MANAGEMENT OF ARDS IN A POLYTRAUMA PATIENT

This was a case of polytrauma involving musculoskeletal system and lungs. During initialevaluation lung contusion was not evident. As the injury worsened patient became hypoxic whichmanifested as low saturation and irritability in the post operative period. Associated hypotension couldhave aggravated the cerebral ischemia. Patient was diagnosed as having ARDS by clinical,biochemical and radiological findings. Onset of ARDS following the lung injury, complicated thecondition further. HIE was diagnosed by neurophysician. Cerebral ischemia in this case, probablyresulted from primary lung injury, ARDS and hypotension. Presence of long bone fracture explainsthe hypotension.Inotrope support was given along with aggressive volume resuscitation with bloodand crystalloids. There was improvement in the hemodynamic status. Lung protective ventilationstrategy was followed to manage ARDS. CVP guided fluid therapy was given. Glycemic control wasmaintained. Gradual improvement in lung injury and oxygenation was indicated by clinical examination, ABG analysis and serial chest X-ray. Though cerebral ischemia took sometime for recovery , it was almost a complete one.