Then we can progress to
something called ECMO.
Now, this is extracorporeal
This is pretty cool stuff.
And this takes a highly trained
nurse to monitor a patient
and to organize
this type of care.
It's only done in
I live in a fairly big town,
but we only have one
hospital in the city
that is available
to do adult ECMO.
Now, we use ECMO for little tiny guys
for like little premature babies.
We have those in the city, but having
ECMO for adults is a whole another level.
So, keep in mind this isn't available
everywhere and in every hospital.
It's got to be a
very specialized ICU.
So a cannula is placed
in a large blood vessel
because it's job is to carry the
patient's blood to a device, the ECMO
that has a gas
You heard me is
this not so cool.
So we take blood out of the
patient's body from a large vessel.
The ECMO delivers O2 to the
blood and removes the CO2.
It's like what the aveoli capillaries
do but we do this outside of their body.
Then the blood is returned and it
goes back into the patient's body.
Now, it's oxygenated and it's had
the CO2 taken out or good to go.
This is a wonderful theory,
but it is a very complicated procedure
and it's not a great sign if your patient
has declined to the point of needing ECMO.
But it is a fabulous thing,
when it works and
everything goes well.
Please keep in mind,
lung damage is progressive in ARDS.
So I have it up here the three
phases we've talked about,
the exudative phase, the proliferative
phase and the fibrotic phase.
Look at that you got,
the days underneath like
0, 2, 7, 14 and 21.
Those are the days that
things start happening.
So, see that hyaline membrane,
you've got edema first
that is definitely
in the early phases.
Then the hyaline
membrane start forming
and you've got significant
as you're in that
then you can end up with fibrosis,
which is long-term damage.
Okay, should you memorize?
should you try?
No, that's not what I want you to
do, I want you to see.
that this is a
We've given you three
categories, phases, stages.
Whatever you want to call them,
just to give you an idea of
some milestones along the way.
Because I want to
ask you a question.
Let's think back and take what you know
about how oxygenation works in the lungs.
I don't want you to
think about VQ mismatch.
Remember V stands for ventilation,
Q stands for perfusion.
So what are the three most likely causes
of the VQ mismatch in the exudative face?
Okay, so think through.
What do you know happens
in the exudative phase?
What are the three things
that are most likely to cause
a ventilation or
Did you get it?
The edema, the infiltrates and the
possible collapse of the alveoli
are the most likely causes of the
VQ mismatch in the exudative face.