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Article written by BSCK I Tran Ngoc Thuy Hang, Emergency Department, Vinmec Central Park International General Hospital
ARDS acute respiratory failure causes serious complications such as deep vein thrombosis, gastrointestinal bleeding due to stress, malnutrition, psychosis... Therefore, early detection has a great influence on effectiveness. treatment. What are the clinical manifestations of the disease? What are the diagnostic criteria and what are the diagnostic approaches?
What are the clinical manifestations of ARDS? Acute respiratory failure ARDS will have clinical manifestations accompanied by precipitating events (sepsis, pneumonia, . . . . . .). ARDS should be considered and sought in patients with progressive dyspnea, increased oxygen demand, and alveolar infiltrates on imaging (chest X-ray, chest CT) after onset of a precipitating event 6 -72 hours.
History and physical examination: The patient presented with dyspnea and decreased blood oxygen saturation (SaO2) 6-72 hours after the onset of the initiating event. Patients may cough, chest pain, wheeze, cough up blood, fever, . . . .depends on the cause of ARDS. Clinical examination revealed: tachypnea, tachycardia, diffuse crackles. Consciousness progresses rapidly, severe, respiratory failure, cyanosis, sweating.
Subclinical indicated in ARDS Blood count and biochemical tests help determine causes and complications.
Arterial blood gases: The alveolar-arterial oxygen concentration difference increases. Early stage when blood shows respiratory alkalosis. Respiratory acidosis is uncommon and is a poor predictor of a patient at risk for apnea. Metabolic acidosis due to hypoxemia is uncommon, often due to causes such as sepsis, renal failure, etc. . . Histopathology: The early stages of histological manifestations are quite inconspicuous. Chest X-ray: diffuse alveolar opacities with atelectasis; CT chest: diffuse, patchy glassy opacities, then as the condition worsens, pulmonary consolidation can be seen.
Bedside lung ultrasound: still being studied. Some preliminary studies have shown sensitivity and specificity to be 83% and 92% compared with chest CT. Electrocardiography: performed to find evidence related to heart failure: arrhythmias, increased ventricular load, ST changes suggestive of ischemic heart disease. Assist in the assessment of heart failure – a common differential diagnosis of ARDS Tests to find the cause of ARDS: endoscopy, sputum culture, blood, Laboratory tests to rule out pulmonary edema with acute heart failure: BNP – NT proBNP; transthoracic echocardiography.
Approach to initial diagnosis:
Identify ARDS and find the cause. Look for differential diagnoses that can be confusing: pay special attention to pulmonary edema, acute heart failure. Differential diagnosis with ARDS
Acute cardiogenic pulmonary edema; Pneumonia spread on both sides of the lung; Diffuse alveolar hemorrhage; autoimmune inflammatory response; Pulmonary vasculitis: associated with autoimmune diseases such as Lupus, . . . Diffuse malignancy.
Complications of ARDS Barometric lung injury: seen in mechanically ventilated ARDS patients. May appear early or late; Healthcare-associated pneumonia: ventilator-associated pneumonia, catheter infection,. . . are important causes of death in ARDS patients; Psychotic; Common complications in critically ill patients - resuscitation: deep vein thrombosis, gastrointestinal bleeding due to stress, malnutrition, . . . . As soon as the first symptoms of the disease appear, you should immediately go to a reputable medical facility for examination and treatment. Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
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