ARDSp - Pulmonary Extra-pulmonary ARDS FIZZ or FUSS Dr Rajagopala Srinivas Senior Resident Dept Pulmonary Medicine PGIMER Chandigarh The

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Pulmonary & Extra-pulmonary ARDS: FIZZ or FUSS? Dr. Rajagopala Srinivas Senior Resident, Dept. Pulmonary Medicine, PGIMER, Chandigarh.
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The beginning. . "The etiology of this respiratory distress syndrome remains obscure. Despite a variety of physical and possibly biochemical insults, the response of the lung was similar in all 12 patients. In view of the similar response of the lung to a variety of stimuli, a common mechanism of injury may be postulated" Ashbaugh et al. Lancet 1967; 2: 319–323.
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The AECC (American European conference) later defined two subsets in their consensus conference “a direct ("primary" or "pulmonary") insult, that directly affects lung parenchyma, and an indirect ("secondary" or "extra-pulmonary") insult, that results from an acute systemic inflammatory response” Bernard GR, Artigas A, Brigham KL, et al Am J Respir Crit Care Med 1994; 149: 818–824.
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Am J Respir Crit Care Med Vol 158. pp 3–11, 1998 Useful concept or distinctive sub-groups?
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12 patients with ARDSp and 9 patients of ARDSexp Est (L) more in ARDSp and Est (w) more in ARDSexp IAP more in ARDSexp and co-related with Est Increase in PEEP lead to rise of Est in ARDSp and fall of Est in ARDSexp (more recruitment in ARDSexp) Different respiratory mechanics and response to PEEP observed consistent with a prevalence of consolidation in ARDSp Vs prevalent edema and alveolar collapse in ARDSexp Am J Respir Crit Care Med Vol 158. pp 3–11, 1998
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Lump or split? SPLIT? Etiological events are distinct Pathogenetically different Morphology differs Physiologically distinguishable Varied responses to Rx PEEP Prone pressure ventilation Response to inhaled vasodilators different Lump? Etiological case mix common Practical difficulties in case assignment Current clinical management similar Not related to outcomes
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Are ARDSp and ARDSexp different? 1) Epidemiology 2) Pathophysiology 3) Morphological aspects 4) Respiratory mechanics 5) Ventilatory strategies 6) Response to pharmacological agents and 7) Long-term recovery
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1.Epidemiology: Is ARDSp more common than ARDSexp? In most studies, ARDSp more common than ARDSexp Varies from 47-75% of total Study from our centre N=180 ARDSp (pneumonia most common)=123 ARDSexp (sepsis most common)=57 In the largest study (n=902), the incidence of both were equal
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Why the discrepancy? The lack of agreement among various studies because 1. Baseline status differ 2. Prevalence of the disease precipitating ARDS in each center 3. Impact of therapy and 4. Overall distribution of these factors in the studied population.
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Early Direct injury Pulmonary contusion Inhalational injuries Aspiration Near-drowning Fat emboli Models (tracheal instillation of endotoxin, complement,
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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ARDSp - Pulmonary Extra-pulmonary ARDS FIZZ or FUSS Dr Rajagopala Srinivas Senior Resident Dept Pulmonary Medicine PGIMER Chandigarh The

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