ARDS (3) Flashcards

1
Q

What are the main benefits of ECMO?

A
  • Promote recovery
  • Prevention of VILI
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2
Q

What is the characteristic of VILI?

A
  • Volutrauma
  • Barotrauma
  • Atelectrauma
  • Biotrauma
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3
Q

What is the ideal driving pressures?

A

< 15 cmH2O

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4
Q

What is driving pressure?

A

This is tidal distending force applied to the alveoli

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5
Q

Veno-venous ECMO is recommended for ?

A

Severe hypoxaemia and hypercapnia in patients with ARDS

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6
Q

What are the common VV-ECMO configurations?

A
  • Femoral (drainage) - Internal Jugular (return)
  • Bicaval dual lumenn cannula (Superior & Inferior vena cava drainage with RA return)
  • Femoral (drainage) - Contralateral femoral (return)
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7
Q

What are the common modes of ECMO in the presence of cardiogenic shock?

A
  • Veno-pulmonary arterial
  • Veno-arterial
  • Veno-veno-arterial
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8
Q

The highly oxygenated blood delivered from the ECLS circuit does what to HPV

A

It reverses hypoxic pulmonary vasoconstriction.

Increases ventilation to poorly ventilated lung units

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9
Q

Initial sweep gas flow setting on ECMO?

A

A low sweep gas flow is used to prevent rapid correction of pH and CO2

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10
Q

What is the main complication of high sweep gas flow in ECMO?

A

Ischaemic complication of cerebral vasoconstriction

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11
Q

What is the main pathophysiological characteristic of obstructive lung disease exacerbation ?

A
  • Expiratory flow limitation
  • Increased small airway resistance
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12
Q

What is the main causes of increased work of breathing in patients with exacerbation of obstructive lung disease?

A
  • Dynamic alveolar hyperinflation
  • Intrinsic PEEP
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13
Q

What are the relative contraindications to ECMO?

A
  • Septic shock
  • MOF
  • Severe arterial occlusive disease
  • Heparin induced thrombocytopenia
  • Long duration of ventilation
  • Advanced age
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14
Q

ECMO configuration?

A
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15
Q

What is the delivery rate of VA-ECMO?

A

2-6L of oxygenated blood

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16
Q

What is the indication for VA-ECMO?

A

Cardiogenic shock

17
Q

What is ARDS?

A

It is an acute inflammatory lung pathology and it is not a disease as it is always precipitated by an underlying cause.

18
Q

ARDS can be classified into ?

A
  • Pulmonary
  • Extrapulmonary
19
Q

What is the mechanism of pulmonary ARDS?

A
  • Direct insult to the lung
  • Damage to alveolar epithelium
20
Q

What is the mechanism of extrapulmonary ARDS?

A
  • Indirect insult to the lung
  • Inflammatory mediators responsible
  • Inflammatory mediators act upon vascular endo
21
Q

What are the causes of pulmonary ARDS?

A
  • Pneumonia (60%)
  • Aspiration
  • Inhalation injury
  • Pulmonary contusion
  • Pulmonary vasculitis
  • Near drowning
22
Q

What are the causes of extra-pulmonary ARDS?

A
  • Non-pulmonary sepsis
  • Non-cardiogenic shock
  • Pancreatitis
  • Trauma
  • Blood transfusion
  • Severe burns
  • Drug OD
23
Q

Characteristics of ARDS?

A
  • Respiratory symptoms within 7 days of insult
  • Disease progression after several weeks
  • Fibrosis, pneumonia & granulomatosis