Acute Respiratory Distress Syndrome

Question 1

ARDS is respiratory failure a/w

Answer 1

• severe hypoxia

- low respiratory compliance

Question 2

characteristic radiological changes

Answer 2

widespread pulmonary infiltrates

Question 3

pulmonary artery occlusion pressure (PAOP)

Answer 3

low or normal

Question 4

2 MCC of ARDS

Answer 4

1. sepsis

2. trauma

Question 5

other causes of ARDS

Answer 5

• hemorrhage w/ hypotension
• transfusion
• obstetric emergencies
• cardiopulmonary bypass
• pancreatitis
• disseminated intravascular coagulation (DIC)
• fat embolus
• post cardiac arrest
• head injury
• aspiration
• smoke inhalation

Question 6

onset of ARDS

Answer 6

rapid, usually < 24 hours of initial insult

Question 7

clinical presentation of ARDS

Answer 7

• tachypnea
• dyspnea
• cyanosis

Question 8

diagnosis of ARDS

Answer 8

• hypoxia
• low lung compliance
• widespread infiltrates on cxr
• known insult
  normal left atrial pressure (indirect measurement by PAOP)
• PaO2/FiO2 27 kPa or 200 mmHg

Question 9

ventilation for ARDS

Answer 9

• PEEP 5-18 cm H2O
• increase inspiratory times (increases intrinsic PEEP)
• small TV, < 7 ml/kg
• reduced FiO2, < 50% asap; acceptable hypoxemia (SaO2 > 88%)
• permissive hypercapnia
• +/- prone position

Question 10

specific treatment for ARDS

Answer 10

• prostaglandin inhibitors
• anti-tumor necrosis factor Abs
• surfactant therapy
• oxypentifylline