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PSBIM Harrison 21st Edition > Acute Respiratory Distress Syndrome > Flashcards

Acute Respiratory Distress Syndrome Flashcards

1
Q

Annual incidence of ARDS pre-covid

A

60 cases/100,000 population

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2
Q

Clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure

A

Acute Respiratory Distress Syndrome

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3
Q

Most frequently reported surgical condition in ARDS (3)

A
  1. Pulmonary contusion
  2. Multiple bone fractures
  3. Chest wall trauma/flail chest
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4
Q

Most common cause of ARDS

A

Sepsis and Pneumonia (~40-60%)

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5
Q

Trauma patients with APACHE score of ____ have a 2.5-fold increased risk of developing ARDS

A

≥ 16

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6
Q

In this phase of ARDS, alveolar capillary endothelial cells and type 1 pneumocytes (alveolar epithelial cells) are injured, with consequent loss of the normally tight alveolar barrier

A

Exudative Phase (first 7 days of illness)

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7
Q

In this phase of ARDS, edema fluid that is rich in protein accumulates in the interstitial and alveolar spaces

A

Exudative phase

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8
Q

In this phase of ARDS, hyaline membrane whorls are seen.

A

Exudative Phase

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9
Q

Xray finding of ARDS

A

Opacities consistent with pulmonary edema, and often involves 3/4 of the lung field

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10
Q

Chest CT scan finding in ARDS

A

Presence of bilateral pulmonary infiltrates

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11
Q

Phase in ARDS where 1st signs of resolution is evident

A

Proliferative phase (days 7-21)

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12
Q

Phase of ARDS, recover rapidly and are liberated from mechanical ventilator

A

Proliferative phase (days 7-21)

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13
Q

Phase of ARDS, shift from neutrophil to lymphocyte-predominant pulmonary infiltrates

A

Proliferative phase (days 7-21)

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14
Q

As part of the reparative process in Proliferative phase, _____ proliferates along the alveolar basement membrane

A

Type II pneumocytes (synthesizes new surfactant)

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15
Q

In ARDS, presence of ____ in lung biopsy, in any phase of the disease, increases risk of mortality

A

Pulmonary Fibrosis

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16
Q

Function of PEEP

A

Promotes alveolar recruitment

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17
Q

This intervention provide significant reduction in 28-day mortality for patients with SEVERE ARDS

A

Prone positioning

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18
Q

Principle of Fluid Management in ARDS

A

Maintain low left atrial filling pressure
Fluid restriction and Diuretics limited only by hypotension and hypoperfusion

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19
Q

Only Category A recommendation in management for ARDS

A

Low tidal volume

20
Q

Category D recommendation in management of ARDS (3)

A

Glucocorticoid treatment
Surfactant replacement
High frequency ventilation

21
Q

Category B recommendation in management of ARDS (4)

A

HELP

Minimize left atrial filling pressure
High PEEP or Open Lung
Prone position
ECMO

22
Q

Category C recommendation in management of ARDS (3)

A

RNV

Recruitment maneuvers
Early neuromuscular blockade (Routine Use)
Inhaled vasodilators

23
Q

Goals and Limits in Management of ARDS

A

Tidal Volume ≤ 6 mL/kg
Plateau pressure ≤30 cmH2O
RR ≤35 bpm
FiO2 ≤ 0.6
SpO2 88-95%
pH ≥ 7.30
MAP ≥ 65 mmHg
Avoid Hypoperfursion

24
Q

Patients with ARDS recover maximal lung function within ___

A

6 months

25
Q

____ after endotracheal extubation, more than 1/3 of ARDS survivor have normal spirometry and normal diffusion capacity

A

1 year

26
Q

Many patients with ARDS recover lung function ______ after initial pulmonary injury

A

3-4 weeks

27
Q

Phase of ARDS, alveolar edema and inflammatory exudates of earlier phases convert to extensive alveolar duct and interstitial fibrosis

A

Fibrotic phase

28
Q

Marked disruption of acinar architecture
leads to__________

A

emphysema-like changes, with large bullae.

29
Q

Intimal fibroproliferation in the pulmonary microcirculation causes ______ (2)

A
  1. Progressive vascular occlusion
  2. Pulmonary hypertension
30
Q

Physiologic consequences in Fibrotic Phase (3)

A
  1. Increased risk of pneumothorax
  2. Reductions in lung compliance
  3. Increased pulmonary dead space
31
Q

General Principles in management of ARDS

A
  1. Recognition and treatment of underlying medical and surgical disorders (e.g., pneumonia, sepsis, aspiration, trauma)
  2. The minimization of unnecessary procedures and their complications
  3. Standardized “bundled care” approaches for ICU patients, including prophylaxis against venous thromboembolism, gastrointestinal bleeding, aspiration, excessive sedation, prolonged mechanical ventilation, and central venous catheter infections
  4. Prompt recognition of nosocomial infections
  5. Provision of adequate nutrition via the enteral route when feasible
32
Q

Repeated alveolar overdistention from excess tidal volume

A

Volutrauma

33
Q

Recurrent alveolar collapse

A

Atelectrauma

34
Q

Trial about use of lung-protective strategy using lower tidal volumes of 6ml/kg of PBW

A

ARDS Network trial (ARMA Trial)

35
Q

Maintaining a ____________ minimizes pulmonary edema and prevents further decrements in arterial oxygenation and lung compliance; improves pulmonary mechanics; and shortens ICU stay and the duration of mechanical ventilation.

A

Low left atrial filling pressure

36
Q

Ways to lower left atrial filling pressure

A

Fluid restriction
Diuretics

limited only by hypotension and hypoperfusion of critical organs

37
Q

Mortality rate for Mild ARDS

A

34.9%

38
Q

Mortality rate for Moderate ARDS

A

40.3%

39
Q

Mortality rate for Severe ARDS

A

46.1%

40
Q

ARDS management that improves survival (3)

A

PEL

Low tidal volume
Prone prositioning
ECMO

41
Q

Major risk factors to ARDS mortality is non-pulmonary. The most important risk factor is:

A

Advance age (>75)

42
Q

TRUE OR FALSE

Patients with ARDS arising from direct lung injury are nearly twice as likely to die as those
with indirect causes of lung injury

A

TRUE

43
Q

Factors associated with LESS recovery of pulmonary function after ARDS (4)

A
  1. Low static respiratory compliance
  2. High levels of required PEEP
  3. Longer duration of mechanical ventilation
  4. High lung injury scores
44
Q

Early neuromuscular blockade with ___ for 48H in patients with severe ARDS had increased survival and ventilator free days without increasing ICU-acquired paresis

A

Cisatracurium besylate

45
Q

Phase of ARDS: pulmonary vascular injury

A

Exudative Phase

46
Q

Central feature of ARDS

A

Increased pulmonary vascular permeability leading to interstitial and alveolar edema fluid rich protein

47
Q
A

PSBIM Harrison 21st Edition (15 decks)

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