ARDS

Question 1

Diagnostic criteria for Acute Respiratory Distress Syndrome. (Harrison’s 19th edition, pp 1736)

Answer 1

PaO2/FiO2 (PF ratio) < or = 300mmHg
Acute onset
Bilateral alveolar or interstitial infiltrates
PCWP < or = 18 mmHg or no clinical evidence of increased left atrial pressure

Question 2

Mild ARDS. (Harrison’s 19th edition, pp 1736)

Answer 2

PF ratio 201-300mmHg

Question 3

Moderate ARDS. (Harrison’s 19th edition, pp 1736)

Answer 3

PF ratio 101-200mmHg

Question 4

Severe ARDS. (Harrison’s 19th edition, pp 1736)

Answer 4

PF ratio < or = 100mmHg

Question 5

Direct lung injury causes of ARDS. (Harrison’s 19th edition, pp 1736)

Answer 5

Pneumonia
Aspiration of gastric contents
Pulmonary contusion
Near-drowning
Toxic inhalation injury

Question 6

Indirect lung injury causes of ARDS. (Harrison’s 19th edition, pp 1736)

Answer 6

Sepsis
Severe trauma (multiple bone fractures, flail chests, head trauma and burns)
Multiple transfusion
Drug overdose
Pancreatitis
Post cardiopulmonary bypass
(Shirley “Superb Practitioner” Panganiban, MD)

Question 7

Phases of ARDS. (Harrison’s 19th edition, pp 1736-1738)

Answer 7

Exudative
Proliferative
Fibrotic

Question 8

Recommended tidal volume for patients with ARDS who are on Mechanical ventilation. (Harrison’s 19th edition, pp 1738)

Answer 8

Low tidal volume (6mL/kg of predicted body weight)

Question 9

Level A recommendations for ARDS therapy. (Harrison’s 19th edition, pp 1739)

Answer 9

Low tidal volume

Early neuromuscular blockade

Question 10

Most important risk factor for ARDS mortality. (Harrison’s 19th edition, pp 1739)

Answer 10

Advanced age ( > 75 yo)

Question 11

ARDS is a clinical syndrome of the following. (Harrison’s 19th edition, pp 1736)

Answer 11

Severe dyspnea
Hypoxemia
Diffuse pulmonary infiltrates leading to respiratory failure

Question 12

Goals and limitations in the initial management if ARDS. (Harrison’s 19th edition, pp 1738)

Answer 12

Tidal volume < 6 ml/kg of ideal body weight
Plateaue pressure < or = 30
RR < or = 35
FIO2 < or = 0.6
PEEP < 10 cmH2O
SPO2 88-95%
pH >/= 7.3
Diurese to maintain MAP >/= 65mmHg
Avoid hypoperfusion

Question 13

Phase of ARDS characterized by organization of alveolar exudates, shift from neutrophil to lymphocyte- predominant pulmonary infiltrate, and initiation of lung repair? (Harrison’s 19th edition, pp 1738)

Answer 13

Proliferative phase

Question 14

Differential diagnosis of ARDS. (Harrison’s 19th edition, pp 1737)

Answer 14

Cardiogenic pulmonary edema
Diffuse pneumonia
Alveolar hemorrhage

Question 15

Phase of ARDS characterized by sloughing of both the bronchial and alveolar epithelial cells, with the formation of protein-rich hyaline membranes on the denuded basement membrane. (Harrison’s 19th edition, pp 1737)

Answer 15

Exudative phase

Question 16

Phase of ARDS characterized by conversion of alveolar edema and inflammatory exudates to extensive alveolar-duct and interstitial fibrosis. (Harrison’s 19th edition, pp 1738)

Answer 16

Fibrotic phase

Question 17

Associated with increased mortality risk in ARDS. (Harrison’s 19th edition, pp 1738)

Answer 17

Lung biopsy evidence for pulmonary fibrosis

Question 18

Condensed plasma proteins aggregate in the air spaces with cellular debris and dysfunctional pulmonary surfactant seen in exudative phase. (Harrison’s 19th edition, pp 1736)

Answer 18

Hyaline membrane whorls

Question 19

Two processes required for ventilator-induced lung injury. (Harrison’s 19th edition, pp 1738)

Answer 19

Repeated alveolar overdistention

Recurrent alveolar collapse

Question 20

Optimal PEEP. (Harrison’s 19th edition, pp 1738)

Answer 20

12-15mmHg

Question 21

Predicts increased mortality risk from ARDS. (Harrison’s 19th edition, pp 1740)

Answer 21

Elevation of pulmonary dead space > 0.60

Severe arterial hypoxemia PF ratio < 100mHg

Question 22

Initial oxygenation goals and limits in ARDS. (Harrison’s 19th edition, pp 1739)

Answer 22

FiO2 < or = 0.6
PEEP < or = 10cmH2O
SpO2 88-95%

Question 23

Initial Volume/pressure-limited ventilation goals and limits in ARDS. (Harrison’s 19th edition, pp 1739)

Answer 23

Tidal volume < or = 6 ml/kg PBW
Plateau pressure < or = 30cmH2O
RR < or = 35 bpm

Question 24

The only Class B recommendation of ARDS therapy. (Harrison’s 19th edition, pp 1739)

Answer 24

Minimized left atrial filling pressures

Question 25

Trauma patients with an Acute Physiology and Chronic Health Evaluation (APACHE) II score __ have a 2.5 fold increased risk of developing ARDS. (Harrison’s 19th edition, pp 1736)

Answer 25

> /= 16

Question 26

Trauma patients with an Acute Physiology and Chronic Health Evaluation (APACHE) II score __ have a 3 fold increased risk of developing ARDS. (Harrison’s 19th edition, pp 1736)

Answer 26

> 20

Question 27

Patients usually recover maximal lung function. (Harrison’s 19th edition, pp 1740)

Answer 27

Within 6 months