Clinical course of ARDS may be divided into four stages or degrees.
1stage,develops usually at the end of the 1-st — beginning of the 2-nd day after the patient had suffered from hemodynamic crisis.
The patient develops euphoria, tachypnea and dyspnea are also noted. Harsh breathing, sometimes, dry rales are auscultated in the lungs. Hypoxemia, eliminated by oxygen inhalation, and hypocapnia are marked in the analysis of gases and AAB of blood. There are increased lung pattern and mesh structure seen on X-ray film of the lungs, microfocal shadows may appear in the peripheral fields.
2stage of ARDSis observed on the 2-nd — 3-rd days from the onset of development of this syndrome. Patients become excited, sharp dyspnea is marked. Zones of diminished respiration are auscultated in the lungs, persistent tachycardia inappropriate to the body temperature. Hypoxemia resistant to oxygen inhalation and hypocapnia are noted. There are confluent shadows seen on X-ray, more often on both sides. A symptom of "air bronchography" is manifested: particularly clear zones are seen along the course of major and medium-size bronchi.
3stage of ARDSdevelops on the 4-th - 5-th days. There is a depression of consciousness down to sopor, rapid shallow breathing with participation of auxiliary musculature. Zones of "amphoric" breathing appear in the lungs and loss of dullness.
Purulent expectoration. Arterial pressure is elevated, expressed hypoxemia resistant to APV, PaC02 begins to raise. On X-ray film there are multiple floccular shadows ("snow-storm") are found in the lungs and exudate in pleural cavities.
4stage of ARDS.Disturbance of consciousness by the type of coma (more often). Diffuse cyanosis. There are moist rales, sharp diminished respiration in the posterolateral sections of the lungs, arterial hypotension and tachycardia. Hypoxemia resistant to APV with PPEE and hypercapnia are noted. On X-ray film there is a shadowing of large areas of the lungs, alveolar edema, exudate in pleural cavities.
TREATMENT OF ARDS
Basic schemes of ARDS treatment are directed to the correction of pulmonary edema, pulmonary hypertension and hypoxemia.
Infusion therapy. Excessive infusion therapy is considered as one of the major iatrogenic causes of ARDS development, therefore, a volume of intravenous infusions is limited in patients with the risk of ARDS that PPAJ should not exceed 12-15 mm Hg.
It is recommended to replenish the volume of circulating blood with crystalloids and to start early application of saluretics.
Very important method of improvement of oxygenation while carrying out APV is regular changes of patient's position and particularly his turns to prone position.
Glucocorticoid hormones, b-adrenomimetics (salbutamol). Application of surfactants.
Curosurf is administered in the dosage of 50 mg/kg into each lung by means of fibrobronchoscopy. Antioxidants.
Ambroxol, N-acetylcystein. Pentoxifylline 1 mg/kg/hour. Hemofiltration. Antibacterial therapy. APV with PPEE to 10 cm water column, RV to 5-7 ml/kg.