Essay --

Acute respiratory distress syndrome (ARDS) is a fatal condition, associated with a high mortality rate and it is difficult to treat. Amend hypoxia, enhance respiratory mechanics in order to optimize gas exchange are the main goals in treating ARDS patients. Management of patient with ARDS secondary to inhalation injury in burns intensive care unit (BICU) is including mechanical ventilator support, pharmacological adjuncts and extracorporeal membrane oxygenation (ECMO) support. Prone positioning act as an adjunctive treatment in treating ARDS patients was acknowledged by many journal articles and also was mentioned in our respiratory failure and ARDS lecture. It improves oxygenation in most of the patients with ARDS. As mentioned in the lecture, until recently, no convincing evidence shows that prone positioning would help with better mortality rate. Meanwhile prone position is not practicing for ARDS patients in BICU in Singapore due to certain complications. Content ARDS is a life threatening condition, various definitions have been proposed. Fast diagnose improves the effect of treatment. However, till the year of 1994, The North American-European Consensus Conference (NAECC) published the criteria for diagnosis of ARDS (Appendix I). Carlson, Good, Kirkwood, and Schulman (2009) stated that the clinical presentation of ARDS including bilateral pulmonary infiltrates, acute onset of hypoxia resistant to supplemental oxygen, tachypnea, and decreased alveolar compliance. It is important to point out that ARDS is not a disease but a syndrome. It is associated with underlying clinical disease such as pneumonia, trauma or sepsis. As mentioned in the lecture, Inhalation injury is one of the common causes of direct lung injury ... ...limit damage from fibrin deposition in the alveolar space and microcirculation in ARDS. It is safe and effective in reducing lung injury (Miller, Rivero, Ziad, Smith & Elamin, 2009). Nebulized heparin and acetylcysteine is usually prescribed for post inhalation burned patients for five to seven days during the hospital stay. In order to reduce oxidants stress and airway obstruction caused by fibrin casts, the using of bronchodilators, anticoagulants, antioxidants and corticosteroids was studied and approved by researchers. The study also shows that heparin nebuliazation may provide pulmonary anticoagulation to absorb the fibrin cast. It is a common practice to administer nebulized N-acetylcysteine in alternation with heparin in BICU post inhalation burn injury due to the efficient antioxidant and mucolytic effects. ( Elsharnouby, Eid, Elezz, and Aboelatta, 2014).