ARDS Flashcards
ARDS Patho
Overall occurrence is?
Diffuse alveolar damage & lung capillary endothelial injury
ARDS Patho
(early phase) is? includes:
Increased?
Influx of?
Exudative
permeability of alveolar-capillary barrier
protein-rich fluid into alveoli
ARDS Patho
Exudative (early phase) includes
injury to?
alveolar epithelial cells promoting pulmonary edema formation, decreased clearance from alveoli, & may decrease surfactant production causing decreased compliance and alveolar collapse
ARDS Patho
Exudative (early phase) includes
what sells are sequestered/activated?
Leads to an imbalance between?
neutrophils, cytokines & platelets
pro-inflammatory & anti-inflammatory cytokines after inciting event
ARDS Patho
Later phase is?
fibroproliferative
Barotrauma is an increase in?
intra-alveolar pressure which can lead to over-distention from delivered tidal volume & rupture (PTX)
Volutrauma is?
over distension d/t excessive volume creates disruption in alveolar basement membrane leading to increased capillary permeability and alveolar edema
Volutrauma:
damaged alveoli may experience injury r/t?
shear forces exerted by collapse @ end-expiration & re-expansion by + pressure @ next inspiration
Trauma promotes secretion of?
pro-inflammatory cytokines worsening inflammation & pulmonary edema
Risk factors for ARDS include
Sepsis
Aspiration
Bacteremia
Trauma
Fractures (multiple & long bone)
Near drowning
Massive transfusion
Pneumonia
Pancreatitis
Presentation of ARDS
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
Differential Dx of ARDS includes
pulmonary hemorrhage
drug/transfusion reaction
non-cardiogenic pulmonary edema
TRALI
Pneumonia/pneumonitis
Shock
Diagnosis of ARDS is?
Clinical diagnosis
Acute onset (w/n 7 days of defined event)
BL opacities on CXR or CT
No need to exclude HF
ARDS severity
Mild P/F ratio is? Mortality?
Moderate P/F ratio is? Mortality?
Severe P/F ratio is? Mortality?
200-300; 27%
100-200; 32%
<100; 45%
ARDS Management
Primary goal?
treat underlying cause
ARDS Management
Lung Protective Strategies include?
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)
ARDS Management
Lung Protective Strategies allow for?
permissive hypercapnia
Caution for increased end-inspiratory volume (volutrauma), decreased preload, increased RV afterload
ARDS Management
Proning
provides what?
is done for how long/day?
Is used in what classification of ARDS
mortality benefit
> 12 hrs/day
mod - severe ARDS
ARDS Management
ECMO is considered for?
P/F ratio < 80 mmHg
High plateau pressures despite other strategies
ARDS Management
IVF?
how do we feed them?
DVT propylaxis? yes no?
conservative fluids
enteral nutrition
yes
Early Management of ARDS
Confirmed ARDS
VT about 6ml/kg of PBW
Plateau pressue < 30 cmH2O
PEEP > 5 cmH2O
Check for hypercapnia
Early Management of ARDS
P/F ratio < 200
High level of PEEP if improves oxygenation
Early Management of ARDS
P/F ratio < 150
NMB
Proning
Early Management of ARDS
P/F ratio < 80
discuss VV-ECMO
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 @?
~30-40%; age
poor prognostic factor
prolonged
HAIs
Weight
months
persistent abnormalities in pulm. function; may have significant impairment for years
6mo
