Ards

ADJUNCTS IN TREATMENT OF ARDS Dr. AKASHDEEP SINGH DEPARTMENT OF PULMONARY AND CRITICAL CARE MEDICINE PGIMER CHANDIGARH

ABJUNCTS IN TREATMENT OF ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRONE VENTILATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PP L -3.0 +2.8 P PL -1.0 +1.0 Supine prone

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PARTIAL LIQUID VENTILATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Loss of gas by evap., cost. 5. Disadvantage Yes Expt. 4. Feasibility Filled till FRC by PFC Completely by PFC 3. Lungs are filled Gas Oxygenated PFC 2. Tidal volume delivered of Conventional Liquid 1. Ventilator PLV TLV

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRACHEAL GAS INSUFFLATION (TGI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

HIGH FREQUENCY VENTILATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Comparison of HFV Vs Conv. Ventil. <or> conv <or> conv P mean < Conv < Conv P PK >> Conv >> Conv VT x f product for effective V A 1+ 2+ 3+ Potentiation of intrinsic PEEP Passive Active Passive Expiration >> V D < V D <or> V D Tidal volume delivered 2-60 b/min 300-3000 b/min upto 600 b/min Freq avail Conventional Oscillator JET

EXTRACORPOREAL MEMBRANE OXYGENATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HEMODYNAMIC MANAGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PULMONARY VASCULAR CHANGES IN ARDS/ALI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SURFACTANT REPLACEMENT THERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Continuous smaller vol. Non uniform distribution. Lab. Studies show efficacy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Aerosolization ,[object Object],Instillation Slow, no optimal device, Filters may plug. ,[object Object],[object Object],[object Object],[object Object]

GLUCOCORTICOIDS IN ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CYCLOOXYGENASE INHIBITORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

KETOCONAZOLE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary of trials of Ketoconazole in ALI/ARDS No – Mortality benefit No effect on lung function, duration of Ventilat. 234 ALI/ARDS NIH ARDS Network, 1997 Trial ,[object Object],[object Object],54 sepsis Yu & Tomasa, 1993 ,[object Object],[object Object],71 high risk surgical Slotmann, 1988 Outcome No. of Pat. Study, yr

ANTIOXIDANTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Improved – LIS No effect – Pao 2 /Fio 2 , mortality. Placebo, NAC 42 Domenighetti, 1997 Improve – ALI free days & cardiac index  new organ failure. Mortality – No diff. Placebo, NAC OTZ 48 Bernard 1997 Improve – Pao 2 /Fio 2 ; Lis; need for M.V. Mortality – No diff. Placebo, NAC 61 Suter 1994 No effect – Pao 2 /Fio 2 time to improve LIS. Improve – compl. *NS. Mortality – No diff. Placebo, NAC 66 Jepsen, 1992 Outcome Therapy No. of Patients Study, yr

ANTICOAGULANT THERAPY IN ALI/ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TF PATHWAY INHIBITORS AND FACTOR Vll ai ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANTITHROMBIN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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