Lecture 35 - ARDS Clinical

Question 1

ARDS better fits the category of ______ respiratory failure, while something like COPD is more ______ respiratory failure.

Answer 1

Hypoxic

Hypercapnic

Question 2

If the _____ pressure in the capillaries is too High or if the _____ pressure in the capillaries is too Low, fluid will move from the capillaries into the Interstitium.

Which of these cases is considered Cardiogenic pulmonary edema, and which one is considered Non-cardiogenic?

Answer 2

Hydrostatic

Colloid osmotic (oncotic)

Increased pulmonary capillary hydrostatic pressure –> cardiogenic

Decreased pulmonary capillary oncotic pressure (so leakage of protein-rich fluid through injured capillary wall –> Non-cardiogenic

Question 3

How does Cardiogenic pulmonary edema typically appear on CXR? How does this compare to ARDS (non-cardiogenic)?

Answer 3

Cardiogenic –> “bat wings” that spread out bilaterally from the hilum.

ARDS –> Diffuse alveolar damage, so that fluffly looking whiteness diffusely throughout the lungs.

Question 4

Diagnostic criteria for ARDS includes a REDUCED lung ______, measured as ____ / ____. It also includes _______ with PEEP greater than or equal to 5cm H2O.

Mild = PaO2 / FiO2 > _____ but < or = _____

Moderate = PaO2 / FiO2 > _____ but < or = _____

Severe = PaO2 / FiO2 < or = _____.

Keep in mind normal PaO2 = 100 and normal FiO2 = 0.21, so normal PaO2 / FiO2 = 500

Answer 4

Compliance

Measured as (Change in Volume / Change in Pressure)

Hypoxemia

Mild = PaO2 / FiO2 > 200 but < or = 300

Moderate = PaO2 / FiO2 > 100 but < or = 200

Severe = PaO2 / FiO2 < or = 100

Question 5

When providing supportive care with a mechanical vent to a patient with ARDS, what is the TV measurement given?

Answer 5

6ml/kg of ideal body weight (so the patient’s ideal weight, given their height)