Respiratory - ARDS

Question 1

What is the mortality rate associated with ARDS?

Answer 1

40%

Question 2

Acute respiratory distress syndrome (ARDS) is caused by the _________ _________ of alveolar capillaries leading to fluid accumulation in the alveoli

Answer 2

Acute respiratory distress syndrome (ARDS) is caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli

Question 3

A 60-year-old woman presents with acute onset of shortness of breath, fever, and cough. A chest x-ray shows a right lower lobe infiltrate, and sputum has gram-positive diplococci. He is given intravenous antibiotics but his respiratory status declines over 24 hours. He become hypotensive and has low oxygen saturations despite high flow oxygen. His repeat chest Xray is shown below.

What one other investigation would be required to confirm the suspected complication of the patients pneumonia and what would the result be?

Answer 3

Arterial Blood Gas
PaO₂/FiO₂ (arterial to inspired oxygen) ratio of ≤300 on positive end-expiratory pressure or continuous positive airway pressure ≥5 cm H₂O

Question 4

What are some causes of ARDS?
______________
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis

Answer 4

infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis

Question 5

You see a patient who you suspect has developed ARDS, what other differentials would you want to exclude and what investigations would you order?

Answer 5

Acute cardiogenic pulmonary edema — the most important to exclude, most clinicians use clinical evaluation and BNP or N-terminal proBNP (NT-proBNP), with or without transthoracic echocardiography to confirm or exclude pulmonary edema:

Bilateral Pneumonia - Bronchoscopy (bronchoalveolar lavage, brush)

Diffuse alveolar hemorrhage — Several conditions are associated with diffuse alveolar hemorrhage (DAH), a condition that mimics ARDS. Up to two-thirds will present with hemoptysis, and some patients present with sudden-onset respiratory distress, symptoms that are unusual for patients with ARDS. Bronchoscopy and bronchoalveolar lavage (BAL) are also helpful in distinguishing DAH from ARDS.

Question 6

As an FY1, if you suspected a patient had ARDS, what would you do?

Answer 6

Escalate to a senior and ITU

Question 7

What would be an indication for ventilation in a patient with ARDS?

Answer 7

Patient persistenly maintains a PaO2 <8 whilst on 60% FiO2 or has a persistent PaCO2 >6.5