, FiO2 0.85, and her chest radiograph shows bilateral diffuse alveolar infiltrates. She is clinically euveolaemic with a normal echocardiogram. Define the syndrome she has, classify its severity, and outline your immediate ventilatory management.
References5ShowHide
- [1]Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 2012.PMID 22797452
- [2]Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA, 2016.PMID 26903337
- [3]Brower RG, Matthay MA, Morris A, et al. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2000.PMID 10793162
- [4]Bersten AD, Soni N (eds). Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [5]Marino PL. The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.