A 4-year old with gram-negative sepsis develops increasing respiratory distress concomitant with antibiotic treatment and her admission to the ICU. What do you think is going on? Why? How does endotoxin release promote ARDS? What are some of the vasoactive mediators involved? How does the release of leukotrienes, tumor necrosis factor (TNF), and prostaglandins involve the pulmonary circulation in ARDS? What implications are there for you as a critical care anesthesiologist? Why? Is there a role for surfactant instillation in such patients? Does surfactant work normally in patients with ARDS? Why/why not? What can you do about it? Will PEEP help? Why? What are the adverse effects of high ranges of PEEP? How can these effects be minimized? Under what circumstances would you consider extracorporeal membrane oxygenation (ECMO)? What about extracorporeal CO2 removal (ECCO2R)? What effects does ARDS have on shunt (venous admixture)? Are there any effects on Vd/Vt? What are they? At what phase of the disease process? What, if anything, can you do about it?
KeywordsDopamine Lipase Influenza Pancreatitis Diarrhea
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