Pt presents with severe dyspnea and crackles not due to CHF, most c/f ARDS 2/2 Transfusion/Trauma/PNA,sepsis. Symptomatic for less than one week with bilateral infiltrates.
Unlikely PE, Diffuse Alveolar hemorrhage, high-altitude pulmonary edema, DIC, or cardiogenic etiology. Not PTX.
Plan CXR, BUS, basic labs, ABG/VBG, blood cultures, influenza testing, BNP.
Tx Intubation, ABX, tamiflu 75mg BID NGT (if in season). Aggressive fluid resuscitation only until out of shock, then conservative fluid therapy. MICU admission.
Vent settings: Low TV ventilation (6ml/kg IBW), High PEEP, permissive hypercapnia, Maintain plateau pressures < 30, OXYGENATION GOAL: PaO2 55-80 mmHg or SpO2 88-95%
**Consider VIOLET trial enrollment (large single oral dose Vitamin D vs placebo).
**Low TV ventilation 6ml/kg where kg is predicted Ideal Body Weight https://www.mdcalc.com/ideal-body-weight
Click to access ventilator_protocol_2008-07.pdf
PaO2/FiO2 Severity Mortality
200-300 Mild 27%
100-200 Mod 32%
<100 Severe 45%
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