ARDS

Question 1

Common conditions associated w onset of ARDS

Answer 1

Pneumonia
Pulmonary contusions
Aspiration
Shock
Sepsis
Burns
Pancreatitis

Question 2

Differential dx for ARDS and Cardiogenic pulmonary edema

Answer 2

Acute onset (w/in 1 week)
Bilateral infiltrates/opacities
Pulmonary edema not due to cardiac failure or fluid overload
Refractory hypoxemia (P/F <300 on +5)

Question 3

Assessment

Answer 3

abrupt onset of respiratory symptoms
Respiratory distress
BS: bil diffuse crackles
Severe hypoxemia: tachycardia, central cyanosis, SpO2 <90% on >30%
Absence of cardiac fail/fluid overload

Question 4

Treatment/decision making

Answer 4

Plat <= 30
I:E of 1:2 or 1:3
Titrate PEEP and FiO2: SaO2 88-95%
Reduce Vt to 4-6 ml/kg IBW
Permissive hypercapnia (pH: 7.20)
Sedation/paralytic

Question 5

Mild ARDS p/f

Answer 5

201-300

Question 6

Moderate ARDS p/f

Answer 6

101-200

Question 7

Severe ARDS P/F

Answer 7

<100

Question 8

Rescue therapies

Answer 8

INO
ECMO

Question 9

Exudative stage

Answer 9

Fluid into alveoli (protein + inflammatory cells)

Question 10

Fibroproliferative stage

Answer 10

Fibrosis

Question 11

Resolution and recovery

Answer 11

Reaorganizes and recovers

Question 12

IG

Answer 12

ABG
CT or CXR
plasma BNP
echocardiography (rule out Cardiogenic pulmonary edema)
CVP (rule out over hydration, adjust fluid balance, assess SvO2)