ARDS

Diagnostic Criteria

• Acute onset (1 week or less) 

• Hypoxemia

  • PaO2 value can be obtained from ABG, and FiO2 is 0.21 at sea level (room air) or depends on supplemental O2

• Pulmonary edema (bilateral opacities on CXR) 

• Non-cardiogenic (not caused by cardiac failure)

• Risk Factors

  • Direct lung injury: pneumonia, gastric aspiration, pulmonary contusion, near drowning, inhalation injury

  • Indirect lung injury: sepsis, shock, acute pancreatitis, burns, crush injury, fat embolism, and massive transfusion

• Tx underlying cause: pneumonia, sepsis, etc

• Diuresis and Conservative fluid management: aim for zero fluid balance

• Mechanical ventilation: Maintain head of bed elevation, low tidal volumes (6-8 mL/kg to avoid barotrauma), prone positioning, sedation, neuromuscular blockade, ARDSnet protocol

• ECMO:

  • If a catheter is placed in a major artery and a major vein (VA ECMO), the patient can be provided with full hemodynamic and respiratory support, aka cardiopulmonary bypass. 

  • If catheters are placed in two major veins (VV ECMO), the patient's respiratory status can be maintained, but without the hemodynamic augmentation

ECMO Inclusion/Exclusion Criteria