Acute Respiratory Distress Flashcards

1
Q

What is acute respiratory distress syndrome (ARDS)?

A

A non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome

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2
Q

What can ARDS often complicate?

A

Critical illness

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3
Q

What is ARDS common in?

A

Traumatic brain injury

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4
Q

How does ARDS occur?

A

Increased permeability of pulmonary microvasculature causing leakage of protein rich fluid into the alveoli

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5
Q

What may increased permeability of pulmonary microvasculature be a manifestation of?

A

More generalised disruption of endothelium

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6
Q

What can ARDS result in?

A

Hypoxia and multipleorgan failure

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7
Q

How else can ARDS affect the respiratory systems normal function?

A

Reduced surfactant production

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8
Q

What are the most common risk factors for ARDS?

A
  • Sepsis
  • Massive trauma with shock and multiple transfusions
  • Pneumonia
  • Hypovolaemic shock
  • Gastric aspiration
  • Head injury
  • Raised ICP
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9
Q

What are the three diagnosis criteria for ARDS?

A
  • Acute onset (within 1 week)
  • Bilateral CXR opacities
  • PaO2/FiO2 (arterial to inspired oxygen) ratio of ≤300 on PEEP or CPAP ≥ 5cm H2O
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10
Q

What may be in the history of a person with ARDS?

A
  • Relevant injury
  • Increasing dyspnoea
  • Other precipitating event
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11
Q

What are the potential signs of ARDS?

A
  • Cyanosis
  • Tachypnoea
  • Tachycardia
  • Peripheral vasodilation
  • Bilateral fine inspiratory crackles
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12
Q

What investigations can be useful in ARDS?

A
  • FBC, U&E’s, LFT, amylase, CRP, clotting, blood cultures, ABG
  • CXR
  • Those relevant to clinical scenario
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13
Q

What will a CXR show in ARDS?

A

Bilateral alveolar shadowing with air bronchograms

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14
Q

What are the differentials for ARDS?

A
  • Acute exacerbation of congestive heart failure
  • Bilateral pneumonia
  • Acute interstitial pneumonia
  • Diffuse alveolar haemorrhage
  • Hypersensitivty pneumonitis
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15
Q

What should happen to patients with ARDS?

A

Be admitted to ITU for supportive therapy and treatment of underlying cause

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16
Q

What may be adequate to maintain oxygenation in early ARDS?

A

CPAP with 40-60% oxygen

17
Q

What do most patients with ARDS need to maintain oxygenation?

A

Mechanical ventilation

18
Q

What are the indications for ventilation in ARDS?

A

Severe hypoxaemia (PaO2 8.3 kPa) or PaCO2 >6kPa

19
Q

What other supportive therapies are required in ARDS?

A
  • Circulatory support
  • Invasive haemodynamic monitoring with arterial line
  • Inotropes
  • Blood transfusion
  • Nutritional support
  • VTE prevention
  • Gastric ulcer prevention
20
Q

What are inotropes used for in ARDS?

A

Maintaining cardiac output

21
Q

Give an example of an inotrope used in ARDS?

A

Dobutamine

22
Q

What are the potential complications of ARDS?

A
  • Pneumothorax
  • Ventilator-associated pneumonia
  • Multiple organ failure
  • Pulmonary fibrosis