2. Out line
• Objectives
• Introduction
• PATHOPHYSIOLOGY
• s/s
• Most common causes
• Risk factors
• Diagnoses test
• Treatment
• Management
• Complications
• Drug therapy
• DIAGNOSES
• EVALUATION
• Summary
• references
3. Objectives
• Define ALI and describe the pathological process
• Know causes of ALI, and differential diagnosis.
• Understand mechanical ventilation of patients
with ALI .
• Most common causes ALI.
• What Diagnostic test do.
• And know nursing care plane.
4. Introduction
• Acute lung injury (ALI) and (ARDS) describe clinical
syndromes of acute respiratory failure with substantial
morbidity and mortality. Even in patients who survive
ALI, there is evidence that their long-term quality of life
is adversely affected.(1,2) Recent advances have been
made in the understanding of the epidemiology,
pathogenesis, and treatment of this disease.
• However, more progress is needed to further reduce
mortality and morbidity from ALI and ARDS
5. PATHOPHYSIOLOGY
It is thought ALI patients follow a similar
pathophysiological process independent of the
aetiology. This occurs in two phases; acute and
resolution, with a possible third fibrotic phase
occurring in a proportion of patients
6. Acute lung injury
• is the sudden failure of the respiratory
(breathing) system person with ALI has rapid
breathing, difficulty getting enough air into the
lungs and low blood oxygen levels.
7. S/S
• Rapid breathing; trouble getting enough air
• Abnormal breathing sounds, such as a crackling
noise or decreased breathing sounds
• Cough
• Fever
• Low blood pressure
• Confusion
• Extreme fatigue
• Bluish lip or skin color
• Anxiety or agitation
•
9. Risk factors for ALI
• Age
• Family history
• Smoking
• COPD
• ARDS
• Preexisting lung disease
• Chronic alcohol use
• Low serum pH
• Sepsis
▫ 40% of patients with sepsis develop ALI
10. And laboratoryDiagnoses test
• physical exam
• Echo (Echocardiogram)
• Oximetry
• Bronchoscopic biopsy
• Chest CT
• chest X-ray
Laboratory :
CBC , ABG , electrolytes test
11. Treatment
• Mechanical Ventilation
(is conventionally delivered as positive pressure
ventilation with PEEP via a tracheal tube)
• Fluid Management
(fluid restriction could lead to improvement in clinically
important outcomes)
• Steroids
Steroids exert an anti-inflammatory effect by inhibiting
arachidonic acid metabolism and reducing eosinophil
activity
• Prone Positioning
(to enhance oxygenation by improving alveolar
ventilation/perfusion AND improves lung mechanism)
12. Management of ALI
• Treat underlying illness
Sepsis, etc
• Nutrition
parenteral nutrition
Physiotherapy
Deep breath excise
• Suction (as needed )
• DVT prophylaxis
low molecular weight heparin
• GI prophylaxis
• Medications
(bronchodilators)
14. Drug therapy
• Agents studied:
▫ Corticosteroids
▫ Ketoconazole
▫ Inhaled nitric oxide
▫ Surfactant
• No benefit demonstrated
15. 1- Nursing DIAGNOSES
1-Ineffective breathing pattern related to Decreased lung
expansion
Goal :
Establish a normal/effective respiratory pattern with ABGs within
patient’s normal range
Nursing interventions
1. • Monitor vital signs every 1 to 2 hours
2. Auscultate breath sounds , chest excursion every 1 to 2
hours.
3. Check out respiratory function, noting rapid or shallow
respirations, dyspnea, reports any abnormal
4. • Monitor oxygen saturation and ETCO2 levels every 30
to 60 min
16. 2-Nursing DIAGNOSES
• 2- Impaired gas exchange related to effects of
near-drowning
Goal :
• Maintain adequate cardiac output and tissue perfusion
Nursing interventions
1. Suction via endotracheal tube as needed to maintain
clear airways.
2. Obtain ABGs as ordered or indicated; monitor and
report results.
3. Allow periods of rest.
17. 3-Nursing DIAGNOSES
• 3- Anxiety related to hypoxemia
Goal
• reduced anxiety levels
• ability to rest
Nursing interventions
1. • Explain the purpose and procedure of intubation.
2. Answer questions and provide Reassurance
3. • Administer analgesics and/or sedatives as ordered.
18. EVALUATION
reduce anxiety. MET
oxygen saturation improve. MET
PEEP is added to ventilator settings. After 3 days
of mechanical ventilation begins to improve.
placed on SIMV course of another 3 days CPAP.
eventually recovers fully, with minimal apparent
long-term effects.
19. Summary
• ARDS is a clinical syndrome characterized by
severe, acute lung injury, inflammation and
scarring
• Significant cause of ICU admissions, mortality
and morbidity
• Caused by either direct or indirect lung injury
• Mechanical ventilation with low tidal volumes
and plateau pressures improves outcomes
• So far, no pharmacologic therapies have
demonstrated mortality benefit
• Ongoing large, multi-center randomized
controlled trials are helping us better
understand optimal management
20. References
Rubenfeld GD, et al. Incidence and outcomes of acute
lung injury N Engl J Med. 2005;353:1685-93.
Luhr OR, et al. Incidence and mortality after acute
respiratory failure and acute respiratory distress
syndrome in Sweden, Denmark, and Iceland. The
ARF study group. Am J Respir Crit Care Med.
1999;159:1849061,
Bersten AD et al. Australian and New Zealand
Intensive Care Society Clinical Trials Group.
Incidence and mortality of acute lung injury and the
acute respiratory distress syndrome in three
Australian states. Am J Respir Crit Care Med.
2002;165:443-8.
Connors AF Jr, et al. The effectiveness of right heart
catheterization in the initial care of critically ill
patients. SUPPORT investigators. JAMA.
1996;276:889-97.
