ARDS

Question 1

Is an acute inflammatory condition resulting in increased lung permeability.

Answer 1

ALI

ALI/ARDS is the same syndrome, but the degree of hypoxemia is worse in ARDS

Question 2

The most common diagnosis associated with ARDS, reported in the National Institutes of Health (NIH) Acute Respiratory Distress Syndrome Network (ARDS NET) study, was?

Answer 2

Pneumonia 2 to ARDS

Question 3

The pathogenesis common to all inciting risk factors is an intense inflammatory pulmonary reaction initially targeted where?

Answer 3

Interstitial and alveolar-capillary membrane

Question 4

What are the stages of ARDS? (3)

Answer 4

1) Exudative (1st week)
2) Proliferative (2nd week)
3) Fibrotic (late ARDS)

Question 5

Clinically lung compliance
remains low because of edema and replacement of fibrin and cell debris with collagen within the intra-alveolar space. There is persistent hypoxemia and increased alveolar dead space hampering CO2 elimination. Pulmonary hypertension progressively worsens as the capillary network is destroyed, and intimal proliferation leads to a reduction of the
luminal cross-sectional area. What ARDS phase is this?

Answer 5

Proliferative

Question 6

This phase is characterized clinically by
symptoms of respiratory distress (dyspnea and tachypnea), refractory hypoxemia, and
patchy bilateral radiographic infiltrates and pathologically by sequestration of
neutrophils.

Answer 6

Exudative

Question 7

Clinically lung compliance is markedly decreased with static compliance values as low as 10 to 20 cm H2O, resulting in increased work of breathing and ventilator dependence. Radiographically the chest x-ray film reveals linear opacities. What phase is this?

Answer 7

Fibrotic

Question 8

As a consequence of the ongoing structural changes occurring within the lung parenchyma, a ventilator-associated lung injury (VALI) may result from maldistribution of tidal volumes (VTs) and high airway pressures creating overdistention of remaing normal, aerated lung regions. This high-volume induced form of lung injury is known as?

Answer 8

Volutrauma

Question 9

Although not completely understood, the formation of this low-volume environment probably occurs as a consequence of the increased shear stress) resulting from repeated opening and closing of occluded bronchioles and alveoli from surfactant deficiency. This low-volume induced region of injury is referred to as?

Answer 9

Atelectrauma

Question 10

Is defined as the application of a prolonged increase in airway pressure,
with the goal being reversal of atelectasis; this is followed by the application of sufficient amounts of PEEP to ensure that the lung stays open.

Answer 10

Lung recruitment

Question 11

Mechanical ventilation settings for patients with ARDS or ALI include? (2)

Answer 11

1) Tidal volume at 6 to 8 ml/kg of ideal body weight

2) Limiting plateau pressures to <30 cm H2O

Question 12

In ALI/ARDS FiO2 should be adjusted to maintain oxygen saturations between?

Answer 12

88% and 92%