Acute Respiratory Distress Syndrome

Question 1

What P:F ratio describes mild oxygenation?

Answer 1

PaO2/FiO2 is less than or equal to 300 but greater than 200

Question 2

What P:F describes moderate oxygenation?

Answer 2

PaO2/FiO2 less than or equal to 200 but greater than 100

Question 3

What P:F ratio describes severe oxygenation?

Answer 3

PaO2/FiO2 less than or equal to 100

Question 4

What are goals of ARDS therapy?

Answer 4

1. treat underlying causes
2. avoid iatrogenic complications (pressure ulcer, DVT, HA-inf)
3. maintain adequate oxygenation

Question 5

What are non-pharm therapies for ARDS?

Answer 5

1. low tidal volume
2. prone positioning >12h/day for severe ARDS
3. decrease fluids, lessen pulmonary edema
4. ECMO

Question 6

What patients are recommended for ECMO?

Answer 6

severe ARDS
1. P:F <80
2. pH <7.25
3. PaCO2 60 or more

Question 7

What agents are recommended to decrease ventilator dyssynchrony and improve oxygenation?

Answer 7

neuromuscular blocking agents (paralytics)

Question 8

What should patients receiving NMBAs also recieve?

Answer 8

1. mechanical and pharm VTE prophylaxis
2. lubricating eye drops or gel to prevent corneal abrasions
3. deep sedation with no vacation
4. pain control

Question 9

Which NMBAs are more likely to cause ICU-acquired weakness and greater length of stay?

Answer 9

aminosteroid

Question 10

What are the aminosteroid NMBAs?

Answer 10

Vecuronium
Rocuronium

Question 11

What are the benzylisoquinolium NMBAs?

Answer 11

1. Atracurium
2. Cisatracurium NIMBEX

Question 12

NMBA dosing is based on what weight?

Answer 12

IBW

Question 13

What is infusion dosing of Vecuronium?

Answer 13

0.08-0.1mg/kg bolus
then 0.8-1.7mcg/kg/min

Question 14

What is the duration of Vecuronium?

Answer 14

20-45 min

Question 15

What is infusion dosing of Rocuronium?

Answer 15

0.6-1mg.kg bolus
then 8-12 mcg/kg/min

Question 16

What is the duration of Rocuronium?

Answer 16

20-35 min

Question 17

What is the infusion dosing of Atracurium?

Answer 17

0.4-0.5 mg/kg bolus
then 4-20mcg/kg/min

Question 18

What is the duration of Atracurium?

Answer 18

20-35min

Question 19

What is the infusion dosing of Cisatracurium NIMBEX?

Answer 19

0.1-0.2 mg.kg bolus
then 1-3 mcg/kg/min

Question 20

What is the duration of NIMBEX?

Answer 20

30-60 min

Question 21

Which NMBA have renal/hepatic metabolites?

Answer 21

Vecuronium

Question 22

What are SEs with Vecuronium?

Answer 22

1. bradycardia
2. prolonged paralysis due to active metabolites

Question 23

What are SEs with Rocuronium?

Answer 23

tachycardia

Question 24

What are SEs with Atracurium?

Answer 24

1. seizures
2. hypotension
3. tachycardia
4. bradycardia

Question 25

What are SEs with Cisatracurium?

Answer 25

1. bronchospasm
2. bradycardia

Question 26

How is the optimal depth of paralysis assessed?

Answer 26

1. 2/4 twitches: 80% blocked
2. started at low rate and titrated up slowly until they arent clinically challenging the ventilator

Question 27

What patients are NMBAs limited to?

Answer 27

1. early severe ARDS already deeply sedated
2. failing light sedation, not responding to vent or sedation, and vent dyssynchrony
3. less than 48h