B4-058 Acute Lung Injury and ARDS Flashcards
abnormal accumulation of extravascular fluid in lung parenchyma
pulmonary edema
intra-alveolar and interstitial accumulation of fluid and congestion of alveolar capillaries
pulmonary edema
pulmonary edema
- left-sided heart failure leads to increased pulmonary venous pressure
- protein poor transudate
cardiogenic pulmonary edema
CXR
- Kerley B lines
- butterfly/batwing sign
- cardiomegaly
cardiogenic pulmonary edema
- hemosiderin- laden macrophages accumulate in alveoli
- deposition of hemosiderin in interstitium
- microhemorrhages
chronic cardiogenic pulmonary edema
- damage to alveolar epithelium and endothelium increased vascular permeability
- protein-rich exudate
pulmonary edema due to alveolar wall injury
direct causes of pulmonary edema due to alveolar wall injury
4
- infection
- aspiration
- inhalation
- radiation
indirect causes of pulmonary edema due to alveolar wall injury
3
- SIRS
- drugs/toxin
- transfusion reaction
if diffuse, this injury may cause ARDS
pulmonary edema due to alveolar wall injury
- impaired gas exchange
- reduction in lung compliance
pulmonary edema
- edema fluid within interstitium and alveoli
- capillary congestion
- hemosiderosis in chronic CHF
pulmonary edema
- rapid onset of life threatening respiratory insufficiency
- severe progress hypoxemia
- bilateral opacities on CXR
- exclusion of cardiogenic pulmonary edema
ARDS
CXR
bilateral opacities
ARDS
causes of ARDS
6
- pneumonia
- sepsis
- aspiration
- trauma
- pancreatitis
- transfusion rx
the alveolar-capillary membrane is compromised by epithelial and endothelial injury
ARDS
acute and organizing diffuse alveolar damage
ARDS
what stage of ARDS
- edema
- hyaline membranes
- impaired gas exchange
acute
what stage of ARDS
- alveolar pneumocyte hyperplasia
- interstitial fibrosis
- alveolar collapse
- reduced lung compliance
- VQ mismatch
organizing stage
what stage of ARDS
- progressive or stable fibrosis
- resolution
fibrotic
- hyaline membranes
- interstitial pulmonary edema
- proliferation of type II pneumocytes, fibroblasts, deposition of collagen
ARDS
- impaired gas exchange
- alveolar collapse
- reduction in lung compliance
- VQ mismatch
ARDS
infant RDS
due to surfactant deficiency in immature lungs or congenital deficiency due to mutations
infant RDS
hyaline membranes in airspaces
infant RDS
risk factors for infant RDS
3
- male gender
- maternal diabetes
- C section
infant RDS
potentially reversible impairment in development of alveolar septation during the saccular stage
bronchopulmonary dysplasia
complication of infant RDS
- larger, simplified alveoli with fewer septation on dysmorphic capillary configuration
- less surface area for gas exchange
bronchopulmonary dysplasia
complication of infant RDS
- decreased levels of VEGF
- endothelial cell apoptosis
hyperoxic phase
retrolental fibroplasia
complication of infant RDS
rebound VEGF levels induce retinal revascularization, retinal detachment
hypoxic phase of retrolental fibroplasia
complication of infant RDS
- alveolar collapse, progressive atelectasis
- impaired gas exchange
- reduction in lung compliance
- VQ mismatch
infant RDS
decreased lamellar bodies in type II pneumocytes
infant RDS
diffuse alveolar damage
ARDS
eosinophilic membranes lining alveolar spaces
ARDS
diffuse alveolar damage
most common causes of ARDS
4
- pulmonary infection
- shock
- sepsis
- aspiration
complication of high dose oxygen therapy
bronchopulmonary dysplasia
defective alveolar septation and abnormal vascular development
fewer, larger alveoli = less surface area
bronchopulmonary dysplasia
hyperoxemia, hyperventilation, prematurity, inflammatory mediators, and vascular maldevelopment play a role in the development of
bronchopulmonary dysplasia
frothy, pink fluid
pulmonary edema
excessive supplemental oxygen used in the management of neonatal RDS is a risk factor for
retinopathy of prematurity
abnormal proliferation of the blood vessels in the retina can lead to retinal detachment and blindness
retinopathy of prematurity
declining in frequency due to improved ventilation and oxygen techniques
retinopathy of prematurity
occurs secondary to heart failure as a result of increased hydrostatic pressure
pulmonary edema
fluid accumulates in alveolar septa/interstitium and in the alveolar spaces
pulmonary edema
leukocyte mediated injury to alveolar capillary endothelium
ARDS
diffuse alveolar damage intitated by injury to capillary endothelium via neutrophils and macrophages
ARDS
