[PG Notes] RESPIRATORY DISTRESS SYNDROME ( ARDS ) [pathogenesis, clinical features, and management]

RESPIRATORY DISTRESS SYNDROME

 respiratory-distress-syndrome-ARDS-hyaline-membrane-disease-helpmedico.jpg

[pathogenesis, clinical features, and management and prevention ]

  • Aka HYALINE MEMBRANE DISEASE
  • Incidence-
    • Overall: 10 to 15%
    • in < 28weeks of gestation: 80%
  • Risk factors: Prematurity, asphyxia, acidosis, maternal diabetes, C-section

 

I.  ETIOPATHOGENESIS

  • Normally:

Type 2 alveolar cells -> produce surfactant -> helps reduce surface tension

  • In RDS: Basic abnormality is surfactant deficiency.

Pathogenesis Of Respiratory Distress Syndrome/ Hyaline Membrane Disease 

Surfactant deficiency -> alveoli collapse -> ventilation perfusion mismatch -> hypoxia and acidosis -> pulmonary vasoconstriction -> alveolar hypoperfusion -> ischaemic damage to alveoli -> transudation of proteins in alveoli -> form hyaline membrane

 

  • Surfactant production
    • Starts around: 20 weeks
    • Peak: 35 weeks
    • That’s why any neonate <35week is prone to develop RDS

 

II. CLINICAL FEATURES

  1. Occur within 1st 6 hours of life
  2. Clinical Features:
    • Tachpnoea
    • Retraction
    • Grunting
    • Cyanosis
    • DECREASED air entry
  3. Radiological feature
    • Retinogranular pattern
    • Ground glass opacity[mcQ]
    • Low lung volume
    • Air bronchogram[mcQ]
    • In severe disease- White out lungs

 

III. MANAGEMENT

  1. SUSPECTED Respiratory Distress Syndrome : Cared in NICU with IV fluids & Oxygen
  1. MILD to MODERATE Respiratory Distress Syndrome: Managed with CPAP [Continuous distending pressure of 5-7cm of water applied at the level of nostrils to keep alveoli open in spontaneously breathing baby]
  1. SEVERE Respiratory Distress Syndrome: Require mechanical ventilation

 

  • InSurE approach
    • INtubated
    • SURfactant given
    • Extubated rapidly to CPAP

 

TREATMENT OF CHOICEExogenous surfactant

Indication- Moderate to severe RDS + Prophylaxis (all neonates <28weeks)

Route of administration- INTRATRACHEAL

Also Download:

 

 

IV. PREVENTION

  • Antenatal steroids given to mother in preterm labor (<35weeks)
    • induce phospholipid synthesis and release of surfactant
    • Enhance lung maturation process
    • Betamethasone phosphate OR acetate (6mg) administered 24-72 hours prior to delivery

 

Also Download :

 

This is all you Need to Know About Hyaline Membrane Disease or Respiratory Distress Syndrome for NEET PG or Your Pediatrics in Final Year MBBS.

Do Share with your Friends….to help them too [If it helped you].

Dr Nishtha Kapil

Dr Nishtha Kapil

Intern, SVBP Hospital, LLRM Medical College Meerut


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