Pulmonary Edema and Acute Lung Injury

Question 1

Refers to collection of exudate (fluid) in the alveolar spaces

Answer 1

pulmonary edema

Question 2

What are the causes of pulmonary edema?

Answer 2

• hemodynamic imbalance

- direct alveolar injury

Question 3

What are the components of hemodynamic imbalance?

Answer 3

• increased hydrostatic pressure
• decreased oncotic pressure
• lymphatic obstruction (rare)

Question 4

What are the components of direct alveolar injury?

Answer 4

• infectious, chemical, thermal, immune injury

- other (altitude, neurogenic)

Question 5

What does increase hydrostatic pressure cause in pulmonary capillaries?

Answer 5

Increased pulmonary capillary pressure causing “plasma” transudate to form in alveoli

Question 6

Is edema independent or dependent?

Answer 6

dependent - settles with gravity

Question 7

What are the causes of increased hydrostatic pressure?

Answer 7

• left HF
• volume overload
• pulmonary hypertension

Question 8

What are the causes of decreased oncotic pressure?

Answer 8

• Hypoalbuminemia
• Nephrotic syndrome
• Liver failure
• Protein losing enteropathies (malabsorption)
• Malnutrition

Question 9

What results when there is injury to alveolar septal tissues?

Answer 9

results in leakage of fluid from blood into alveolar spaces

Question 10

What are some examples of direct alveolar injury?

Answer 10

• inhaled gases
• liquid aspiration
• drug and chemicals
• shock, sepsis, trauma
• radiation
• transfusion mismatch

Question 11

What does ARDS stand for?

Answer 11

acute respiratory distress syndrome

Question 12

ARDS is a clinical syndrome resulting from what?

Answer 12

resulting from diffuse alveolar capillary damage

Question 13

ARDS is characterized by rapid onset of what?

Answer 13

• severe respiratory insufficiency
• cyanosis
• hypoxemia

Question 14

What is ARDS resistant to?

Answer 14

resistant to oxygen therapy

Question 15

What is ARDS resistant to oxygen therapy?

Answer 15

due to loss of gas exchange surface as alveoli are filled with fluid

Question 16

What are causes of ARDS?

Answer 16

• direct injury

- systemic disorders

Question 17

What is the main pathological feature of ARDS?

Answer 17

diffuse alveolar damage

Question 18

What does endothelial injury result in?

Answer 18

increased permeability

Question 19

In ARDS, what collects in alveoli?

Answer 19

protein-rich exudate

Question 20

In ARDS, what are attracted and activated?

Answer 20

neutrophils

Question 21

In ARDS, what contribute to tissue injury and signs/symptoms?

Answer 21

• cytokines
• phagocyte-release digestive enzymes
• oxygen radicals

Question 22

What is recovery from ARDS usually associated with to some degree?

Answer 22

Recovery usually associated with some degree of pulmonary fibrosis

Question 23

What kind of onset is ARDS?

Answer 23

progressive

Question 24

What does ARDS present with?

Answer 24

acute respiratory distress

Question 25

In ARDS, what is often resistant to respiratory support?

Answer 25

hypoxemia

Question 26

In ARDS, what is present on chest xray?

Answer 26

bilateral infiltrates

Question 27

What can pulmonary HTN progress to?

Answer 27

right HF

Question 28

In ARDS, how long does resolution occur over?

Answer 28

6-12 months

Question 29

In ARDS, what is the overall mortality?

Answer 29

approx 40%