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he acute respiratory distress syndrome (ARDS) is the most seriousform of acute hypoxic respiratory failure. ARDS represents theexpression of an acute, diffuse, inflammatory process in the lungsconsequent to a variety of infectious and noninfectious conditions.It is characterized pathologically by damage to pulmonary epithelialand endothelial cells, with subsequent alveolar-capillary leak andexudative p

lmonary edema. The main clinicalfeatures of ARDS include rapidonset of dyspnea, severe defects in gas exchange, and imagingstudies demonstrating diffuse pulmonary infiltrates. The role ofnutrition in the management of ARDS has traditionally beensupportive. Recent research has demonstrated the potential ofcertain dietary oils (eg, fish oil, borage oil) to modulate pulmonaryinflammation, thereby improving lung compliance and oxygenation,and reducing time on mechanical ventilation. This article reviewsthe alterations in the immune response that underlie ARDS,discusses the physiology of dietary oils as immunonutrients,summarizes animal and human studies that explore the therapeuticeffects of dietary oils, and provides clinical recommendations fortheir use.

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Effects of enteral feeding with eicosapentaenoicacid, gamma-linolenic acid, and antioxidants inmechanically ventilated patients with severe

sepsis and septic shock. OBJECTIVES: Enteral diets enriched

with eicosapentaenoic acid (EPA),

gamma-linolenic acid (GLA), andantioxidants have previously been shown

to improve outcomes in patients with

acute respiratory distress syndrome.

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Acute Respiratory Distress Syndrome:Treatment & Medication

Diet

Institution of nutritional support after 48-72 hours of mechanical

ventilation usually is recommended. Unless contraindicated

because of an acute abdomen, ileus, gastrointestinal bleeding, or

other conditions, enteral nutrition via a feeding tube is preferable

to intravenous hyperalimentation. A low-carbohydrate high-fat

enteral formula containing components that are anti-inflammatory

and vasodilating (eicosapentaenoic acid and linoleic acid) with

antioxidants has been demonstrated in some studies to improve

outcome in ARDS.20,21 In a prospective, randomized study ofARDS patients fed with an enteral nutrition formula containing

antioxidants, eicosapentaenoic acid, and gamma-linoleic acid

compared with a standard isocaloric formula, Pontes-Arruda

demonstrated improved survival and oxygenation in patients

receiving the specialized diet.

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Acute Respiratory DistressSyndrome: Treatment & MedicationActivity

Patients with acute respiratory distress

syndrome (ARDS) are at bedrest. Frequentposition change and passive and, if possible,

active range of motion activities of all muscle

groups should be started immediately.

Elevation of the head of the bed to a 45 angleis recommended to diminish the development

of ventilator-associated pneumonia.

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Prone position

Although, 60-75% of patients with ARDS have significantlyimproved oxygenation when turned from the supine to theprone position, no survival benefit exists for patients treated

in the prone position. When the prone position is used, theimprovement in oxygenation is rapid and often significantenough to allow reductions in FIO2 or level of CPAP. Theprone position is safe, with appropriate precautions to secureall tubes and lines, and does not require special equipment.The improvement in oxygenation may persist after the patientis returned to the supine position and may occur on repeat

trials in patients who did not respond initially.