Acute respiratory distress syndrome 2 General management

1. Remove the cause whenever possible, e.g. drain pus, antibiotic therapy, fix long bone fracture.

2. Sedate with an opiate-benzodiazepine combination as mechanical ventilation is likely to be prolonged. Doses should be kept to the lowest possible but consistent with adequate sedation.

3. Muscle relaxation is indicated in severe ARDS to improve chest wall compliance and gas exchange.

4. Haemodynamic manipulation with either fluid, dilators, pressors, diuretics and/or inotropes may improve oxygenation. This may be achieved by either increasing cardiac output, and thus mixed venous saturation in low output states, or by decreasing cardiac output thereby lengthening pulmonary transit times in high output states. Care should be taken not to compromise the circulation.

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