ARDS Flashcards
Define ARDS
No single disease entity, but a syndrome
Multiple symptoms and signs that are pathologically related
What is the consequences of ARDS on oxygenation
Refractory Hypoxemia
How is ARDS defined by Berlin
Time of onset
CXR
Respiratory failure not explained by heart failure
Impaired oxygenation
How is heart failure found
Pulmonary capillary wedge pressure less to or equal to 18mmHg
Pulmonic closed and mitral open. Pascals principle says pressure will match LV
Echocardiogram
What is the onset time of ARDS
7 days
What is seen on a CXR of ARDS
Bilateral infiltrates
(Can’t be explained by pleural effusion, lobar or lung collapse, or pulmonary nodules)
Normal P/F
400-500
Mild ARDS P/F
201-300
With PEEP or CPAP
Moderate ARDS P/F
101-200
W/ PEEP
Severe ARDS P/F
Less or equal to 100
W/ PEEP
What happens if Pi decreases
Negative pressure pulmonary edema
What happens when you have frequent deep gasp for air
Self-induced lung injury (SILI)
Negative pressure pulmonary edema
(Pleural effusion)
What causes a decrease in Pi
High altitude
Repeated gasp for air
What causes high altitude pulmonary edema (HAPE)
Exercising at high altitudes before acclimation
Reduced PB decrease interstitial pressure relative to blood pressure
(Deep breaths for air)
What happens if intracapillary oncotic pressure decreases
Low albumin cause release of fluid causing ascites, lower extremity edema, pleural effusion, pulmonary edema
What causes low oncotic pressure in the capillaries
Malnutrition
Liver disease
Kidneys disease
Other than what can be explained by sterlings law, what else can cause non-Cardiogenic edema
Lymphatic insufficiency
Is negative pressure and high altitude pulmonary edema transudate or exudative
Transudate
Increases venous return to RV causing demand to move forward (hydrostatic)
Why is low oncotic pressure due to malnutrition, liver disease, and kidney disease transudate.
Low albumin causes fluid to leak and causes pulmonary edema with low protein
Medical dictionaries definition of sepsis
The presence in the blood or other tissues of pathogenic microorganisms or their toxins
Surviving sepsis campaign definition of sepsis
A life-threatening organ dysfunction caused by dysregulated host response to infection
What does surviving sepsis campaign do
Authoritative guidelines for the identification, assessment, and treatment of of sepsis
Key differences between non and Cardiogenic edema
Non is caused by injury causing increased permeability
Protein rich plasma enters interstitium and leaks into alveoli
The three stages of ARDS
Edema
Hyaline membrane
Interstitial fibrosis
Three phases of ARDS
Exudative
Proliferation
Fibrotic
When is the exudative phase of ARDS
Within 72 hours
When is the proliferation phase of ARDS
4-14 hours
When is the fibrotic phase of ARDS
Within 14-21 days
Is ARDS homogeneous
No. Stress strains can occur with impacted alveoli harming health alveoli
What happens to type 2 cells with ARDS
Proliferate and swell
What happens to the alveoli walls with ARDS
They become fibrotic with hyaline
What occurs during the exudative phase ARDS
Interstitial edema
Acute and chronic inflammation
Type 2 cell hyperplasia
Hyaline membrane formation
What occurs during the proliferation phase of ARDS
Resolution of pulmonary edema
Proliferation of type 2 cells
Squamous metaplasia
What occurs during the fibrotic phase of ARDS
Some patients
Obliteration of normal cell
Fibrosis
Cyst formation
Varying levels of damage
What does the American Thoracic Society recommend for ARDS management
Neuromuscular blockade
VV-ECMO
Systemic Corticosteroids
High PEEP
Prone
Lung Protective Ventilation
What intervention for ARDS is strongly recommended against according to (ATS)
Prolonged recruitment maneuver
High frequency oscillatory ventilation
Describe high-frequency oscillatory ventilation
Delivers sub-Vt at a rate of 60cycles/min
