Acute Lung Injury

Question 1

what are ARDS/ALI?

Answer 1

life-threatening acute diffuse, inflammatory lung injury

Question 2

what are the criteria for acute lung injury and acute respiratory distress syndrome for people?

Answer 2

acute onset of clinical signs of respiratory distress
bilateral infiltrates on chest radiographs
no evidence of heart failure
ALI: less severe hypoxemia
ARDS: more severe hypoxemia

Question 3

what is the definition of ALI/ARDS in veterinary medicine?

Answer 3

acute onset (<72hrs)
known risk factor present
evidence of pulmonary capillary leak or inflammation
inefficient gas exchange

Question 4

what distinguishes ALI from ARDS?

Answer 4

PaO2/FiO2 ratio <300 (60% of normal): ALI
<200 (40% of normal): ARDS

Question 5

what causes ALI and ARDS?

Answer 5

transfusion related ALI
ventilator associated ALI
life-threatening condition
neonatal

Question 6

what direct lung injuries can predispose you to ALI/ARDS?

Answer 6

pneumonia
respiratory tract trauma
thoracic surgery
aspiration of gastric/ruminal contents
near drowning
lung metastases
inhalation of toxic vapors

Question 7

what indirect lung injuries can predispose you to ALI/ARDS?

Answer 7

sepsis
endotoxemia or systemic inflammation
disseminated intravascular coagulation
non-lung trauma
transfusion
excessive fluid/oncotic support
severe burns, electrocution, pancreatitis
drugs and toxins

Question 8

what is PaO2 of normal adults (room air)?

Answer 8

90-105 mmHg

Question 9

what is PaO2/FiO2 of normal adults?

Answer 9

500

Question 10

what are the advantages of PaO2/FiO2 ratios?

Answer 10

patient assessment of supplemental oxygen
evaluation of neonates

Question 11

what are the normal PaO2 and PaCO2 of a 30 minutes-old foal (lateral recumbency)?

Answer 11

55-60 mmHg
50-55 mmHg

Question 12

what are the normal PaO2 and PaCO2 of a 12 hour-old foal (lateral recumbency)?

Answer 12

70-80 mmHg
43-47 mmHg

Question 13

what is the pathogenesis of ALI/ARDS?

Answer 13

exudative phase
proliferative phase
fibrotic phase

Question 14

what happens in the exudative phase of ALI/ARDS?

Answer 14

edema
neutrophil influx
fibrin exudation
starting hyaline membrane formation
type 1 pneumocyte necrosis
surfactant inactivation/dysfunction

Question 15

what happens in the proliferative phase of ALI/ARDS?

Answer 15

proliferative diffuse alveolar damage: changes seen in exudative phase and type 2 pneumocyte hyperplasia

Question 16

what happens in the fibrotic phase of ALI/ARDS?

Answer 16

fibrotic diffuse alveolar damage: changes seen in proliferative phase and fibrosis

Question 17

what causes hypoxemia in ALI/ARDS?

Answer 17

diffusion limitation
shunt
V/Q mismatch
hypoventilation

Question 18

what is transfusion related ALI characterized by?

Answer 18

onset of acute hypoxemia within 6 hours of a blood transfusion in the absence of circulatory overload

Question 19

what is transfusion related ALI associated with?

Answer 19

plasma or whole blood

Question 20

what causes ventilator associated lung injury?

Answer 20

oxygen toxicity
over-inflation

Question 21

what are some disease conditions similar to ALI/ARDS that are not ALI/ARDS?

Answer 21

cardiogenic pulmonary edema
equine asthma
localized bronchopneumonia
idiopathic pulmonary fibrosis
pulmonary macro-thromboembolism
neonatal respiratory distress syndrome

Question 22

what causes neonatal respiratory distress syndrome?

Answer 22

primary surfactant deficiency