ARDS

Question 1

ARDS Patho
Overall occurrence is?

Answer 1

Diffuse alveolar damage & lung capillary endothelial injury

Question 2

ARDS Patho
(early phase) is? includes:
Increased?
Influx of?

Answer 2

Exudative
permeability of alveolar-capillary barrier
protein-rich fluid into alveoli

Question 3

ARDS Patho
Exudative (early phase) includes
injury to?

Answer 3

alveolar epithelial cells promoting pulmonary edema formation, decreased clearance from alveoli, & may decrease surfactant production causing decreased compliance and alveolar collapse

Question 4

ARDS Patho
Exudative (early phase) includes
what sells are sequestered/activated?
Leads to an imbalance between?

Answer 4

neutrophils, cytokines & platelets
pro-inflammatory & anti-inflammatory cytokines after inciting event

Question 5

ARDS Patho
Later phase is?

Answer 5

fibroproliferative

Question 6

Barotrauma is an increase in?

Answer 6

intra-alveolar pressure which can lead to over-distention from delivered tidal volume & rupture (PTX)

Question 7

Volutrauma is?

Answer 7

over distension d/t excessive volume creates disruption in alveolar basement membrane leading to increased capillary permeability and alveolar edema

Question 8

Volutrauma:
damaged alveoli may experience injury r/t?

Answer 8

shear forces exerted by collapse @ end-expiration & re-expansion by + pressure @ next inspiration

Question 9

Trauma promotes secretion of?

Answer 9

pro-inflammatory cytokines worsening inflammation & pulmonary edema

Question 10

Risk factors for ARDS include

Answer 10

Sepsis
Aspiration
Bacteremia
Trauma
Fractures (multiple & long bone)
Near drowning
Massive transfusion
Pneumonia
Pancreatitis

Question 11

Presentation of ARDS

Answer 11

Acute dyspnea, hypoxemia w/n hours-days of inciting event
Critically ill, often w/ multisystem organ failure
Increased HR, RR
Anxiety
Agitation
Increasing O2 requirements
Bilateral rales (possible)
Manifestations of underlying cause

Question 12

Differential Dx of ARDS includes

Answer 12

pulmonary hemorrhage
drug/transfusion reaction
non-cardiogenic pulmonary edema
TRALI
Pneumonia/pneumonitis
Shock

Question 13

Diagnosis of ARDS is?

Answer 13

Clinical diagnosis
Acute onset (w/n 7 days of defined event)
BL opacities on CXR or CT
No need to exclude HF

Question 14

ARDS severity
Mild P/F ratio is? Mortality?
Moderate P/F ratio is? Mortality?
Severe P/F ratio is? Mortality?

Answer 14

200-300; 27%
100-200; 32%
<100; 45%

Question 15

ARDS Management
Primary goal?

Answer 15

treat underlying cause

Question 16

ARDS Management
Lung Protective Strategies include?

Answer 16

low TV (4-8ml/kg PBW)
Peep (>5 cm H2O) for O2 say 85-90%
Lower FiO2 to minimize O2 toxicity (DAD, hyaline membrane formation, fibrosis)

Question 17

ARDS Management
Lung Protective Strategies allow for?

Answer 17

permissive hypercapnia
Caution for increased end-inspiratory volume (volutrauma), decreased preload, increased RV afterload

Question 18

ARDS Management
Proning
provides what?
is done for how long/day?
Is used in what classification of ARDS

Answer 18

mortality benefit
> 12 hrs/day
mod - severe ARDS

Question 19

ARDS Management
ECMO is considered for?

Answer 19

P/F ratio < 80 mmHg
High plateau pressures despite other strategies

Question 20

ARDS Management
IVF?
how do we feed them?
DVT propylaxis? yes no?

Answer 20

conservative fluids
enteral nutrition
yes

Question 21

Early Management of ARDS
Confirmed ARDS

Answer 21

VT about 6ml/kg of PBW
Plateau pressue < 30 cmH2O
PEEP > 5 cmH2O
Check for hypercapnia

Question 22

Early Management of ARDS
P/F ratio < 200

Answer 22

High level of PEEP if improves oxygenation

Question 23

Early Management of ARDS
P/F ratio < 150

Answer 23

NMB
Proning

Question 24

Early Management of ARDS
P/F ratio < 80

Answer 24

discuss VV-ECMO

Question 25

ARDS Prognosis
Mortality rate is about? & increases w/?
Failure of pulmonary function to improve in 1st week is?
Hospital course is?
Development of what?
The patient will lose?
Muscle weakness/functional impairment lasts for how long?
Disease severity & duration of MV are predictors of?
HRQOL significantly < normal @?

Answer 25

~30-40%; age
poor prognostic factor
prolonged
HAIs
Weight
months
persistent abnormalities in pulm. function; may have significant impairment for years
6mo