Respiratory Failure/Respiratory Arrest Flashcards
ards
denotes acute hypoxemic respiratory failure following a systemic or pulmonary. insult w/o evidence of heart failure
what is the FI o2 ratio in ards?
<200
what are the main causes of ards
sepsis syndrome, severe muliple trauma, and aspiration of gastric contents
(others- shock, toxic inhalation, near-drowning, multiple transfusions)
RF of ards
sepsis, aspriation of gastric contents, shock infxn, lung contusion, non-thoracic trauma, toxic inhalation,
1/3 of ards pts have sepsis syndrome
ards pathogenesis
increases permeability of the alveolar capillary membranes, which leads to the development of protein-rich edema
pro-inflammatry cytokines released from stimulated inflammatory cells-pivotal in lung injury ** damage to capillary endothelial cells and alveolar epithelial cells is common to ARDS regardless of cuas–> interstitial and alveolar pulmonary edema, alveolar collapse, and hypoxemia
CF of ards
o Rapid onset of profound dyspnea that usually occurs 12-48 hours after the initiating event.
o Labored breathing
o Tachypnea
o Frothy pink or red sputum
o Intercostal retractions
o Diffuse crackles
o ** A quiet chest, agitation or confusion are ominous signs of impending respiratory failure
o Many patients are cyanotic with increasingly severe hypoxemia that is refractory to administered oxygen
dx of ards
CXR-normal at first, but then shows diffuse or patchy bilateral infiltrates that spare costrophrenic angles
air bronchograms-80%, upper lung zone venous engorgement is distinctly UNcommon.
heart size normal
multiple organ failur is common
prevention of ards
nada. PEEP and I V methylprednisolones doesn’t prevent ards
tx of ards
tx underlying cause
o Treatment of hypoxemia seen in ARDS usually requires tracheal intubation and positive pressure mechanical ventilation. Hypoxia is often refractory to treatment
o The lowest levels of PEEP and supplemental oxygen required to maintain PAO2 above 55 mmHg or the SaO2 above 88% should be use.
o Efforts should be made to decrease FIO2 to less than 60% as soon as possible in order to avoid oxygen toxicity.
o PEEP can be increased as needed as long as cardiac output and oxygen delivery do not decrease and airway pressures do not increase excessively.
o Prone position may transiently improve oxygenation in selected patients by helping recruit atelectatic alveoli; however, great care must be taken during the maneuver to avoid dislodging catheters and tubes.
what is the most common cardiac failure, cardiac arrest?
ischemic heart dz
vtach and vfib