Management of Acute Respiratory Distress Syndrome (ARDS)
| Element | Comment |
|---|---|
| Transfer to ICU | ARDS is usually part of multiorgan failure |
| Oxygenation | Increase inspired oxygen, target PaO2 >8kPa |
| Ventilation will be needed if PaO2 is <8kPa despite FiO2 60% | |
| Ventilation in the prone position improves oxygenation | |
| Haemoglobin should be kept around 10g/dl (to give the optimum balance between oxygen-carrying capacity and blood viscosity) | |
| Fluid balance | Acute kidney injury is commonly associated with ARDS |
| Consider early haemofiltration | |
| Prevention and treatment of sepsis | Sepsis is a common cause and complication of ARDS |
| Culture blood, tracheobronchial aspirate and urine daily | |
| Treat presumed infection with broad-spectrum antibiotic therapy | |
| Nutrition | Enteral feeding if possible, via nasogastric tube if ventilation needed |
| DVT prophylaxis | Give DVT prophylaxis with stockings and LMW heparin |
| Prophylaxis against gastric stress ulceration | Give proton pump inhibitor |
DVT, deep vein thrombosis; ICU, intensive care unit; LMW, low molecular weight.