Definitions

• P/F < 300
• PEEP > 5
• Onset within 7 days
• No signs of elevated LVEDP
• Bilateral and asymmetric opacities

ARDS Severity Calculator

PaO2 (mmHg):


FiO2 (as a decimal, e.g., 0.21 for 21%):


Calculate ARDS Severity

Causes

• PNA
• Sepsis
• Pancreatitis
• Burns
• Trauma
• Aspiration

Treatment

• Low TV (6cc/kg)
• Plateau pressure < 30
• High PEEP (5-12)
• Proning
• Paralytics and steroids
• VV ECMO

Proning

• Proning should be considered in patients requiring FiO2 ≧60% who have a PaO2/FiO2 ratio <150 despite 12-24 hours of optimization on the ventilator (based on the PROSEVA trial)

Paralytics

• The ACURASYS trial evaluated early paralysis with cisatracurium for 48 hours among patients with PaO2/FiO2 <150 mm (20 kPa), found mortality benefit--> helps ventilator dyssynchrony
• Cisatracurium: Continuous infusion: IV: 0.1 to 0.2 mg/kg initial loading dose, followed by continuous infusion of 1 to 3 mcg/kg/minute

Steroids

• Steroid has demonstrated benefit in most of the diseases which commonly cause ARDS, for example:
  • Bacterial pneumonia
  • Viral pneumonia such as COVID-19
  • Non-pulmonary sepsis
  • Most interstitial lung diseases (e.g., vasculitis, cryptogenic organizing pneumonia, hypersensitivity pneumonitis)
  • Drug-induced pneumonitis, radiation pneumonitis
• Methylprednisolone: 1 mg/kg/day, with a gradual taper over 14 days OR
• Solumedrol: 20mg/day for 5 days then 10mg/day for 5 days