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Physical Therapy Management of Acute

Respiratory Distress Syndrome (ARDS) in an

Acute Care Setting

Chase Eifert, Amber Denomme, Ross

Fenimore, and Emma Richards

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Objectives

• Define Pulmonary Edema

• Define ARDS

– Goals for treatment

– Interventions

• Current research for interventions of ARDS

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What is Pulmonary Edema?

• Classifications

– Cardiogenic

– Non-cardiogenic

• Pathophysiology

– ↓ Lung compliance

– ↓ Lung volume

– ↑ Work of breathing

– ↑ Pressure in lung tissue

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What is Pulmonary Edema cont.

• Diagnostic Tests– Chest x-rays

– ↑ BNP levels (only in cardiogenic)

– Pulmonary function test changes• ↓ Lung volumes

• ↑ RR

• No change in FEV1

• Normal flow rate

– Arterial blood gasses• ↑ pH (respiratory alkalosis)

• ↓ PaO2

• ↓ PaCO2

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What is Pulmonary Edema cont.

• Clinical Manifestations

– Breath sounds• Wet Rales

• Wheezing

– Cardiovascular• Dysfunction

• Arrhythmias

– Symptoms• Respiratory distress

• SOB

• Cyanotic

• Labored breathing

• Pallor

• Diaphoresis

• Cough

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ARDS

• Non-cardiogenetic form of pulmonary edema

• Characterized by bilateral pulmonary infiltrate

and hypoxemia

• No cardiogenic problems

• Usually results from injury to the lungs

• Diagnosis defined by PaO2 to the fraction of

oxygen in the inspired air is less than 200mmHg

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PT Goals for the treatment of ARDS in the Acute

Care Setting

• Improve Oxygenation

• Decrease incidence of ventilator induced

pneumonia

• Initiate gradual mobilization

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• Mobilization

• Continuous Rotational

Therapy

• Posture

• Limb Exercise

• NMES

• Respiratory Muscle

Training

• Management of Airway

Secretion

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Mobilization

• Immobility contributes to patient decline in function

• Patient outcomes associated with early mobilization

• Holistic improvements with:– Overall Function

– Muscular Strength

– Cognition

– Respiratory Function

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Continuous Rotational Therapy

• Continually turning

patient on

longitudinal axis 60

degree

• Lack of sufficient

evidence

https://images.dlf.org.uk/mee/products/full/0042431.jpg

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Posture

• Improvements in V/Q

mismatch & residual

volume

• Prone ventilation

improved survival of

hypoxemic patients

• Techniques not widely

used

http://accessphysiotherapy.mhmedical.com/data/

books/detu2/detu2_c019f004.jpg

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Limb Exercise

• PROM, AAROM, &

AROM

– ↑ ROM, prevent

contracture, ↑ strength,

& prevent DVT

• Effects of limb exercise

of mechanical

ventilation weaning time

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NMES

• Low-intensity NMES

applied to LE

• Outcomes improved

without respiratory stress

• Patients suffering from

COPD, SCI, or CHF may

see greater benefits

http://www.kneeguru.co.uk/assets/images/

Community_Hub/kokmeyer/IMG_1871.png

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Respiratory Muscle Training

• Inspiratory muscle training safe with ventilated patients

• Outcomes dependent on case-by-case basis

• More research required before universal application to patients with ARDS

https://i.pinimg.com/originals/fd/59/79/fd597974caa0ec8a387ccd36ce2c65c5.jpg

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Management of Airway Secretion

• The relationship between mechanical ventilation and airway secretion

• Humidification

• Manual hyperinflation

• Percussion & vibration

• Intrapulmonary percussive ventilation

• Cough assist http://downloads.lww.com/wolterskluwer_vitalstream_c

om/sample-

content/9780781788786_Craven/samples/mod09/img/1

0a_2.jpg

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Objectives

• Define Pulmonary Edema

• Define ARDS

– Goals for treatment

– Interventions

• Current research for interventions of ARDS

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References

1. Ambrosino N, Makhabah D. Comprehensive Physiotherapy Management in ARDS. Vol 792013

2. Chung F, Mueller D. Physical Therapy Management of Ventilated Patients with Acute Respiratory Distress Syndrome or Severe Acute Lung Injury. Physiotherapy Canada. 2011;63(2):191-198.

3. Hillegass, Ellen et al. Essentials of Cardiopulmonary Physical Therapy 4th Edition. 2017, 152-153

4. Murray. Pulmonary edema: pathophysiology and diagnosis. The international journal of tuberculosis and lung disease. 2011;15(2):155

5. Purvey M, Allen G. Managing acute pulmonary oedema. Australian Prescriber. 2017;40(2):59-63.