The acute respiratory distress syndrome represents the symptom complex which is characterized by the expressed anoxemia which arises in response to acute pulmonary damage.
Originally this syndrome was connected with shock from where also its earliest name — a shock lung came. However in the subsequent it became clear that this pathology has much more wide range of the reasons.
ORDS is characterized by a heavy current and rather high lethality. Such patients practically always demand respiratory support for a long time.
The etiology acute respiratory a distress syndrome is rather various and includes a set of disturbing factors. Can be basic reasons of ORDS:
Depressed cases of various genesis
Aspiration of gastric contents
Viral and bacterial pneumonia
Influence of toxic agents
Thermoinhalation trauma
Transfusion of components of blood
Sepsis and other system infections
Acute respiratory distress syndrome
The pathogeny acute respiratory a distress syndrome consists in disturbance of permeability of an alveolocapillary membrane for protein and water, development of pulmonary intersticial inflammation and formation of infiltrates. There is a state reminding an intersticial fluid lungs. There is an increase in pressure in pulmonary capillaries, that is pressure of jamming of pulmonary capillaries stops being the informative monitor and does not reflect actual pressure in them. All above-mentioned leads to decrease in extensibility (komplayns) in lungs that is called as cider of rigid lungs. There is a decrease in functional residual capacity of lungs. All this complicates normal transport of oxygen through an alveolocapillary membrane and involves development of an anoxemia.
The acute respiratory distress syndrome has a certain staging of a current. At first there is a phase of exudation which proceeds several days. Then there comes the proliferation phase. Process comes to the end with a fibrosis phase which takes place not at all patients.
Diagnostics acute respiratory a distress syndrome is carried out, as a rule, in intensive care units and an intensive care. Now the Berlin diagnostic criteria of ORDS are used. They include the following parameters: a time interval, data of a X-ray analysis of bodies of a thorax, verification of a source of an intersticial fluid lungs and indicators of oxygenation at the patient.
Treatment acute respiratory a distress syndrome represents one of the most difficult tasks of a modern intensive care. Patients, as a rule, need performing respiratory therapy which considerably is complicated by a progressive aggravation of symptoms of lungs.
Correction of the main pathology which caused ORDS is always the cornerstone of treatment. Without it the intensive care of pulmonary function will not make success. Make stopping of the phenomena of shock, treatment of infectious pathology, elimination of consequences of a thermoinhalation trauma, sanitation of respiratory tracts at aspiration complications and so on.
Respiratory therapy as a cornerstone of treatment acute respiratory the distress syndrome was already mentioned, is. The problem consists that it is possible to reach acceptable indicators of oxygenation at a heavy current of ORDS often only by exposure of competent parameters of ventilation of the lungs which demand constant correction in the subsequent. It is connected first of all with decrease in a pulmonary komplayns owing to ORDS. The strategy of so-called pulmonary and protective ventilation is used: seek to use the minimum respiratory volume and the minimal peak pressure on a breath. Maneuvers of disclosure of alveoluses (so-called recruitment) can be used.
Other directions of an intensive care include control of a water balance and optimization of warm emission. In some cases extracorporal membrane oxygenation can be used.