[Artigo] Acute respiratory distress syndrome in adults
Acute respiratory distress syndrome
TERMINOLOGY
CLINICAL CLARIFICATION
- Acute respiratory distress syndrome is severe and often fatal acute respiratory failure; characterized by diffuse
inflammatory lung injury rapidly progressing to increased pulmonary vascular permeability, increased lung weight, and
hypoxemia - Preceded by a clinical insult—usually pneumonia, nonpulmonary sepsis, or trauma
- Berlin definition of acute respiratory distress syndrome includes presence of all following criteria:
○ Timing of acute onset of symptoms (or worsening of nonacute symptoms) within 1 week of a known clinical insult
○ Hypoxemia as shown by the PaO₂ to FIO₂ ratio of 300 mm Hg or less with PEEP or CPAP of 5 cm H₂O or greater
○ Chest imaging showing bilateral opacities that are not explained by effusions, atelectasis, or nodules, and are not
cardiogenic in nature
○ Respiratory failure or pulmonary edema not fully explained by cardiac failure or fluid overload
CLASSIFICATION
- Under conventional mechanical ventilation, the following apply:
○ The 3 categories of acute respiratory distress syndrome are based on degree of hypoxemia, as follows:
– Mild: 200 mm Hg < PaO₂/FIO₂ ≤ 300 mm Hg2
– Moderate: 100 mm Hg < PaO₂/FIO₂ ≤ 200 mm Hg2
– Severe: PaO₂/FIO₂ ≤ 100 mm Hg2
○ A minimum PEEP of 5 cm H₂O is required to make the severity classification; it may be delivered noninvasively with
CPAP to classify mild cases
DIAGNOSIS
CLINICAL PRESENTATION
- History
○ Recent known clinical insult (usually within 3 days and nearly always within 7 days) or new or worsening respiratory
symptoms
○ Symptoms may vary in severity, with some being mild initially; all worsen over a period of several hours
– Dyspnea
– Cough
– Chest discomfort
– Anxiety
○ With vaping-related lung injury, some patients report nonspecific gastrointestinal symptoms
– Nausea, vomiting, diarrhea, and abdominal pain - Physical examination
○ Cyanosis may be evident
○ Tachypnea at rest
○ Tachycardia at rest
○ Hypotension is often present
○ Fever may or may not be present, depending on the presence of infection as an underlying cause
○ Use of accessory muscles of respiration (usually indicates moderate to severe disease)
○ Coarse crepitations of both lungs at presentation
○ Cold, mottled extremities with prolonged capillary refill time (longer than 2 seconds) indicates ineffective circulation
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