Acute Respiratory Distress Syndrome

Question 1

ARDS is a a clinical syndrome of the following: (Harrison pp 1736)

Answer 1

Severe dyspnea of rapid onset
Hypoxemia
Diffuse pulmonary infiltrates leading to respiratory failure

Question 2

Direct lung injury with ARDS (Harrison pp 1736)

Answer 2

PANT
P neumonia
P ulmonary Contusion 
A spiration of gastric contents
N ear-drowning 
T oxic- inhalation injury

Question 3

Indirect lung injury (Harrison pp 1736)

Answer 3

SP MD
S epsis
S evere trauma (Multiple bone fractures, Flail chest, Head trauma, Burns)
P ancreatitis 
P ostcardiopulmonary bypass
M ultiple transfusions
D rug Overdose

Question 4

Moderate ARDS (Harrison pp 1736)

Answer 4

PaO2/FiO2 = 100 - 200 mmHg

PCWP ≤ 18 mmHg or No clinical evidence of increased left atrial pressure

Question 5

Three phases of ARDS (Harrison pp 1736)

Answer 5

Exudative phase
Proliferative phase
Fibrotic phase

Question 6

Condensed plasma proteins aggregate in the air spaces with cellular debris and dysfunctional pulmonary surfactant seen in exudative phase (Harrison pp 1736)

Answer 6

Hyaline membrane whorls

Question 7

Present in the 1st 7 days of illness after exposure. Alveolar edema
Microvascular occlusion (Harrison pp 1736)

Answer 7

Exudative phase

Question 8

Most common disorders for differentiating ARDS (Harrison pp 1737)

Answer 8

Cardiopulmonary edema
Pleural effusion
Alveolar hemorrhage

Question 9

1st sign of resolution are often evident at this phase; shift from neutrophil to lymphocytes predominant pulmonary infiltrates (Harrison pp 1737)

Answer 9

Proliferative phase

Question 10

Alveolar edema and inflammatory exudates CONVERTED to extensive alveolar duct and interstitial fibrosis (Harrison pp 1738)

Answer 10

Fibrotic phase

Question 11

Evidence of ______ in any phase of ARDS is associated with increased mortality risk. (Harrison pp 1738)

Answer 11

Pulmonary fibrosis

Question 12

2 process require for ventilator- induced lung injury (Harrison pp 1738)

Answer 12

Repeated alveolar overdistention

Recurrent alveolar collapse

Question 13

What is the theoretical PEEP for alveolar recruitment? (Harrison pp 1738)

Answer 13

12-15 mmHg

Question 14

Class A recommendation of ARDS therapy. (Harrison pp 1739)

Answer 14

↓ Tidal volume

Early neuromuscular blockage

Question 15

Major risk factors for ARDS mortality (Harrison pp 1739)

Answer 15

Non pulmonary

Question 16

Only Class B recommendation of ARDS therapy (Harrison pp 1739)

Answer 16

Minimal lung atrial filling pressure

Question 17

Predicts increased mortality risk from ARDS (Harrison pp 1740)

Answer 17

Elevation of pulmonary dead space (> 0.60)

Severe arterial hypoxemia (PaO2/FiO2 < 100 mmHg)

Question 18

What is the initial goals for ARDS? (Harrison pp 1739)

Answer 18

Tidal volume < 6ml/kg
Plateau pressure ≤ 30
RR ≤ 35 bpm

Question 19

What should be the oxygenation goals for initial management of ARDS? (Harrison pp 1739)

Answer 19

FiO2 ≤ 0.6
PEEP ≤ 10cm H2O
SpO2 88-95%