ARDS

Question 1

5 criteria for ARDS

Answer 1

1. risk factor, 2. severe hypoxemia despite supplemental O2, 3. bilateral pulm infiltrates, 4. reduced lung compliance, 5. absence of CHF

Question 2

examples of direct lung injury that could cause ARDS

Answer 2

pneumonia, aspiration, pulm contusion, fat emboli, near drowning

Question 3

examples of indirect lung injury that could cause ARDS

Answer 3

SEPSIS, multiple trauma, other shock, acute pancreatitis, multiple transfusions, drug tox

Question 4

what is SIRS?

Answer 4

systemic inflammatory response causing 4 things: fever, tachypnea, tachycardia, leukocytosis

Question 5

what is sepsis?

Answer 5

infection + at least 2 SIRS criteria (inflammation occuring in tissues remote from infection)

Question 6

what is severe sepsis?

Answer 6

sepsis + organ dysfunction

Question 7

what are the criteria for septic shock?

Answer 7

sepsis + hypotension

Question 8

what is MODS?

Answer 8

multiple organ dysfnc syndrome - altered organ dysfnc in an acutely ill patient; homeostasis cannot be maintained without intervention

Question 9

sepsis and severe sepsis are a result of disturbed?

Answer 9

homeostasis

Question 10

body systems commonly presenting with symptoms in a patient with sepsis and organ failure (severe sepsis)

Answer 10

CNS, respiratory system, liver, heart, kindey, hematological

Question 11

what happens when a patient progresses to septic shock?

Answer 11

pathogens/cytokines –> NO release –> low SVR –> high cardiac output hypotension

Question 12

sx of septic shock

Answer 12

wide pulse pressure, brisk cap refill, decreased urine output, decreased mental status, lactic acidosis

Question 13

what three mechanisms prevent alveolar edema?

Answer 13

1. retained intravascular protein (oncotic gradient), 2. interstitial lymphatics, 3. tight jnc prevent leakage

Question 14

what goes wrong in sepsis/acute respiratory distress syndrome?

Answer 14

pro-inflammatory cytokines –> neutrophils –> proteases that damage endo- and epithelium –> proteins escape, loss of oncotic gradient, fluid loss, filling of airspaces, atelactasis, shunt, deadspace, decreased compliance, and increased work of breathing

Question 15

what are the three pathologic stages of ARDS

Answer 15

1. exudative phase - high permeability pulm edema & hyaline membranes, 2. 7-10 days later = proliferative stage –> prolif of type II, deposition of collagen, 3. fibrotic stage, disordered healing

Question 16

management of ARDS

Answer 16

1. underlying process, 2. support patient (ventilation), 3. don’t kill the patient with 1 or 2

Question 17

when should ABX be given?

Answer 17

EARLY

Question 18

how can you kill someone with supportive care?

Answer 18

give them oxygen –> overdistension of aerated lung –> BAD

Question 19

how do you prevent overdistension during oxygen therapy?

Answer 19

induced mild hypoxemia through lower tidal volumes

Question 20

most ARDS deaths are due to?

Answer 20

underlying etiology or multi-organ failure (NOT hypoxemia)

Question 21

severity of ARDS is based on? (predictively)

Answer 21

PaO2:FiO2 ratio (mild = 200-300; moderate = 100-200; severe = less than 100)

Question 22

other predictors of poor outcomes include?

Answer 22

age, etiology

Question 23

what are some of the long-term consequences of ARDS?

Answer 23

decreased exercise endurance, impaired lung fnc, neurocog impairments, depression, pervasive memories of critical care

Question 24

what is ICU acquired weakness?

Answer 24

critical illness poluneuropathy and myopathy

Question 25

how to prevent ICU acquired weakness

Answer 25

immediate physical rehabilitation