ARDS: etiopathogenesis and physiology -DR BALAJI RAJARAM ( APOLLO CHENNAI) скачать в хорошем качестве

ARDS: etiopathogenesis and physiology -DR BALAJI RAJARAM ( APOLLO CHENNAI)

00:00:00 INTRO 00:01:00 etiology, definition and pathology 00:29:16 gas exchange 00:40:10 vascular 00:53:20 VILI 01:02:00 DP ,MP stress strain 01:13:04 pearls by dr tapesh bansal DR Balajirajaram discussed the pathogenesis of alveolar capillary barrier injury, focusing on the structural and functional integrity of the alveolar and capillary sides. He explained how water accumulation, cytokine release, and loss of tight junctions can lead to fluid leakage and impaired surfactant production, causing alveolar collapse. He also differentiated between alveolar and systemic inflammation, noting that both can be hyperinflamed or hypo-inflamed. Balajirajaram highlighted the importance of understanding these processes for clinical applications, such as determining the appropriate time to initiate steroids and the potential benefits of therapies like simvastatin for hyperinflammatory subphenotypes. He concluded by outlining the stages of injury, from early edema to late fibroproliferation, and the implications for patient management. ARDS Pathophysiology and Gas Exchange Balajirajaram discussed the pathophysiology of Acute Respiratory Distress Syndrome (ARDS) and its impact on gas exchange. He explained that ARDS can cause alveolar-capillary barrier injury, leading to decreased lung compliance, ventilation-perfusion (V/Q) mismatch, and pulmonary hypertension. He also highlighted the role of type 2 alveolar cells in surfactant production and its impact on surface tension and alveolar collapse. Balajirajaram further discussed the three types of shunts in ARDS: physiological shunt, intrapulmonary shunt, and intracardiac shunt. He also explained the concept of dead space in ARDS and its correlation with increased mortality. Balajirajaram concluded by emphasizing that ARDS is characterized by a combination of both shunt and dead space, leading to impaired gas exchange. Lung Physiology and ARDS Management Balajirajaram discussed the complexities of lung physiology and its application in treating Acute Respiratory Distress Syndrome (ARDS). He explained the concept of ventilation-perfusion (V/Q) ratio and its variations in different lung compartments, including the possibility of a patent foramen ovale (PFO) causing shunting. He also highlighted the importance of understanding non-pulmonary determinants of oxygen delivery, such as cardiac output and hemoglobin concentration. Balajirajaram emphasized the need for a fine balance in managing these factors to optimize oxygenation. He also discussed the role of hypoxic pulmonary vasoconstriction (HPV) and its potential loss in ARDS patients. Lastly, he shared an example of how reducing dead space in a ventilated patient can significantly improve their condition. Ventilator-Induced Lung Injury and ARDS He discussed the importance of lung mechanics in respiratory failure, emphasizing that while oxygenation is often prioritized, lung mechanics are often overlooked. Balajirajaram also highlighted the significance of reducing nosocomial areas and adopting lung-protective ventilation strategies to reduce mortality in acute respiratory distress syndrome (ARDS). Ventilation Mechanics and VILI Prevention Lung Mechanics and Precision Medicine He discussed the concepts of stress, strain, and mechanical power in the context of lung mechanics and their implications for patient care. He explained that stress is the force acting per unit area, strain is the amplitude of deformation, and mechanical power is the product of stress and strain rate. He also highlighted the limitations of measuring stress and strain in heterogeneous lung units and the importance of understanding the pathophysiology of(ARDS) to improve patient outcomes.& emphasized the need for precision medicine in ARDS, including the identification of subtypes and the use of novel concepts such as lung deflation injury and effort-induced lung injury. He concluded by stressing the importance of early recognition of ARDS, understanding its variations in pathophysiology, and tailoring treatments accordingly. ARDS Pathology and Ventilator Management In the meeting, Dr.Tapesh Bansal discussed the pathologic definition ofARDS and its etiologies. He clarified that not all conditions causing acute hypoxemic respiratory failure are classified as ARDS, and the presence of hyaline membranes is a key distinguishing factor. Dr. also emphasized the importance of etiological diagnosis, highlighting the role of bronchoalveolar lavage (BAL) and polymerase chain reaction (PCR) in identifying the cause of ARDS. He also discussed the potential for fibrosis in patients recovering from ARDS and the importance of considering cardiac output when ventilating these patients. Lastly, Dr. touched on the ongoing debate about the optimal ventilator settings for ARDS patients, stating that precision medicine is the future direction for managing these patients.