A 26 year old man is critically ill, with multisystem organ failure, and he has not been able to give a clear history of respiratory distress. You suspect Acute Respiratory Distress Syndrome (ARDS). 1. The lung injury may be direct, as occurs in sepsis, or indirect, as occurs in Toxic inhalation 2. The aerial (a) PO2 (in mmHg)/FIO2 (inspiratory O2 fraction) > 200 mmHg is characteristic of ARDS 3. Ventilator-induced injury will be more with low tidal volume ventilation in ARDS 4. Moality was significantly lower in the high tidal volume ventilation, compared to the conventional tidal volume ventilated patients 5. High-dose glucocoicoids are useful in the care of ARDS patients
High-Yield Explanation
In ARDS the lung injury may be direct, as occurs in toxic inhalation, or indirect, as occurs in sepsis. The aerial (a) PO2 (in mmHg)/FIO2 (inspiratory O2 fraction) <200 mmHg is characteristic of ARDS. Ventilator-induced injury can be demonstrated in experimental models of ALI, with high tidal volume (VT) ventilation. Ventilating patients suffering from ALI or ARDS with lower VTs would protect against ventilator-induced lung injury and improve clinical outcomes. Current evidence does not suppo the use of high-dose glucocoicoids in the care of ARDS patients. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2205-07