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Chapter 294 - Acute Respiratory Distress Syndrome Flashcards

1
Q

How many percent of all ICU admission involve patients with ARDS?

A

10%

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2
Q

Most common cause of ARDS

A

Pneumonia and Sepsis

40-60%

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3
Q

Most frequently reported surgical conditions in ARDS

A

pulmonary contusion
multiple bone fractures
chest wall trauma/flail chest

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4
Q

Trauma patients with an APACHE score of ≥16 has how much risk in developing ARDS

A

2.5 time increased risk

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5
Q

Phases of ARDS

A

Exudative
Proliferative
Fibrotic

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6
Q

Identify which phase:

alveolar capillary endothelial cells and type I pneumocytes are injured with consequent loss of a normally tight alveolar barrier

A

Exudative

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7
Q

Identify which phase:

interleukin 1, interleukin 8, TNF and Leukotriene B are increased leading to leukocyte recruitment

A

Exudative

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8
Q

Identify which phase:

Formation of hyaline membrane whorls

A

Exudative

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9
Q

Identify which phase:

Vascular obliteration by microthrombi and fibrocellular proliferation

A

Exudative

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10
Q

Identify which phase:

Reduction in arterial blood flow resulting to increased dead space and pulmonary hypertension

A

Exudative

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11
Q

Hypercapnia in early ARDS results from?

A

increased pulmonary dead space

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12
Q

Where does alveolar edema predominantly involve?

A

dependent portions of the lung

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13
Q

Exudative phase usually present within how many hours? and can be delayed by how many days?

A

present w/in 12-36h

delayed by 5-7 days

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14
Q

Duration of the proliferative phase

A

from day 7 to day 21

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15
Q

Identify which phase:

most patients recover and are liberated from mechanical ventilation

A

Proliferative

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16
Q

Identify which phase:

Some patients may develop early changes of pulmonary fibrosis

A

Proliferative

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17
Q

Identify which phase:

First sign of resolution histologically

A

Proliferative

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18
Q

Identify which phase:

Initiation of lung repair

A

Proliferative

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19
Q

Identify which phase:

organization of alveolar exudates

A

Proliferative

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20
Q

Identify which phase:

shift from neutrophil to lymphocyte predominant pulmonary infiltrates

A

Proliferative

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21
Q

Which type cells proliferate along the alveolar basement membranes during the proliferative phase?

A

Type II Pneumocytes

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22
Q

Identify which phase:

Requires long term support on Mechanical Ventilation

23
Q

What causes progressive vascular occlusion and pulmonary hypertension in the Fibrotic phase?

A

Intimal fibroproliferation in the pulmonary microcirculation

24
Q

General Principles

A

(1) recognition and treatment of underlying disorders
(2) minimization of unnecessary procedures
(3) standardized ICU “bundled care” approaches (4) prompt recognition of nosocomial infections
(5) provision of adequate nutrition

25
Q

Two principal mechanisms of ventilator induced lung injury

A

Volutrauma

Atelectrauma

26
Q

Benefit of prone positioning

A

28-day mortality

27
Q

Fluid restriction and diuretics benefit

A

shortens ICU stay and duration of mech vent

28
Q

In controlled trials, which agent was used for neuromuscular blockade

A

cisatracurium besylate for 48h

29
Q

Benefit of neuromuscular blockade

A

increased survival and ventilator free days

30
Q

Low tidal volume

A

6 ml/kg of predicted body weight

31
Q

Only Grade A recommendation

A

Low tidal volume

32
Q

Which treatment strategy demonstrated mortality benefit in RCTs

A

Prone position

Early neuromuscular blockade

33
Q

Grade B recommendations

A
  • Minimized Left atrial filling pressures
  • High PEEP or Open Lung
  • Prone Position
  • Extracorporeal membrane oxygenation
  • Early neuromuscular blockade
34
Q

Grade C recommendation

A
  • Recruitment maneuvers

- Inhaled NO, Inhaled epoprostenol

35
Q

Grade D recommendation

A 
Glucocorticoid
High frequency ventilation
Surfactant replacement 
Ketoconazole
PGE1
NSAIDs
36
Q

Mortality rate of ARDS from the LUNG SAFE trial

A

Mild 34.9%
Moderate 40.3%
Severe 46.1%

37
Q

mortality in ARDS is largely attributable to NONPULMONARY causes

38
Q

sepsis and nonpulmonary organ failure accounts for how many percent of deaths of ARDS patients

39
Q

Important risk factors of ARDS mortality are non pulmonary which includes

A

Advanced Age

Preexisting organ dysfunction

40
Q

Patients with ARDS arising from direct lung injury (including pneumonia, pulmonary contusion, and aspiration) are nearly twice as likely to die as those with indirect causes

41
Q

surgical and trauma patients with ARDS—especially those without direct lung injury—generally have a higher survival rate than other ARDS patients.

42
Q

there is LITTLE additional value in predicting ARDS mortality from other parameters of lung injury, including the level of PEEP (≥10 cm H2O), respiratory system compliance (≤40 mL/cm H2O), the extent of alveolar infiltrates on chest radiography, and the corrected expired volume per minute (≥10 L/min)

43
Q

After how many months will the patient regain a maximal lung function

A

within 6 months

44
Q

Diagnostic Criteria

A

A - Absence of left atrial hypertension
R - radiograph showing Bilateral opacities at least 3/4 of the lung fields
D - Duration within 1 week of clinical insult
S - Severity by Berlin criteria

45
Q

Berlin criteria for ARDS severity

A

Mild: PFR 201 - 300
Mod: PFR 101 - 200
Sev: PFR ≤ 100

46
Q

Initial management of ARDS

A
  1. Initiate volume/pressure limited ventilation
  2. Oxygenate
  3. Minimize acidosis
  4. Diuresis
47
Q

Goal tidal volume

A

≤ 6 ml/kg PBW

48
Q

Goal plateau pressure

A

≤ 30 cmH2O

49
Q

Goal RR

A

≤ 35 bpm

50
Q

Goal FiO2

51
Q

Goal SpO2

A

88 – 95%

52
Q

Goal pH

53
Q

Goal MAP

A

≥ 65 mmHg

54
Q

Direct causes of lung injury

A 
Pneumonia
Aspiration of gastric contents
Pulmonary contusion
Near drowning
Toxic inhalation injury

PULMONOLOGY (10 decks)

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