ARDS

Question 1

Acute respiratory distress syndrome (ARDS) is a clinical syndrome leading to respiratory failure. What is the diagnostic criteria:

Answer 1

severe dyspnea of rapid onset =ACUTE
hypoxemia
diffuse pulmonary Infiltrates (bilateral alveolar infiltrates)
Pao2/fio2 <200mmhg
No evidence of increased left atrial pressure

Question 2

ARDS DIRECT LUNG INJURIES

Answer 2

Pneumonia
Aspiration of gastric lavage
Pulmonary contusion 
Near drowning
Toxic inhalation injury

Question 3

Value of MILD ARDS

Answer 3

Pao2/fio2 200-300mmhg

Question 4

Chest radiograph of ARDS

Answer 4

Bilateral opacities consistent With PULMONARY EDEMA

Question 5

Value on severe ARDS

Answer 5

Pao2/fio2 <100mmhg

Question 6

Last diagnostic criteria of ARDS

Answer 6

Absence of left atrial hypertension

Question 7

ARDS severity of Pao2/fio2 100-200 mmHg

Answer 7

moderate ARDS

Question 8

most frequently reported surgical conditions in ARDS are

Answer 8

pulmonary contusion,
multiple bone fractures,
and
chest wall trauma/flail chest,

Question 9

Trauma patients with an Acute Physiology and Chronic Health Evaluation(APACHE) II score ≥ ___ have a 2.5-fold increased risk ofdeveloping ARDS.

Answer 9

≥ 16

Question 10

In this phase, alveolar capillary endothelial cells and type I pneumocytes (alveolar epithelial cells) are injured,with consequent loss of the normally tight alveolar barrier to fluid and macromolecules

Answer 10

Exudative phase

Question 11

Chest X-ray in exudative phase 1

Answer 11

Alveolar and interstitial opacities ≥ 3/4 of the lung fields

Question 12

What phase:

• recruitment of leukocytes (especiallyneutrophils) into the pulmonary interstitium and alveoli
• dysfunctional pulmonary surfactant to form hyaline membrane whorls

Answer 12

Exudative phase

Question 13

in addition to severe hypoxemia, _____ secondary to an increase in pulmonary dead space can beprominent in early ARDS.

Answer 13

hypercapnia

Question 14

This phase of ARDS usually lasts from day7 to day 21. Most patients recover rapidly and are liberated from mechanical ventilation during this phase. Despite this improvement,many patients still experience dyspnea, tachypnea, and hypoxemia

Answer 14

Proliferative phase

Question 15

In proliferative phase, Histologically, the first signs of resolution are often evident in this phase, with the initiation of lung repair, the organization of alveolar exudates, and a shift from neutrophil- to

Answer 15

lymphocyte-predominant pulmonary infiltrates

Question 16

These specialized epithelial cells synthesized new pulmonary surfactant and differentiate into type I pneumocytes.

Answer 16

type II pneumocytes.

Question 17

Histologically, the alveolar edema and inflammatory exudates of earlier phases convert to extensive alveolar-duct and interstitial fibrosis. Marked disruption of acinar architecture leads to emphysema-like changes, with large bullae

Answer 17

Fibrotic phase 3-4 weeks

Question 18

Consequences of fibrotic phase

Answer 18

Increased risk for pneumothorax
Decreased lung compliance
Increase pulmonary dead space

Question 19

Experimental models have demonstrated that ventilator-induced lung injury can arise from at least two principal mechanisms:

Answer 19

1. “volutrauma” from repeated alveolar over distention from excess tidal volume
   and
2. “atelectrauma” from recurrent alveolar collapse

Question 20

Minimizing Ventilator-Induced Lung Injury by using

Answer 20

1. low VT ventilation (6 mL/kg of predicted body weight)
2. plateau pressure ≤30 cm H2O

(measured on the ventilator after a 0.5-s pause after inspiration)

Question 21

What is used to prevent alveolar collapse to minimize atelectrauma by setting to minimize Fio2 (inspired O2 percentage) and provide adequate Pao2 (arterial partial pressure of O2) without causing alveolar overdistention.

Answer 21

positive end-expiratorypressure (PEEP)

Question 22

a recent trial demonstrated a significant reduction in 28-day mortality (32.8 to 16%) for patients with severe ARDS (Pao2/Fio2 <150 mmHg).

Answer 22

prone positioning

Question 23

Not recommended in ARDS therapy (grade D recommendation)

Answer 23

Glucocorticoids
Surfactant replacement therapy
High frequency ventilation
Anti-inflammatory therapy

Question 24

ARDS Grade B recommendation based on supportive but limited studies

Answer 24

Minimized left atrial filling pressures
High-PEEP or “open lung”
Prone position
ECMO (extracorporeal membrane oxygenation)
Early neuromuscular blockade

Question 25

The only class A recommendation with strong clinical evidence for ARDS therapy

Answer 25

LOW TIDAL VOLUME

Question 26

ARDS alternative therapy Class C

Answer 26

Recruitment maneuvers

Inhaled vasodilator

Question 27

Initial management of ARDS

Answer 27

Tidal volume ≤ 6 ml/kg
Plateau pressure ≤ 30 cmH2O
RR ≤ 35 bpm
FIO2 ≤ 0.6
pH ≥ 7.30
SpO2 88 – 95%
MAP ≥ 65 mmHg 
Avoid hypoperfusion