Episode 36 - ARDS Fundamentals I: Classification, Pathophysiology & Initial Vent Management

Trauma ICU Rounds

Dr. Dennis Kim

Emergency General Surgery, Critical Care, Foam, Intensive Care, Education, Health & Fitness, Science, Life Sciences, Acute Care Surgery, Trauma Surgery, Medicine, Medical Education

4.8 • 663 Ratings

🗓️ 2 February 2021

⏱️ 22 minutes

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Summary

Back to the basics! In this episode we review the evolving criteria, etiologies, and pathophysiology of ARDS. A brief review of ventilator induced lung lung injury and initial vent setup provide the groundwork for future episodes exploring how to troubleshoot the vent and therapies for ARDS that have been shown to improve oxygenation and mortality. Please check out Episodes Support the show

Transcript

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0:00.0	From the classroom to the emergency room, OR and beyond.
0:05.7	You're joining trauma ICU rounds with your host, Dr. Dennis Kim.
0:11.8	Welcome back to trauma ICU rounds.
0:14.2	I'm your host, Dr. Dennis Kim, wishing you, your colleagues, and loved ones all the best.
0:20.1	You know, one thing about critically ill
0:22.3	patients with COVID-19 is that from day to day, very little changes, and there are a few
0:28.8	big moves to be made. I find that it's really been challenging, especially as a trauma
0:34.4	surgeon, our natural desire for forward momentum is really hampered by the sheer
0:40.3	inertia of this particular pathogen and its wide-ranging pathophysiologic downstream effects.
0:46.7	And with that said, given the sheer volume and severity of illness of patients that were currently
0:51.4	managing with ARDS, I thought it would be beneficial to just
0:55.8	take a step back and discuss some fundamentals of ARDS management.
1:00.4	In subsequent episodes, we'll discuss adjunctive supportive therapies, pharmacologic,
1:05.7	non-pharmacologic, and ventilator strategies for improving outcomes in patients with ARDS.
1:12.1	And when we talk about or discuss outcomes in the setting of ARDS, there really are two outcomes
1:17.5	that we care about and that have been the subject of the ARDS literature, namely, improvements
1:23.9	in oxygenation and mortality.
1:30.4	So when we discuss therapies, it's helpful to ask yourself,
1:37.7	does this treatment improve oxygenation, mortality, or both? To a lesser degree, we also care about things like duration and mechanical ventilation and length of stay, but oxygenation
1:42.5	and mortality are really the key outcomes.
1:45.2	In terms of objectives for today's episode, by the end of today's podcast, you should be able
1:50.2	to, number one, identify the key diagnostic criteria for ARDS.
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