ARDS is considered to be present if the patient has
1. refractory hypoxemia
2. a chest x-ray with new bilateral interstitial or alveolar infiltrates
3. a pulmonary artery wedge pressure of 18mmHg or less and no
evidence of heart failure
4. a predisposing condition for ARDS within 48 hours of clinical
manifestations
At the time of the initial injury the patient may not experience respiratory symptoms or may exhibit only dyspnea, tachypnea, cough and restlessness.
Chest auscultation may be normal or reveal fine scattered crackles.
ABG’s usually indicate mild hypoxemia and respiratory alkalosis caused by hyperventilation.
Chest x-ray may be normal or exhibit evidence of minimal scattered interstitial infiltrates or demonstrate diffuse and extensive bilateral infiltrates termed whiteout or white lung.
As ARDS progresses, tachypnea and intercostal and suprasternal retractions may be present and pulmonary function tests reveal decreased compliance and decreased lung volumes.
Tachycardia, diaphoresis, changes in sensorium with decreased mentation, cyanosis and pallor may develop.
Pulmonary artery wedge pressure does not increases in ARDS because the cause of pulmonary edema is noncardiogenic.
Hypoxia and a PaO2/FIO2 ratio below 200 despite increase FIO2 are the hallmarks of ARDS.
(Lewis, et. al 2007 pg 1815)
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