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Pulmonary Medicine > ARDS > Flashcards

ARDS Flashcards

1
Q

ARDS

A

Acute Respiratory Distress Syndrome

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2
Q

The presence of acute, severe arterial hypoxemia and bilateral pulmonary infiltrates not attributable exclusively to cardiogenic or hydrostatic causes.

A

Acute Respiratory Distress Syndrome

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3
Q

_______ causes diffuse inflammation process affecting both lungs and arises secondary to another condition.

A

ARDS

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4
Q

What can cause ARDS to occur?

A

Injury or infection that has allowed fluid to leak into the interstitium and alveoli.

  1. Sepsis. The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream.
  2. Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS, as can inhaling (aspirating) vomit.
  3. Severe pneumonia. Severe cases of pneumonia usually affect all five lobes of the lungs.
  4. Head or chest injury. Accidents, such as falls or car crashes, can directly damage the lungs or the portion of the brain that controls breathing.
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5
Q

An excess of fluid can cause:

A
  1. Impaired gas exchange
  2. Pulmonary HTN
  3. Decreased Lung Compliance
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6
Q

What is released in response to lung damage?

A

Proinflammatory cytokines

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7
Q

What do proinflammatory cytokines do?

A

Recruit neutrophils

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8
Q

The recruitment of neutrophils and proinflammatory cytokines cause

A

Pulmonary edema to occur

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9
Q

When there is a loss of functional surfactant, what can happen?

A

Alveolar collapse

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10
Q

Where there is an intrapulmonary shunting of blood….

A

There is NO ventilation and therefore severe hypoxemia will occur.

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11
Q

Would 100% O2 help improve health when there is an intrapulmonary shunt?

A

No

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12
Q

Where there is an impairment of blood flow to the lung, what will happen?

A

An increase in Alveolar Dead Space due to a lack of healthy vasculature

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13
Q

A decrease in pulmonary compliance would lead to

A

A decreased inspiratory capacity.

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14
Q

Signs and Symptoms of ARDS

A
  1. Progressive Hypoxemia (PaO2/FiO2 < 200)
  2. Dyspnea
  3. Tachypnea
  4. Tachycardia
  5. Cyanosis
  6. Rapid Onset 6-48 hours

** Remember in ARDS, no benefit to giving O2

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15
Q

What tests would you do for suspected ARDS?

A
  1. CXR
  2. ABG
  3. Pulmonary Artery Catheter
  4. Bronchoscopy
  5. CT Scan
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16
Q

What are you looking for on a CXR for ARDS?

A

Bilateral diffuse “fluffy” lung infiltrates

17
Q

What are you looking for on an ABG for ARDS?

A

Despite hypoxemia, the ventilation rate remains normal or even increased (bigger respiratory effort from the patient) This actually results in decreased CO2. This effect does not typically last, as patients cannot maintain the increased effort which ultimately results in an increased CO2 (respiratory acidosis)__________________________________________

  1. Hypoxemia: PaCO2 < 60
  2. Respiratory Alkalosis initially (PaCO2 < 40), followed by acidosis (later on)
18
Q

What are you looking for in a Pulmonary capillary wedge?

A

PCWP < 18 mm Hg would indicated ARDS

19
Q

What are you looking for in a Bronchoscopy?

A
  1. Fluid collection

2. Looking for BAL results!!

20
Q

What are the BAL results going to show in a bronchoscopy?

A
  1. Neutrophils = ARDS
  2. Eosinophils = Eosinphilic pneumonia
  3. Lymphocytes = Hypersensitivity pneumonia or COP
21
Q

Which is the most useful test in distinguishing ARDS from cardiogenic pulmonary edema/CHF?

A

Pulmonary Capillary Wedge Pressure (PCWP)

22
Q

DDx for ARDS

A
  1. CHF
  2. Acute Presenting ILD
  3. Pulmonary Vasculitis
  4. Acute Hypersensitivity Pneumonia
  5. Acute Eosinophilic Pneumonia
  6. AOP
23
Q

How do you manage/treat a patient that is presenting with Respiratory Distress?

A
  1. Treat the underlying cause!
  2. Get O2 sats > 90%
  3. Ventilation may be needed to protect the lungs (PEEP). Try to get TV to 6 mL/kg
  4. Fluid Management
  5. Supportive Measure
  6. Alternative Recruitment Management
24
Q

What will open collapsed alveoli that could cause decreased atelectasis and improve O2 in the body?

A

PEEP (Positive End-Expiratory Pressure)

25
Q

Goal of Fluid Management?

A
  1. Avoid fluid overload!
  2. Sepsis patient needs fluid so it needs to be monitored
  3. Fluid can affect BP, so vasopressor would be needed to remain consistent.
26
Q

What are supportive methods for respiratory distress?

A
  1. Infection Control (protects against new infections)
  2. Nutritional Needs
  3. DVT, Stress ulcer prophylaxis
27
Q

What would consist of Alternative Recruitment Management?

A 
CPAP
Prone Positioning (to expand dorsal lung O2)
28
Q

Epidemiology and Risk Factors of Hyaline Membrane Disease?

A

Most common cause of respiratory distress!

50% 26-28 week gestation
5% 35-36 week gestation

29
Q

Pathophysiologic Features of ARDS:

A
  1. Shuntin and V/Q Mismatching
  2. Secondary alterations in function of surfactant
  3. Increased pulmonary vascular resistance
  4. Decreased Pulmonary Compliance
  5. Decreased FRC
30
Q

What are hyaline membranes?

A

Membranes believed to represent the protein-rich edema fluid that has filled the alveoli in ARDs

Composed of:

  • Fibrin
  • Cellular Debris
  • Plasma Proteins
31
Q

Presence of Hyaline Membrane indicates:

A

Alveolar Injury OR Permeability Issues causing edema

As opposed to Hydrostatic Pressures

32
Q

If you were to stain Hyaline Membrane, it will look like?

A

Hyaline Cartilage

33
Q

What happens to the epithelium under the hyaline membrane?

A

It dies
(x.x) #RIP

whaaant whaant whaaaa

que TAPS…“day is done, gone the sun…”

34
Q

Signs and Symptoms of Hyaline Membrane Disease

A
  1. Tachypnea
  2. Cyanosis
  3. Expiratory Grunting
  4. Poor air movement with increased work of breathing
35
Q

Diagnosis for Hyaline Membrane Disease would be made on

A

CXR

36
Q

What do you look for on a CXR for a patient with suspected Hyaline Membrane Disease?

A
  1. Hypoexpansion and air bronchogasms

2. Diffuse Bilateral atelectasis

37
Q

What is the preferred treatment for Hyaline Membrane Disease

A
  1. O2
  2. Nasal CPAP
  3. Intubation for surfactant administration and ventilation (TV 6 ml/kg)
  4. Surfactant Therapy
38
Q

What benefit does Surfactant Therapy have?

A
  1. Decreased Mortality Rate

2. Can be used as prophylaxis in pre-term babies

39
Q

why don’t you always see an increase in O2 sat, even after you administer 100% O2 in ARDS patients?

A

shunting

Pulmonary Medicine (14 decks)

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