Resp - Resp Failure Flashcards

Question

What are the 2 main causes of ARDS

Answer 1

Pulmonary and extra-pulmonary

Answer 2

``` Largely infection Aspiration Trauma Burns Surgery Drug toxicity ```

Answer 3

``` Infection trauma Pancreatitis Burns Transfusions Surgery BM transplant Drug toxicity ```

Answer 4

Injury leads to damage of the lung interstitium. This causes macrophage activation and the release of cytokines e.g. TNF-a and IL-8 We get alveolar fluid build up therefore protein rich oedema in the lungs Therefore we get degradation and inactivation of surfactant meaning that the alveolus is less efficient at expanding Inflammation of the alveolus leads to migration of leucocytes e.g. neutrophils which cause further damage This widens the distance between the alveolus and the capillaries therefore less efficient gas exchange and respiratory failure

Answer 5

``` TNF signalling Leucocyte activation and migration DAMP release Cytokine release e.g. IL-6/8 Cell death - necrotic tissue in ARDS ```

Answer 6

``` Steroids e.g. dexamethasone Salbutamol Surfactant N-ACh - reduces viscosity of secretions Neutrophil elastase inhibitors GM-CSF Statins ```

Answer 7

ARDS is extremely severe and very heterogenous therefore hard to find overarching patterns for treatment

Answer 8

Treat underlying disease Respiratory support Multi-organ support

Answer 9

``` Inhaled therapies e.g. bronchodilators Steroids ABx Antivirals Drugs e.g. rituximab ```

Answer 10

``` Physiotherapy Oxygen (not in type 2) Nebuliser NIV Extra corporeal support ```

Answer 11

CV support e.g. fluids. vasopressors Renal support e.g. hemodialysis Immune therapies e.g. plasma exchange

Answer 12

Poor gas exchange leads to multi-organ dysfunction Infection leads to sepsis Inflammation leads to oedema

Answer 13

Pressure not volume - this is because pressure is more likely to cause damage to the lung

Answer 14

Pressure that drives into the lung

Answer 15

Baseline pressure that keeps the airways open - this means less force is required at the start for recruitment therefore less likely to damage the airways - atelectasis is more likely if pressure falls below the PEEP

Answer 16

We use a sensor and then when the patient is trying to inhale then we can give them some driving pressure

Answer 17

There is marked reduction in compliance during ARDS therefore the PVL is much flatter - we are using a lot more pressure in order to generate a lower volume

Answer 18

In people with type 2 hypercapnic failure - their airways are often constricted therefore cannot normally exhale fully. This means that they get air trapping and breath stacking

Answer 19

We give them longer periods to exhale in order to get as much air out as possible - make sure expiratory pressure is low enough fro them to be able to expire, but high enough to keep airways open

Answer 20

We use a driving pressure to distend the lung and see if its recruitable - we need to make sure pressure isn't too high otherwise we may over distend the lung and trap gas in the chest to damage the lung and impart perfusion.

Answer 21

US at the bedside to examine the lung expansion and any fluid

Answer 22

Murray scoring

Answer 23

0 = normal 1-2.5 = mild 2.5 = severe 3 ECMO

Answer 24

Severe resp failure - Murray score is 3+ Positive pressure ventilation is not appropriate e.g. tracheal injury Reversible disease process that is unlikely to lead to prolonged disability

Answer 25

Significant life-limiting co-morbidity - likely to remain on ECMO or life support

Answer 26

Large cannula is passed through the femoral vein to the IVC, we then run blood through an external pump across an artificial membrane. Here, we flow gas to allow removal of CO2 and blood oxygenation. This can also be done in the jugular