Definition

1. Acute – Develops < 1 week from insult
2. Bilateral CXR opacities
3. Hypoxemia – P/F < 300
4. Not due to Left Heart Failure

Common Causes

• Pneumonia – viral or bacterial
• Sepsis and septic shock – inflammatory injury
• Trauma
• Drugs
• Transfusion

Treatment

• Lung protective ventilation – 4-6 ml/kg IBW
• Permissive hypercapnea – pH ≥ 7.2 is ok, can choose to allow lower if hemodynamics tolerate
• High PEEP – monitor for adverse effects such as high Pplat or decreased cardiac output
• Recruitment maneuvers – don’t drop PEEP back down to low setting after competing
• Diuresis
• Prostacyclin – inhaled vasodilator to improve V/Q
• Prone
• Paralysis
• Steroid – Maybe – if it works it works early and needs a long course (e.g. ~ 1 month)