ARDS Flashcards
mild ARDS PF ratio?
200-300
moderate ARDS PF ratio?
100-200
stage 1 ARDS pathophysiology?
exudative stage with the reelease opf cytokines, protein leakage leading to hyaline membrane development
Stage II ARDS pathophysiology?
proliferative phase in which fibrosis developed around day 21 and leads to the proliferation of type II cells
Stage III ARDS pathophysiolgy?
extensive fibrosis with loss of architechture mimicing emphysema
extrapulmonary ARDS signs?
GGO, PEEP responsive
pulmonary ARDS signs?
basilar opacities, less PEEP responsive
highest surgical risk factor for ARDS?
aortic surgery
studies on high versus low PEEP?
no difference but for very severe ARDS high PEEP strategy could have a mortality benefit
DLCO in ARDS?
decreased due to thickening of the alveolar membrance
equation for compliance?
change in volume / change in pressure
physiology of prone positioning benefit?
redistribution of perfusion, dec VQ mismatch, perfusion better in dorsal regions
when to stop proning?
PF>150, PEEP<10, Fio2<60% all these for 4 hours
conservative fluid strategies led to what benefits in studies?
no mortality benefit but increase in VFD and increase in ICU free dasy
cisatracurium mechanism?
non depoarlizing, and eliminated via hoffman degradation(ph and temp)
benefit of cisatracurium over other paralytics?
less ICU paresis
risk factors for ICU aquired paresis?
female, steroids, days with organ failure, duration of MV
equation for transpulmonary pressure
alveolar pressure- pleural pressure
transpulmonary pressure is equivalent to what parameter?
lung stress
long term pulmonary consequence of ARDS?
ILD
how does ILD develop in patients recovering from ARDS?
type 2 pneumocytes and fibroblasts leading to development of fibrosis
dead space in ARDS?
increased
elastance and compliance in ARDS?
elastance increased, compliance decreased
what disease can be a protective factor in ARDS?
diabetes
inc reisk of developing ARDS?
BMI>30, acidosis, alcohol, smoking, recent chemo, air pollution
static complicance?
change in volume/ change in pressure
what level of ARDS should get high PEEP strategy?
moderate to severe PF <200
goal transpulmonary pressure in ARDS?
<25
TPP=plateau- pleural pressure
transpulmonary pressure is a surrogate for what?
lung stress
lung strain is
TV/FRC
benefits of prone positioning?
redistributes perfusion
improves homogeneity
reduces ventral to dorsal transpulmonary difference
Proseva trial
improved mortality with prone positioning
PEEP effect on RV afterload and PVR?
increase both
