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Critically Ill Exam 2 > ARDS > Flashcards

ARDS Flashcards

1
Q

What is ARDS caused by?

A

Loss of epithelial integrity of alveoli

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2
Q

For mild ARDS what is the P:F ratio?

A

200-300 mmHg

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3
Q

For moderate ARDS what is the P:F ratio?

A

100-200 mmHg

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4
Q

For severe ARDS what is the P:F ratio?

A

</= 100 mmHg

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5
Q

What are 4 problems that you want to avoid causing during ARDS therapy?

A
  1. Pressure ulcers
  2. Hypoglycemia
  3. HAP
  4. DVT
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6
Q

What is strongly recommended for all patients with ARDS?

A

Low tidal volume

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7
Q

Special beds that suspend patients and rotated them in the air

A

Rotoprone

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8
Q

When is prone positioning recommended?

A

For >12 hours/day in all patients with severe ARDS

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9
Q

Why do patients with ARDS need prone positioning?

A

To mobilize fluid and send blood flow to different lung regions

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10
Q

What type of fluid management is used to reduce ventilator days and optimize other outcomes?

A

Conservative

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11
Q

When is venovenous ECMO recommended for ARDS patients?

A
  1. P:F <80
    OR
  2. pH < 7.25
    AND
  3. PaCO2 >/=60
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12
Q

What drug class can be used to reduce inflammatory mediators in ARDS?

A

Corticosteroids

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13
Q

What are NMBAs used for?

A

To reduce ventilator dyssynchrony/ preventing patients from fighting the ventilator

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14
Q

What should be given first before giving an NMBA?

A

Sedation and pain medication

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15
Q

What do NMBAs have an interaction with? What is the interaction?

A

Corticosteroids; myopathies and persistent neuromuscular weakness

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16
Q

If you use NMBAs and corticosteroids together, how long should they be used for?

A

< 48 hours

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17
Q

What should NMBAs always be combined with?

A

Deep sedation and no sedation vacations as well as pain control

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18
Q

What supportive care methods should patients receiving NMBAs also receive? 2

A
  1. Mechanical and pharmacological VTE prophylaxis
  2. Lubricating eye drops or gel
19
Q

What type of NMBAs are more likely to cause ICU- acquired weakness, greater LOS and mechanical ventilation duration?

A

Aminosteroid

20
Q

What are the 2 aminosteroid NMBAs?

A
  1. Vercuronium
  2. Rocuronium
21
Q

What is the intermittent dose for vecuronium?

A

0.1-0.2 mg/kg

22
Q

What is the bolus dose for vecuronium?

A

0.08-0.1 mg/kg

23
Q

What is the duration for vecuronium?

A

20-45 minutes

24
Q

What NMBA is commonly associated with prolonged paralysis after discontinuing?

A

Vecuronium

25
Q

What is the duration for rocuronium?

A

20-35 minutes

26
Q

What is the intermittent dose with rocuronium?

A

50 mg IV followed by 25 mg IV

27
Q

What is the bolus dose for rocuronium?

A

0.6-1 mg/kg then infuse 8-12 mcg/kg/min

28
Q

What are the 2 benzylisoquinolinium NMBA?

A
  1. Atracurium
  2. Cisatracurium
29
Q

What is the duration of atracurium?

A

20-35 minutes

30
Q

What is the bolus dose for atracurium?

A

0.4-0.5 mg/kg then infuse 4-20 mcg/kg/min

31
Q

What is the duration of cisatracurium?

A

30-60 minutes

32
Q

What is the bolus dose for cisatracurium?

A

0.1-0.2 mg/kg then 1-3 mcg/kg/min

33
Q

What NMBA has active metabolites that are excreted renally?

A

Vecuronium

34
Q

What NMBA has no active metabolites or prolonged paralysis?

A

Rocuronium

35
Q

What are the 4 ADRs of atracurium?

A
  1. Seizures
  2. Hypotension
  3. Tachycardia
  4. Bradycardia
36
Q

What is the main ADR of vecuronium?

A

Tachycardia

37
Q

What is the main ADR of rocuronium?

A

Bradycardia

38
Q

How are the aminosteroid NMBAs metabolized?

A

Hepatically

39
Q

What is used to monitor the and correctly titration infused NMBAs?

A

Peripheral nerve stimulation

40
Q

What should NMBAs be limited to? 3

A
  1. Patients with early severe ARDS who are already receiving deep sedation
  2. Patients who are failing light sedation with evidence of ventilator dyssynchrony
  3. Duration should be limited to 48 hours when treating ARDS
41
Q

When should NMBAs be used according to the 2024 ARDS guidelines?

A

Patients with early (<48H) severe ARDS P:F </= 100

42
Q

What are prostacyclins traditionally used for?

A

Pulmonary hypertension

43
Q

What inhaled prostacyclin is used in ICU patients?

A

Epoprostenol

Critically Ill Exam 2 (7 decks)

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