ARDS study guide

Question 1

Distinguishing between hydrostatic and nonhydrostatic pulmonary edema is often difficult, even for skilled clinicians

Answer 1

True

Question 2

The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades

Answer 2

False

Question 3

Which of the following risk factors for ARDS is considered a secondary risk factor?

Answer 3

sepsis

also burn injury, prolonged hypotension/shock, multi-trauma, pancreatitis

Question 4

What are PRIMARY risk factors for ARDS?

Answer 4

pneumonia, gastric aspiration, toxic inhalation, near drowning lung contusion

Question 5

Which of the following factors are associated with a higher risk for ARDS?

Answer 5

gastric aspiration and septic shock

Question 6

According to the Starling’s equation, which forces influence the movement of fluid from the bloodstream to the interstitium?

Answer 6

MICROVASCULAR HYDROSTATIC PRESSURE + INTERSTITIAL OSMOTIC PRESSURE

Question 7

Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathologic conditions?

Answer 7

The lung lymphatic drainage system

Question 8

Which of the following mechanisms ultimately leads to ARDS regardless of the etiology?

Answer 8

NONHYDROSTATIC PULMONARY EDEMA, [also PMN (neutrophils and inflammatory byproducts like neutrophil elastase and myeloperoxidase)]

Question 9

What term describes programmed cell death?

Answer 9

apoptosis

Question 10

Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS?

Answer 10

Neutrophils

Question 11

Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)?

Answer 11

DIFFUSE ALVEOLAR AND INTERSTITIAL INFILTRATES IN CXR; also reduced lung volumes & decreased compliance, ABG initially showing respiratory alk and hypoxemia; anxiety, dyspnea, tachypnea

Question 12

Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response?

Answer 12

the gut liver lung axis

Question 13

What time does the exudative phase of ARDS typically presents?

Answer 13

1-3 days

Question 14

Which of the following is not a common finding in the exudative phase of ARDS?

Answer 14

bradypnea

Question 15

What is the name of the period that follows the exudative phase in ARDS?

Answer 15

Fibroproliferative phase

Question 16

Which of the following assessment tools is most useful in distinguishing ARDS from CHF?

Answer 16

Swan-Ganze catheter

Question 17

Which of the following tests provides useful information in making the diagnosis of ARDS?

Answer 17

BALF, broncoalveolar lavage fluid

Question 18

Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS?

Answer 18

DO2

Question 19

What is recommended in terms of fluid management of patients with ARDS?

Answer 19

Conservative Fluid Management

Question 20

Which of the following parameters are important in the management of patients with ARDS?

Answer 20

KEEP HEMOGLOBIN SATURATION ABOVE 90%;
ENSURE ADEQUATE URINE OUTPUT;
KEEP MEAN ARTERIAL PRESSURE ABOVE 60 mmHg;
PREVENT HYPOTENSION

Question 21

The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size.

Answer 21

True

Question 22

Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS?

Answer 22

improved venous return is NOT associated with PEEP

Question 23

Which of the following complications has been associated with the use of PEEP in patients with ARDS?

Answer 23

Reduced cardiac output

Question 24

What ventilatory strategy has been found to be useful for avoiding barotrauma in the treat-ment of patients with ARDS?

Answer 24

Permissive hypercapnia or controlled hypoventilation

Question 25

What range is now recommended for tidal volumes (VT) in a patient with ARDS who is be-ing mechanically ventilated?

Answer 25

5-7 ml/kg

Question 26

What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS?

Answer 26

High frequency ventilation (HFV)

Question 27

What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS?

Answer 27

30-35 cmH2O

Question 28

What mode of mechanical ventilation is designed to optimize ventilation by recruiting alveo-lar units while minimizing ventilator-induced barotrauma in patients with ARDS?

Answer 28

APRV (AIRWAY PRESSURE RELEASE VENTILATION)

Question 29

Which of the following statements is true about prone-positioning of patients with ARDS?

Answer 29

It produces a transient improvement in gas exchange

Question 30

The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of pa-tients with ARDS is not recommended at this time.

Answer 30

True

Question 31

What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might be useful?

Answer 31

Severe elevation of pulmonary vascular resistance

Question 32

Although promising, inhaled NO remains an experimental therapy for patients with ARDS.

Answer 32

True

Question 33

In ARDS, all lung volumes are

Answer 33

decreased

Question 34

In ARDS, what happens to resistance and compliance?

Answer 34

resistance in increased

compliance is decreased

Question 35

Acute Alveolar hyperventilation secondary to hypoxemia- what ABG values?

Answer 35

pH- alkalotic- 7.50 or greater
PaCO2 - alkaline (in the high 20’s)
HCO3- normal trending up
PaO2- under 60 (hypoxemic)

Question 36

What are hyaline membranes in ARDS?

Answer 36

lining of the alveolar walls that is a product of inspissation of protein rich edema fluid that entraps debris of dead alveolar epithelial cells

Question 37

General management of ARDs/ALI includes what protocols?

Answer 37

oxygen therapy, lung expansion measures (PEEP or CPAP), mechanical ventilation protocol involving low tidal volumjes and high respiratory rates (5-7 ml/kg and rr 20-25 (up to 35) with plat pressure less than 30 cmH2O; permissive hypercapnia (not to exceed pH of 7.2)

Question 38

The therapeutic goals of low tidal volume ventilation is: (there are 3)

Answer 38

1. decrease high transpulmoary pressures
2. reduce overdistention of the lungs
3. decrease barotrauma

Question 39

List 3 known causative factors known to produce ARDS (from case study)

Answer 39

1. drug overdose
2. aspiration of gastric contents
3. excessive FIO2 for long periods

Question 40

Crackles, rhonchi, refractory hypoxemia, and cxr indicating infiltrates/atelectasis are all findings consistent with

Answer 40

increased alveolar-capillary membrane thickening

Question 41

Chest assessment findings in ARDS -

Percussion, breath sounds, adventitious sounds?

Answer 41

dull percussion
bronchial breath sounds
crackles