[Cheri O]

I am currently attending the University of Alabama On line RN to BSN program and have been asked to post a discussion on a current issue in my practicum area. My area of practicum is in the ICU. I have several questions with regard to ARDS.
a. Anyone have any success stories in taking care of patients with ARDS?
b. What is your current treatment with regards to ARDS, such as protocols.
c. What is your current nurse-to-patient ratio in your unit - are you "acuity" or "numbers" on staffing, or mixture of both?

[KR]

Where I am at, the hospital uses a combination of acuity and staffing ratios to staff the unit. I am travelling in a Trauma/Medical/Surgical ICU that has 40 some beds. The hospital is licensed for about 550 beds I think. As far as ARDS yes, I have seen some do okay. The hospital I am working at now actually uses Nitric Oxide as a last ditch effort in ARDS. I am taking care of a patient on Nitric Oxide now. I have not been able to find any literature on it yet, but this is what they told me about Nitric.
Nitric oxide has a very short half life, so it does not build up in the system. It is used to treat pulmonary hypertension and has a vasodilation effect. The other different treatments I have seen for ARDS include proning and Bi Level ventilation. I hope this helps! Feel free to email me with any questions! Kimberly

[obeyacts2]

Hi. I am an ARDS survivor myself. I recommend the website http://ardsusa.org. It is primarily for survivior support, but does offer links to other sites.

Laura

[zcubed]

http://ardsusa.org/Inhaled-NO.htm


http://www.ctsnet.org/doc/1743


Nitric is not used very often in the US though in Europe it is; at last year's ATS conference, they discussed and debated this very issue and I believe that you could probably get a copy of this debate from ATS online.

Basically, the reason why, they said, it is not used in the US, is because of the huge exprense, and because initially it might be effective, but the effectiveness is very quick and then, almost immediately, the effectiveness, however slight, is gone, and this expensive treatment is still being used.

In the cost/benefit analysis, doctors don't believe it is worth it.

From a patient stand point, even if it works only for a day or two, with ARDS, maybe that is all the patient will need to get them through the worst of their ARDS, the worst of their crisis, to bring them out of the coma...

The people who have had nitric and have survived swear by it.

And it seems to have more success with pediatric patients.

[MarkHammerschmidt]

As I understand it, the whole thing about surviving ARDS comes from using vent strategies that result in lower lung pressures, whch is what pressure-limited ventilation is all about. I seem to recall a notice that they were stopping the study trials because all the ARDS patients on conventional ventilation weren't getting better, and the ones on PC or PSV were. The same idea lies behind "permissive hypercapnia" - you let the pCO2 drift upwards, deliberately underventilating the patient, to expose them to less vent pressure. They become acidotic as a result, which makes ICU nurses very unhappy...

[gwenith]

Mark - that has been our experience too in Australia. We have and do sometimes use Nitric but not at the hospital where I currently work. Oh! and BTW besides Mark's very good website there is this site

http://www.ccmtutorials.com

[KR]

Thank you all for your replies regarding Nitric Oxide! It is very much appreciated Have a great one! Kimberly