ARF emphasizes blood gas results: PaO2<60mmHg under spontaneous breathing or accompanied by PaCO2>50mmHg. Not all patients have lung disease.

ARDS is a special type of ARF. Lung changes are a necessary diagnostic condition. Hypoxemia is often more severe. Conventional oxygen therapy is not effective. Mechanical ventilation is the main means of respiratory support.

Capillary endothelial damage and massive plasma leakage; alveolar and interstitial edema, pulmonary congestion, and alveolar atelectasis; microthrombi in the pulmonary arterioles; dark red or dark purple liver-like changes in the lungs, with edema and hemorrhage visible

1 to 3 weeks after injury, type II epithelial cells, fibroblast proliferation and collagen deposition

ARDS patients who survive more than 3 to 4 weeks have extensive thickening of alveolar septa and air cavity walls, cell hyperplasia, and pulmonary fibrosis.

Non-cardiogenic pulmonary edema caused by increased permeability of alveolar epithelium and pulmonary capillary endothelium

Alveolar edema and alveolar collapse lead to severe V/Q imbalance, especially an increase in intrapulmonary shunt, resulting in severe hypoxemia.

Pulmonary arterial hypertension caused by pulmonary vasospasm and pulmonary microthrombosis

A large number of inflammatory mediators (cytokines, peroxides, leukotrienes, proteases, platelet activating factors, etc.) are involved in the lung injury process

Cyanosis of lips and nail beds

It is difficult to correct hypoxia even by inhaling pure oxygen (refractory hypoxemia)

Middle and late stage: dry or wet rales

Difficulty breathing and "three depressions" occur

oxygenation index

acute injury stage

relatively stable period

acute respiratory failure stage

terminal stage

Chest CT

Decreased arterial oxygen tension, often accompanied by a decrease in carbon dioxide partial pressure

Oxygenation index calculation (PaO2/FiO2) to determine severity

The protein content of edema fluid is not high

In ARDS, due to damage to the alveolar capillary membrane, permeability increases and the protein content of edema fluid is high.

Anti-infective

Control inflammatory response

Oxygen therapy

Mechanical Ventilation

Extracorporeal membrane oxygenation technology

Limit fluid while ensuring perfusion of tissues and organs

The strategy is open infusion under early target management, with tissue perfusion first and oxygenation improvement second.

Use colloids with caution. Hypoalbuminemia is an independent risk factor for ARDS in patients with severe infections.

Glucocorticoids

NO

alveolar surfactant

Prostaglandin E1

fish oil

enteral nutrition total parenteral nutrition

important organ functions

support and monitor

Comprehensive Treatment