Clinical Perspective of Respiratory Failure & ARDS Flashcards
What are the treatment steps for acute respiratory distress?
1 - establish an airway
2 - administer O2
3 - maintain ventilation
4 - hemodynamic support
5 - treat underlying cause
For every 1L increase in O2, how much is FiO2 increased?
By 3%
What are the Berlin criteria for acute respiratory distress syndrome?
Develops within a week of insult, bilateral opacities on CXR, not fully explained by cardiac failure or hypervolemia
These disorders present with failure of oxygenation and an abnormal (“white”) chest x-ray.
Lung infection, congestive heart failure, atelectasis, pleural effusion, pulmonary edema not related to the heart
The V/Q ration measure ventilation and perfusion of the lungs. What would be the ratio in a patient with adequate ventilation, but poor perfusion.
V/Q > 1
These factors shift the oxyhemoglobin curve to the left, indicating an increased O2 affinity.
Increased pH
Decreased temperature, CO2, 2,3-DPG
These disorders prevent with a failure of oxygenation, but normal chest x-ray.
Pulmonary embolism, COPD/asthma exacerbation, R to L shunt, low cardiac output, microatelectasis
What immune cells mediates acute respiratory distress syndrome?
Neutrophils
What is a venturi mask?
A type of oxygen mask that allows delivery of a specific FiO2 independent of patient RR
What is the most common cause of death in patients with acute respiratory distress syndrome?
Sepsis and multiorgan dysfunction
What does a V/Q < 1 indicate?
Poor ventilation with adequate perfusion
What are the indications for intubation?
Respiratory failure, airway protection, hypothermia, hyperventilation
While PEEP is helpful to treat ARDS patients, a higher PEEP is not always best. How does PEEP help improve outcomes?
Opens atelectatic, fluid-filled alveoli
True/False. When treating patients with acute respiratory distress syndrome, a low tidal volume is preferred.
True - this prevents damage to the alveoli and capillaries
Low TV has been shown to lead to better outcomes
This type of acute respiratory failure is due to a decreased respiratory drive.
Type 2 - Hypercapnia
CO2 increases, and O2 decreases
True/False. Placing a patient in a prone position improves V/Q.
True - this is sometimes used in patients with ARDS. Improvements are seen within 30mins
BIPAP is used to treat patients in acute respiratory failure. How does BIPAP differ from CPAP?
BIPAP delivers a continuous positive pressure, but decreases pressure when the patient exhales for more ease
These factors shift the oxyhemoglobin curve to the right, indicating a decreased O2 affinity.
Increased temperature, CO2, 2,3-DPG
Decreased pH
True/False. A hypercapnic patient with present with blueish discoloration.
False - they appear red. Hypoxic patients appear blue
What are the two classifications of acute respiratory failure?
Type 1 - hypoxemic respiratory failure
Type 2 - hypercapnic respiratory failure
True/False. Corticosteroids have been shown to improve outcomes in patients with ARDS.
False - but could administered as a last resort option
