ARDS and Berlin criteria

250 words with 2 scholarly references

A 42-year-old male with no significant past medical history presented to the emergency department (ED) with severe abdominal pain. Work-up revealed acute pancreatitis due to alcohol consumption. He disclosed being a binge drinker. Gallbladder disease, the most common cause of acute pancreatitis, was ruled out with imaging and laboratory studies. The patient was admitted to the hospital and treated according to the standard of care for management of acute pancreatitis which included aggressive fluid resuscitation and pain management. On hospital day 3, he developed mild shortness of breath. Although the etiology of his respiratory symptoms was initially unclear, upon further inquiry, he recalled several episodes of vomiting prior to arrival in the ED. Your suspicion for aspiration and possible aspiration pneumonia are raised. The patient is placed on supplemental oxygen via nasal cannula with no improvement. High flow nasal cannula (HFNC) is ordered and initiated with significant improvement in respiratory symptoms. He has a mild non-productive cough and low-grade fever. A chest x-ray revealed mild vascular congestion and a possible right middle lobe opacity. He is pan-cultured and started empirically on antibiotics to cover aspiration pneumonia, he is also given diuretics for suspected volume overload. Overnight, he became tachypneic with respiratory rate in the 40s and increased work of breathing. Peripheral oxygen saturation (SpO2) was 82% despite titration of fraction of inspired oxygen (FiO2) to 100% on HFNC. He was intubated, placed on mechanical ventilation and transferred to the ICU for management. A chest x-ray following intubation revealed diffuse bilateral infiltrates. He was initially placed on standard ventilatory settings with brief improvement but, over the next several hours, it became increasingly difficult to oxygenate him despite titration of FiO2 to 85% on the ventilator. He was given an additional dose of intravenous (IV) diuretic with no improvement. An arterial blood gas (ABG) revealed arterial oxygen of 70mmHg and a repeat CXR revealed progression of diffuse bilateral infiltrates. Acute respiratory distress syndrome (ARDS) was suspected and ARDS specific ventilatory strategies were initiated.

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Depending on your role, you may be the first person to recognize a critical change in respiratory status. Understanding the potential continuum of respiratory decompensation is essential to ensure safe management of our patients. Respiratory failure is one of the most common conditions treated in intensive care units (ICUs).

Discuss your top 5 priority nursing interventions for this patient and explain your rationale for why they are your priority. Discuss the Berlin criteria and explain how it is applicable to this patient. What are the ARDS specific ventilatory strategies which would be appropriate for this patient?

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