| Abstract | ARDS je specifična vrsta hipoksemičnog zatajenja disanja karakterizirana obostranom akutnom abnormalnošću pluća. Klinička obilježja ARDS-a su hipoksemija te bilateralna zamućenja na radiogramu. Incidencija ARDS-a raste s dobi, no ukupna incidencija je u padu. Najčešći uzroci razvoja ARDS-a su sepsa, pneumonija, aspiracija i trauma. ARDS je posljedica difuznog oštećenja alveola. Velika količina intersticijske tekućine, u kombinaciji sa oštećenim alveolarnim epitelom, uzrokuje nakupljanje krvavog sadržaja bogatog proteinima u zračnim prostorima pluća. Pacijenti sa ARDS-om prolaze kroz tri diskretna stadija bolesti: eksudativni, proliferativni i fibrozni stadij. Simptomi ARDS-a pojavljuju se 6 do 72 sata nakon inicijalnog događaja i naglo se pogoršavaju. Pacijent je obično dispnoičan, cijanotičan (hipoksemičan), a auskultacijom pluća čuje se obostrano pucketanje. Respiratorni distres je naglašen s tahipnejom, tahikardijom, profuznim znojenjem te korištenjem pomoćne respiratorne muskulature prilikom disanja. Pacijenti s ARDS-om imaju visok rizik za razvoj komplikacija. Neke su povezane uz mehaničku ventilaciju poput barotraume i nozokomijalnih pneumonija, dok su druge posljedica inicijalne bolesti te boravka u jedinici intenzivnog liječenja. Dijagnoza se temelji na identifikaciji specifičnih uzroka ARDS-a koji se mogu liječiti te eliminaciji drugih stanja koja dovode do hipoksemije, bilateralnih alveolarnih infiltrata i respiratornog distresa. Uz mehaničku ventilaciju, pacijentima koji boluju od ARDS-a potrebna je i suportivna skrb. Prognostički pokazatelji dijele se u odnosu na pacijenta, bolest i liječenje, no nisu dovoljno precizni da bi se pomoću njih prognozirao tijek bolesti. Kognitivni, psihološki te fizički komorbiditeti su česti kod ljudi koji su preživjeli ARDS. |
| Abstract (english) | ARDS is a specific type of hypoxemic respiratory failure characterised by bilateral acute lung abnormalities. Clinical features of ARDS include hypoxemia and bilateral opacities which can be seen on the radiograph. Incidence of ARDS gets higher with age, but global incidence is decreasing. The most common causes of ARDS are sepsis, pneumonia, aspiration and trauma. ARDS is created by diffuse alveolar injury. High amounts of interstitial fluid, in combination with damaged alveolar epithelium, causes filling of alveolar air space with bloody, protein-rich material. Patients with ARDS go through three discreet stages of the disease: exudative, proliferative and fibrous stage. Symptoms of ARDS appear aproximately 6 to 72 hours after the event which caused it and have a tendency to rapidly get worse. Patient usually shows signs of dyspnoea, cyanosis (hypoxemia), and lung auscultation detects bilateral crackling. Respiratory distress is followed with tachypnea, tachycardia, sweating and the use of supportive respiratory muscles. Patients with ARDS have a high risk 29
7. Summary
ARDS is a specific type of hypoxemic respiratory failure characterised by bilateral acute lung abnormalities. Clinical features of ARDS include hypoxemia and bilateral opacities which can be seen on the radiograph. Incidence of ARDS gets higher with age, but global incidence is decreasing. The most common causes of ARDS are sepsis, pneumonia, aspiration and trauma. ARDS is created by diffuse alveolar injury. High amounts of interstitial fluid, in combination with damaged alveolar epithelium, causes filling of alveolar air space with bloody, protein-rich material. Patients with ARDS go through three discreet stages of the disease: exudative, proliferative and fibrous stage. Symptoms of ARDS appear aproximately 6 to 72 hours after the event which caused it and have a tendency to rapidly get worse. Patient usually shows signs of dyspnoea, cyanosis (hypoxemia), and lung auscultation detects bilateral crackling. Respiratory distress is followed with tachypnea, tachycardia, sweating and the use of supportive respiratory muscles. Patients with ARDS have a high risk of developing complications. Some are connected with mechanical ventilation such as barotrauma and nosocomial pneumonia, while others are a consequence of the initial disease and the time spent in intensive care unit. Diagnosis is based on the identification of specific causes of ARDS which can be treated as well as eliminating other causes which lead to hypoxemia, bilateral alveolar infiltrates and respiratory distress. Aside from mechanical ventilation, patients with ARDS require supportive care. Prognostic parameters can be grouped into those which are associated with patient, with the disease and with the treatment. However, they are not precise enough to provide a prognosis for the disease. Cognitive, psychological and physical comorbidities can often be found in patients which have survived ARDS. |
