08.14 - ARDS (Muthiah) - Questions Flashcards
Berlin Criteria
(1) Acute Onset of Respiratory Failure; (2) Bilateral Infiltrates; (3) No evidence of Volume overload; (4) PaO2/FiO2 < 300
Cells damaged in ARDS
Capilary Endothelial, Alveolar Epithelial
Character of edema in ARDS
Protein-rich
Surfactant in ARDS
Dysfunctional
Most common direct cause of ARDS
Pneumonia
Most common indirect cause of ARDS
Sepsis
What is TRALI
Transfused blood has antibodies to white blood cells
Stages of ARDS (no time)
(1) Exudative; (2) Proliferative; (3) Fibrotic; (4) Recovery
4 predictors of worse outcome
(1) Chronic Liver Disease; (2) Non-pulmonary organ dysfunction; (3) Sepsis; (4) Advanced age
Which is more susceptible to injury: Type 1 or 2 Pneumocyte
Type 1
Which can proliferate: Type 1 or 2 Pneumocyte?
Type 2
4 components of lung injury score
CXR; PaO2:FIO2; PEEP; Respiratory Compliance
How do you improve oxygenation in a patient with ARDS?
Increase the PEEP
T/F: Using a pulmonary vasoconstricting agent will improve oxygenation in a patient with ARDS?
FALSE
T/F: Decreasing the peak inspiratory flow rate will improve oxygenation in a patient with ARDS?
FALSE
What is FRC
Amount of air left in lungs after normal expiration
Possible mechanism of improvement in oxygenation with application of PEEP in ARDS
Recruiting atelectatic alveoli and increasing FRC
Bigger FRC = ___ oxygenation
better
3 situations of Low FRC
Pregnancy, Large Ascites, Really Obese
T/F: PEEP reduces lung water in ARDS
FALSE
T/F: PEEP increases pulmonary vascular resistance and therefore improves oxygenation
FALSE
Compliance in ARDS
Acute decrease in compliance due to edema
Recommended tidal volume in ARDS
6 cc / kg
T/F: Nitric Oxide administration in patients with refractory hypoxemia reduces mortality
False, but it does improve oxygenation
The incidence of pneumothorax as a complication of ARDS is usually seen
After 2 weeks of ARDS onset
Death in a patient with ARDS is usually due to
Multi-organ failure from raging inflammation
T/F: Refractory Hypoxemia often causes death in ARDS
FALSE
Acute onset dyspnea, left sided pleuritic chest pain, purulent sputum since last night
Pneumonia
Most likely etiological agent of pneumonia
Strep Pneumoniae
Doesn’t respond to supplemental O2
Shunt
In ARDS, there is severe hypoxemia due to ___
Shunting
Require mechanical ventilation with ___
PEEP
Ventilatory defects in ARDS survivors
Mild to moderate restrictive defects, with mild reduction in DLCO; Improve over following year and may normalize
