The answer is A – Tracheal intubation
Tracheal intubation with lowest level of PEEP is required to maintain the PaO2 above 60 mmHg or SaO2 above 90% in a patient with ARDS
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Pearls
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by fluid collecting in the lungs depriving organs of oxygen
- The underlying abnormality in ARDS is ⇑ Permeability of alveolar-capillary membranes ⇒ development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema)
- ARDS can occur in those who are critically ill or who have significant injuries
Three clinical settings account for 75% of ARDS cases:
- Sepsis syndrome (most common cause)
- Severe multiple trauma
- Aspiration of gastric contents (alcoholics), toxic inhalation, near-drowning
People with ARDS have severe shortness of breath and often are unable to breathe on their own without support from a ventilator
- Occurring 12-24 hours after the precipitating event
- Tachypnea, pink frothy sputum, crackles
Diagnosis
Chest radiograph shows air bronchograms and bilaterally fluffy infiltrate
- Normal BNP, pulmonary wedge pressure, left ventricle function and echocardiogram
Treatment
- Treatment involves identifying and managing underlying precipitation and secondary conditions
- Tracheal intubation with the lowest level PEEP to maintain PaO2 >60 mmHg or SaO2 >90
- ARDS is often fatal, the risk increases with age and severity of illness
