ARDS

Question 1

mild ARDS PF ratio?

Answer 1

200-300

Question 2

moderate ARDS PF ratio?

Answer 2

100-200

Question 3

stage 1 ARDS pathophysiology?

Answer 3

exudative stage with the reelease opf cytokines, protein leakage leading to hyaline membrane development

Question 4

Stage II ARDS pathophysiology?

Answer 4

proliferative phase in which fibrosis developed around day 21 and leads to the proliferation of type II cells

Question 5

Stage III ARDS pathophysiolgy?

Answer 5

extensive fibrosis with loss of architechture mimicing emphysema

Question 6

extrapulmonary ARDS signs?

Answer 6

GGO, PEEP responsive

Question 7

pulmonary ARDS signs?

Answer 7

basilar opacities, less PEEP responsive

Question 8

highest surgical risk factor for ARDS?

Answer 8

aortic surgery

Question 9

studies on high versus low PEEP?

Answer 9

no difference but for very severe ARDS high PEEP strategy could have a mortality benefit

Question 10

DLCO in ARDS?

Answer 10

decreased due to thickening of the alveolar membrance

Question 11

equation for compliance?

Answer 11

change in volume / change in pressure

Question 12

physiology of prone positioning benefit?

Answer 12

redistribution of perfusion, dec VQ mismatch, perfusion better in dorsal regions

Question 13

when to stop proning?

Answer 13

PF>150, PEEP<10, Fio2<60% all these for 4 hours

Question 14

conservative fluid strategies led to what benefits in studies?

Answer 14

no mortality benefit but increase in VFD and increase in ICU free dasy

Question 15

cisatracurium mechanism?

Answer 15

non depoarlizing, and eliminated via hoffman degradation(ph and temp)

Question 16

benefit of cisatracurium over other paralytics?

Answer 16

less ICU paresis

Question 17

risk factors for ICU aquired paresis?

Answer 17

female, steroids, days with organ failure, duration of MV

Question 18

equation for transpulmonary pressure

Answer 18

alveolar pressure- pleural pressure

Question 19

transpulmonary pressure is equivalent to what parameter?

Answer 19

lung stress

Question 20

long term pulmonary consequence of ARDS?

Answer 20

ILD

Question 21

how does ILD develop in patients recovering from ARDS?

Answer 21

type 2 pneumocytes and fibroblasts leading to development of fibrosis

Question 22

dead space in ARDS?

Answer 22

increased

Question 23

elastance and compliance in ARDS?

Answer 23

elastance increased, compliance decreased

Question 24

what disease can be a protective factor in ARDS?

Answer 24

diabetes

Question 25

inc reisk of developing ARDS?

Answer 25

BMI>30, acidosis, alcohol, smoking, recent chemo, air pollution

Question 26

static complicance?

Answer 26

change in volume/ change in pressure

Question 27

what level of ARDS should get high PEEP strategy?

Answer 27

moderate to severe PF <200

Question 28

goal transpulmonary pressure in ARDS?

Answer 28

<25

TPP=plateau- pleural pressure

Question 29

transpulmonary pressure is a surrogate for what?

Answer 29

lung stress

Question 30

lung strain is

Answer 30

TV/FRC

Question 31

benefits of prone positioning?

Answer 31

redistributes perfusion
improves homogeneity
reduces ventral to dorsal transpulmonary difference

Question 32

Proseva trial

Answer 32

improved mortality with prone positioning

Question 33

PEEP effect on RV afterload and PVR?

Answer 33

increase both