ARDS study guide Flashcards
Distinguishing between hydrostatic and nonhydrostatic pulmonary edema is often difficult, even for skilled clinicians
True
The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades
False
Which of the following risk factors for ARDS is considered a secondary risk factor?
sepsis
also burn injury, prolonged hypotension/shock, multi-trauma, pancreatitis
What are PRIMARY risk factors for ARDS?
pneumonia, gastric aspiration, toxic inhalation, near drowning lung contusion
Which of the following factors are associated with a higher risk for ARDS?
gastric aspiration and septic shock
According to the Starling’s equation, which forces influence the movement of fluid from the bloodstream to the interstitium?
MICROVASCULAR HYDROSTATIC PRESSURE + INTERSTITIAL OSMOTIC PRESSURE
Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathologic conditions?
The lung lymphatic drainage system
Which of the following mechanisms ultimately leads to ARDS regardless of the etiology?
NONHYDROSTATIC PULMONARY EDEMA, [also PMN (neutrophils and inflammatory byproducts like neutrophil elastase and myeloperoxidase)]
What term describes programmed cell death?
apoptosis
Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS?
Neutrophils
Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)?
DIFFUSE ALVEOLAR AND INTERSTITIAL INFILTRATES IN CXR; also reduced lung volumes & decreased compliance, ABG initially showing respiratory alk and hypoxemia; anxiety, dyspnea, tachypnea
Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response?
the gut liver lung axis
What time does the exudative phase of ARDS typically presents?
1-3 days
Which of the following is not a common finding in the exudative phase of ARDS?
bradypnea
What is the name of the period that follows the exudative phase in ARDS?
Fibroproliferative phase
Which of the following assessment tools is most useful in distinguishing ARDS from CHF?
Swan-Ganze catheter
Which of the following tests provides useful information in making the diagnosis of ARDS?
BALF, broncoalveolar lavage fluid
Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS?
DO2
What is recommended in terms of fluid management of patients with ARDS?
Conservative Fluid Management
Which of the following parameters are important in the management of patients with ARDS?
KEEP HEMOGLOBIN SATURATION ABOVE 90%;
ENSURE ADEQUATE URINE OUTPUT;
KEEP MEAN ARTERIAL PRESSURE ABOVE 60 mmHg;
PREVENT HYPOTENSION
The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size.
True
Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS?
improved venous return is NOT associated with PEEP
Which of the following complications has been associated with the use of PEEP in patients with ARDS?
Reduced cardiac output
What ventilatory strategy has been found to be useful for avoiding barotrauma in the treat-ment of patients with ARDS?
Permissive hypercapnia or controlled hypoventilation
What range is now recommended for tidal volumes (VT) in a patient with ARDS who is be-ing mechanically ventilated?
5-7 ml/kg
What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS?
High frequency ventilation (HFV)
What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS?
30-35 cmH2O
What mode of mechanical ventilation is designed to optimize ventilation by recruiting alveo-lar units while minimizing ventilator-induced barotrauma in patients with ARDS?
APRV (AIRWAY PRESSURE RELEASE VENTILATION)
Which of the following statements is true about prone-positioning of patients with ARDS?
It produces a transient improvement in gas exchange
The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of pa-tients with ARDS is not recommended at this time.
True
What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might be useful?
Severe elevation of pulmonary vascular resistance
Although promising, inhaled NO remains an experimental therapy for patients with ARDS.
True
In ARDS, all lung volumes are
decreased
In ARDS, what happens to resistance and compliance?
resistance in increased
compliance is decreased
Acute Alveolar hyperventilation secondary to hypoxemia- what ABG values?
pH- alkalotic- 7.50 or greater
PaCO2 - alkaline (in the high 20’s)
HCO3- normal trending up
PaO2- under 60 (hypoxemic)
What are hyaline membranes in ARDS?
lining of the alveolar walls that is a product of inspissation of protein rich edema fluid that entraps debris of dead alveolar epithelial cells
General management of ARDs/ALI includes what protocols?
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)
The therapeutic goals of low tidal volume ventilation is: (there are 3)
- decrease high transpulmoary pressures
- reduce overdistention of the lungs
- decrease barotrauma
List 3 known causative factors known to produce ARDS (from case study)
- drug overdose
- aspiration of gastric contents
- excessive FIO2 for long periods
Crackles, rhonchi, refractory hypoxemia, and cxr indicating infiltrates/atelectasis are all findings consistent with
increased alveolar-capillary membrane thickening
Chest assessment findings in ARDS -
Percussion, breath sounds, adventitious sounds?
dull percussion
bronchial breath sounds
crackles
