Peri-operative lung protective ventilation

 

Definition of ARDS:

Diagnosis

Berlin criteria:

1.      Acute

2.      Hypoxaemia

3.      Bilateral opacities

4.      Non-cardiogenic

Severity

·        Mild: P/F 2-3

·        Mod: P/F 1-2

·        Sev: P/F <1

 

Lung-protective ventilation:

Peri-op benefits:

·          ↓Inflammatory markers

·          ↓Failed extubation

·          ↓Pneumonia

↓Volutrauma

·          VT <6mL/kg

↓Barotrauma

·          PPlat <30cmH2O

·          ∆P <15cmH2O

↓Atelectrauma

·          PEEP 5-15cmH2O

·          Recruitment manoeuvres – good in general, bad in ARDS

↓Aspiration

·          Head up 45°

·          Cuff inflated

·          Suction mouth, pharynx, trachea

·          Chlorhex wash

 

Other management of ARDS:

Positioning

·          If mild: head up 45°

·          If severe: prone 16/24

Medication

Systemic:

·          Relaxant (controversial)

·          Diuretics / restrictive fluid strategy

Inhaled:

·          Inhaled prostacyclin

·          Inhaled nitric oxide

Hail Mary

·          vvECMO

 

 

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