https://youtu.be/hayvknzetZM

One of the most frequently asked questions we get is, “What is best care and treatment for ARDS (Acute Respiratory Distress Syndrome) in intensive care?” I’ve got the answer to that today, stay tuned! 

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

So, one of the most frequently asked questions we get from our readers and clients is, “Is my mom, my dad, my family member getting best care and treatment for ARDS in intensive care?” ARDS stands for acute respiratory distress syndrome, also known as lung failure. The mortality for ARDS is, generally speaking, higher compared to other admissions into ICU. So, this is a very relevant question, and you obviously need to know and understand what’s happening when your loved one is in intensive care with ARDS.

ARDS, or also known as acute respiratory distress syndrome, in Layman’s terms, lung failure, is a severe lung condition that requires intensive care management. Treatment in ICU is focusing on improving oxygenation, supporting organ function, and addressing the underlying causes.

There’s an overview of ARDS treatment in ICU and before I go on in the overview, as much as improving oxygenation, is obviously one of the main goals, the issue and major challenge with ARDS are that chest X-rays are often showing a complete white-out and what that means is the lung tissue is often damaged. The lungs cannot oxygenate, and that obviously is life threatening.

So, let’s look at it in more detail. Number one is mechanical ventilation. Low tidal volume ventilation, also known as LTVV, 4 to 6 mL per kilo of predicted body weight to reduce ventilator induced lung injury. Why is that? Especially when the lungs lack compliance and are very resistant to oxygenation. The lower the tidal volume, the higher chances you’re overcoming that resistance, and you’re improving compliance. Therefore, gas exchange, i.e. oxygen going into the body, and carbon dioxide coming out of the body is actually happening and improving.

Next, PEEP (positive end-expiratory pressure) which keeps the alveoli open, which is where the gas exchange is taking place and is improving oxygenation.

Next, prone positioning. Turning patients onto their stomach can improve oxygenation by redistributing lung perfusion.

Also, High Frequency Oscillatory Ventilation (HFOV), sometimes also used in severe cases. I’ve worked in intensive care and critical care nursing for 25 years in three different countries. I’ve seen some cases with high frequency oscillation ventilation, once again, the approach is to get lower volumes but at a high speed, and that is also helping. That is always combined with oxygen therapy, which means FiO2 titration. 

FiO2 stands for fraction of inspired oxygen to maintain oxygen saturation between 88 to 95% to avoid oxygen toxicity, but also to avoid desaturation because desaturation could become lethal, and patients could die. Oxygen therapy is also necessary to maintain physiological arterial blood gases that are compatible with life. 

As a last resort, ECMO can be used. ECMO stands for extracorporeal membrane oxygenation, which is used in severe refractory areas when ventilation fails. So, what is ECMO doing? ECMO is basically a bypass machine that oxygenates blood. So, how does it work? Blood is being withdrawn from the big veins in the body, they are run through a bypass machine where carbon dioxide is getting removed and oxygen is getting basically put back into the blood, and that’s being reinserted into the arteries of the body. Basically, bypassing the lungs to take over the function of the lungs so that the lungs can actually recover.

Next, fluid management. Conservative fluid strategy to prevent pulmonary edema while ensuring adequate organ profusion. So, what that means is, most ventilated patients in intensive care should be kept dry. What that means is, the minute you’re fluid overloading a patient that’s ventilated, the chances of them not being able to ventilate properly is much higher because you’ve got fluid buildup on the lungs, diminishing gas exchange, and now you’ve got ARDS. You’ve already got damaged lungs. You don’t want to have an extra fluid buildup on top of that, because that could make things even worse.

Next, medications, sedation and neuromuscular blockade to facilitate ventilation and reduce oxygen demand. So, what does that mean? It means that in order to ventilate a patient that’s suffocating more or less, because the lungs are so severely damaged, patients end up on sedatives such as propofol, midazolam/Versed or Precedex. They also end up on morphine or fentanyl for pain relief or pain management, while they’re being ventilated with a breathing tube or a tracheostomy. Most cases for ARDS are ventilated with the breathing tube, not the tracheostomy. The breathing tube in the mouth or in the nose can be very uncomfortable.

So, on top of that, neuromuscular blockade, what does that mean? Sometimes in ARDS or even with other ventilated patients, sedatives such as propofol, midazolam/Versed and/or Precedex are not enough to keep patients sedated, even if you’re giving morphine and fentanyl on top of that. They are fighting against the ventilator. They feel like they’re suffocating. 

One way to deal with that is by giving patients a muscle relaxant or a neuromuscular blocker to basically stop all resistance. It’s not very nice, and patients need to be even on more sedatives and opiates so that they can’t feel that they can’t move, but it is effective. It’s effective in a moment, but it also takes longer for patients to recover once they’ve had neuromuscular blockade, and high doses of sedatives and high doses of opiates.

Next, steroids or corticosteroids. It’s also considered in moderate to severe ARDS to reduce inflammation. Most ICUs that I worked at, we always were giving steroids for ARDS, and I’ve worked in many ICUs around the world, and I’ve looked after thousands of critically ill patients and their families, so I can confirm that steroids is a regular treatment option.

Next, antibiotics if a bacterial infection is present or suspected. But the same is applicable, antivirals if a viral infection is present or suspected, and the same is applicable, antifungals if a fungal infection is present or suspected.

Next, vasopressors or inotropes if needed to support blood pressure. Vasopressors or inotropes should be used to support blood pressure. Assuming blood pressure is low and not compatible with life and not compatible with organ perfusion, that’s when you need inotropes or vasopressors such as Levophed, norepinephrine, noradrenaline, phenylephrine, epinephrine, vasopressin, norepinephrine, dopamine dobutamine and the list goes on. Milrinone as well.

Next, treating the underlying cause. Addressing infections such as pneumonia, sepsis, etc. Managing trauma or other conditions, contributing or leading to ARDS.

Lastly, supportive care. Nutritional support via enteral feeding, nasogastric tube, in some very rare cases, PEG (Percutaneous Endoscopic Gastrostomy) tubes, deep vein thrombosis (DVT), and stress ulcer prophylaxis. Deep vein thrombosis prophylaxis is usually done with calf compressors, TED (Thrombo-Embolic Deterrent) stockings, or medications such as Clexane or heparin. Stress ulcer prophylaxis is usually done with enteral feeding, and it’s usually done with giving proton pump inhibitors such as esomeprazole, omeprazole, ranitidine, or Zantac to prevent stress ulcers.

Next, physical therapy to prevent muscle wasting whenever possible. Again, that goes without saying because when someone is in an induced coma for ARDS, they need to keep moving, because otherwise they decondition extremely fast. It’s also DVT prophylaxis (the movement), so that definitely needs to happen as well.

Like I said, I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews. You can find our podcast again at intensivecarehotline.com.

Because our advice is absolutely life changing, it’s absolutely life changing, you can join a growing number of clients and members that we have helped over the years to improve their lives instantly and to save their loved ones’ lives, or at least to get a better outcome for their loved ones.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly. I ask all the questions to the doctors and nurses that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I hold them accountable, and you will see how the dynamics will change in your favor very quickly.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time, so that you can get a second opinion in real time. We also do medical record reviews after intensive care, if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. You also have access to 21 eBooks and 21 videos that I’ve personally written and recorded, making sure you make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets the best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.

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