Sindrome da distress respiratorio acuto
Table of Contents
Che cos’è la sindrome da distress respiratorio acuto?
Lasindrome da distress respiratorio acuto( ARDS) è un tipo di danno infiammatorio acuto e diffuso del parenchima polmonare caratterizzato da rapida comparsa di ipossiemia refrattaria all’ossigeno in presenza di infiltrati polmonari bilaterali. Questa sindrome pone in pericolo di vita il paziente per la rapidità d’insorgenza e la grave insufficienza respiratoria.
Incidenza, mortalità e diagnosi precoce
L’incidenza annuale della sindrome da distress respiratorio acuto varia secondo le casistiche da 1,5 a 75 casi/100.000/abitanti anno. Il 15-20% dei pazienti ricoverati in terapia intensiva sottoposti a ventilazione meccanica presenta caratteristiche cliniche compatibili con la ARDS.
La mortalità, seppur diminuita rispetto ad alcuni decenni, è ancora elevata, raggiungendo spesso il 35- 40% dei casi.La mortalità è condizionata dalla patologia che ha scatenato questa sindrome clinicae dallo sviluppo di insufficienza multiorgano.
Tra i fattori prognostici negativi sono stati riconosciuti:
- L’età avanzata
- Il sesso maschile
- La razza afroamericana
- L’abitudine tabagica
- La gravità e il numero del comorbilità
- La gravità del danno polmonare, della disfunzione extra polmonare e della sepsi.
Quali sono i sintomi della sindrome da distress respiratorio acuto?
L’esordio è acutocon presenza di segni di distress respiratorio (tachipnea, forte dispnea, attivazione dei muscoli accessori, segno di Hoover, segno di Campbell, alternanza toraco-addominale). Si manifesta in genere entro 24-48 ore dall’evento causale. In alcuni casi si associano tosse secca e dolore toracico, ma il quadro iniziale può essere dominato da segni e sintomi della causa scatenante con un possibile sviluppo più o meno rapido verso una MOF.
I segni obiettivi riscontrabili sono:
- Cianosi periferica
- Tachicardia, tachipnea e fini crepitii diffusi
- Talora è presente ipotensione
- Astenia importante
- Stato confusionalese l’apporto di O2 ai parenchimi nobili (cervello, rene cuore) è drasticamente ridotto.
Dopo alcuni giorni dal ricovero può insorgere ipertensione polmonare per il rimodellamento del circolo polmonare. La grave ipossiemia, refrattaria all’ossigenoterapia ad alti flussi, rende necessaria L’assistenza ventilatoria meccanica, o perlomeno l’applicazione di CPAP o PEEP esterna.
Diagnosi
Da un punto di vista laboratoristico possono comparireleucocitosi, acidosi lattica e coagulazione intravascolare disseminata. Allaradiografia del toracesi osservano , bilateralmente, soprattutto nelle regioni inferiori dei polmoni,diffusi infiltrati di tipo interstiziale, mentre la TC del toraceevidenzia multipleaddensamenti parenchimali.
Terapia
Per sua natura la sindrome da distress respiratorio acuto è un’emergenza medica a evoluzione rapida e potenzialmente fatale, pertanto, chi ne è affetto deve essere anzitutto accolto in ambiente intensivo, anche specialistico pneumologico, con idonea capacità di monitoraggio e assistenza. Le strategie terapeutiche si basano su tre principi:il trattamento della patologia di base, il supporto delle funzioni fisiologiche e il controllo dei meccanismi patogenetici.Trattare la causa scatenante è fondamentale. Con un’accurata diagnosi eziologica. La terapia di supporto ventilatorio ha l’obiettivo di mantenere un adeguato scambio dei gas.
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