Respiratory pathophysiology 8 Flashcards

1
Q

What are the MOST important strategies for managing mechanical ventilation in the patient with acute respiratory distress syndrome? (select 2)
a. low tidal volume
b. reducing plateau pressure
c. high-frequency oscillatory ventilation
d. permissive hypocapnia

A

a. low tidal volume
b. reducing plateau pressure

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2
Q

ARDS is a form of

A

non-cardiogenic pulmonary edema

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3
Q

We make the ARDS diagnosis with the

A

Berlin definition of ARDS

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4
Q

The most common pulmonary etiology of ARDS is

A

pneumonia

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5
Q

The most common extra-pulmonary etiology of ARDS is

A

sepsis

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6
Q

ARDS is caused by

A

inflammation injury (mediated by neutrophils and platelets) leading to diffuse alveolar destruction

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7
Q

Key pathophysiologic features of ARDS include:

A

protein-rich pulmonary edema
loss of surfactant
hyaline membrane formation
possible long-term lung injury

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8
Q

The ______ position may improve V/Q matching allowing a higher PaO2 for a given FiO2.

A

prone

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9
Q

CXR in the ARDS patient reveals

A

bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules

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10
Q

Strategies and tactics for mechanical ventilation include:

A

pressure control ventilation
low Vt (4-6 mL/kg IBW)
PEEP titrated with FiO2 (keep FiO2 below 50% if possible)
Plateau pressure <30 cm H2O
RR 6-35 BPM (permissive hypercapnia if needed)
I:E ratio 1:1-1:3

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11
Q

The target oxygenation goals for the patient with ARDS is

A

PaO2 55-80 mmHg or SpO2 88-95%

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12
Q

The Berlin definition of ARDS includes

A

time of onset
diagnostic imaging results
origin of edema
classifies patients based on disease severity

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13
Q

Mild ARDS is defined as

A

PaO2/FiO2 ratio <201-300 mmHg

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14
Q

Moderate ARDS is defined as

A

PaO2/FiO2 ratio <101-200 mmHg

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15
Q

Severe ARDS is defined as

A

PaO2/FiO2 ratio <100 mmHg

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16
Q

Pulmonary causes of ARDS include

A

pneumonia
covid 19
aspiration of gastric contents
smoke inhalation injury
near-drowning events

17
Q

Extra-pulmonary causes of ARDS include

A

sepsis
hematologic (TRALI, TACO, mass transfusion)
trauma/shock
burns
cardiopulmonary bypass

18
Q

What are the three stages of ARDS?

A

exudative
proliferative
fibrotic