Chapter 24 - ALI and ARDS

Question 1

Three phases of the case of suspected ARDS

Answer 1

exudative phase (0-6 days): protein-rich edema and the presence of eosinophilic hyaline membranes in the walls of alveolar ducts
proliferative phase (4-10): decrease in edema and hyaline membranes and an increase in interstitial fibrosis
fibrotic phase (day 8 onward): pronounded fibrosis that may ultimately obliterate areas of lungs

Question 2

T/F: ARDS is a clinical diagnosis, with a lung biopsy or autopsy not required to reach the diagnosis

Answer 2

True

Question 3

Underlying specific cause of ALI/ARDS

Answer 3

pneumonia, sepsis, trauma: common precursors to systemic inflammation that results in MODS

Question 4

Commons features of lung injury in ALI/ARDS

Answer 4

pronounced microvascular permeability
leukocyte activation
alteration in cytokine production

Question 5

Major humoral mediators of ALI/ARDS

Answer 5

proinflammatory cytokines 1 and TNF-a

cellular mediators: neutrophil, macrophage

Question 6

hallmark finding in ARDS ventilator scalar/loop

Answer 6

lower compliance, determined by the slope of P-V curve

Question 7

Major breakthrough in treatment of ARDS in ventilation

Answer 7

lower TV in mechanical ventilation, associated with decreased ventilator associated lung injury and improved patient outcome

Question 8

Most current ventilation guideline

Answer 8

limiting fluid balance to prevent overhydration, limiting TV, appropriate PEEP, avoiding other complication