ARDS, Ventilator & Suctioning

Question 1

Define ARDS

Answer 1

A life-threatening lung injury that allows fluid to leak into the lungs

Question 2

Histology of ARDS

Answer 2

Damage to the alveoli and capillary epithelial cells causing cell death

Question 3

What are possible causes of ARDS

Answer 3

• Trauma
• septic shock
• pancreatitis
• CABG
• Pulmonary infection
• Burns
• High concentration of O2
• Aspiration of gastric contents
• COVID-19
• Cardiothoracic Surgery
• Drug toxicity

Question 4

T or F: ARDS is a disease

Answer 4

False - it is a syndrome

Question 5

What is the onset & course of progression ARDS

Answer 5

Abrupt onset w/progression determined by the body response (can be short or long)

Question 6

List the stages of ARDs

Answer 6

1. Exudate
2. Cellular Proliferation
   3.Fibroproliferation

Question 7

What occurs during the exudate phase of ARDS?

Answer 7

Rapid onset of resp failure characterized by pulmonary edema, hemorrhage & hyaline membrane formation

Question 8

What occurs during the cellular proliferation phase of ARDS?

Answer 8

Elevation of neutrophils & other inflammatory cells leading to cellular necrosis, epithelial hyperplasia & further inflammation

Question 9

What leads to fibroproliferation?

Answer 9

Results from chronic inflammation whereby lung tissue is replaced with fibrotic tissue & if it becomes significant, the patient will develop pulmonary hypertension and will present w/right-sided heart failure

Question 10

What are the s/s of ARDS

Answer 10

• severe dyspnea
• initial increased respiratory rate followed by shallow, rapid breathing
• Cyanosis
• dec. lung compliance
• Pulmonary edema (pink frothy secretions)
• atelectasis
  -Multisystem failure

Question 11

What is the pharm mgt of ARDS?

Answer 11

• fluid balance
• surfactant replacement therapy
• NO gas mixture
• antibiotics
• neuromuscular blocking agents (sedation)
• high dose corticosteroids

Question 12

What are medical tests significant for ARDS?

Answer 12

• blood gasses = shows hypoxemia& if acute hypercapnic resp. acidosis = SEVERE ARDS w/impending respiratory arrest
• Radiograph: shows alveolar opacities w/dependent atelectasis
• ECG changes (arrythmias, ST changes)

Question 13

What procedures/Surgery are good for ARDS?

Answer 13

• mechanical ventilation
• ECMO for vital organs
• prone positioning (16 hrs)
• bronchoscopy (ID cause)
• lung biopsy (RARE)

Question 14

What is mild ARDS?

Answer 14

PaO2/FiO2 is >200 and < 300 mmHg

Question 15

What is moderate ARDS?

Answer 15

PaO2/FiO2 is >100 and <200 mmHg

Question 16

What is severe ARDS?

Answer 16

PaO2/FiO2 is <100 mmHg

Question 17

T or F: You should definitely use high flow nasal oxygen for individuals w/ARDS

Answer 17

It is actually controversial and depends on where we are