Question Answer
What are the pathologic or structural changes with ARDS? Interstitial and intra-alveolar edema and hemorrhage Alveolar consolidationIntra-alveolar hyaline membrane pulmonary surfactant deficiency or abnormality atelectasis
What was ARDS first referred to as? “Shock Lung Syndrome”
What are the etiologic factors that may produce ARDS? Aspiration, disseminated intravascular coagulation, drug overdose, fat or air emboli, fluid overload, infection, inhalation of toxins and irritants, immunologic reaction, massive blood transfusion, Oxygen toxicity, pulmonary ischemia
What are the etiologic factors that may produce ARDS? radiation induced lung injury, shock, systemic reactions to processes initiated outside the lungs, thoracic trauma, uremia.
What are the clinical manifestations of ARDS? Atelectais, Alveolar consolidation, increased alveolar-capillary membrane thickness.
What is the clinical data obtained at the bedside? Increased RR, HR, BP, CO.Chest: Dull percussion note, bronchial breath sounds, crackles.
What is the clinical data obtained from the lab? Expiratory maneuver: PEFR(N), FEF50%(N), FEF200-1200(N), FEV1%(NorINC), rest low.Lung volumes: low ABG:Mild to moderate-acute alveolar hyperventilation with hypoxemia. Severe-Acute ventilatory failure with hypoxemia.
What are the radiologic findings for ARDS? Increased opacity.
What ventilator setting should you use for ARDS patients? Low tidal volumes (4-8ml/kg) and high respiratory rates (as high as 35bpm)


Question Answer
how do we treat hypoxia? treatment is directed at the cause
what three factors contribute to improving ventilation? 1.improving alveolar ventilation2.reducing dead space3.reducing CO2 production
when is Fio2 measured in the clinical setting? at least every 24 hours
the most common parameter to assess oxygenation 1.FIO22.SaO23.ABG4.Hb5.PaO26.PAO27.PaO2/FIO28.shunt9.CO10.SvO211.CvO2
what can determine oxygen utilization by the tissues? 1.C(a-v)O22.VO23.cardiac output4.SvO2
Goals of PEEP/CPAP 1.enhance oxygenation2.maintain PaO2 >60mmHg3.maintain SaO2 at 90% or greater4.recruit alveoli5.restore FRC
mode in which Ti is longer than Te IRV
PEEP definition ventilatory support at a baseline pressure above 0
CPAP definition pressure above ambient pressure maintained during spontaneous ventilation
definition: flow restrictor acchieves expiratory pressure by creating a resistance to expiratory flow through an orifice
definition:threshold restrictor device that provides a constant pressure through expiration regardless of flow rate
Minimum or low PEEP 3-5cmH2O
therapeutic PEEP 5cmH2O or greater
indications for PEEP therapy 1.bilateral infiltrates on CXR2.recurrent atelectasis with low FRC3.reduced Compliance4.PaO2 <60nnHg on an FIO2 >50%5.PaO2/FIO2 ratio <200 refractory hypoxemia
Oxygen delivery equation Cardiac output x CaO2

 

Question Answer
Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS? Neutrophils
The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades. False
Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)? Diffuse alveolar and interstitial infiltrates in chest radiograph
What time does the exudative phase of ARDS typically presents? Between days 1 and 3
Which of the following is not a common finding in the exudative phase of ARDS? Bradypnea
What mode of mechanical ventilation is designed to optimize ventilation by recruiting alveolar units while minimizing ventilator-induced barotrauma in patients with ARDS? Airway pressure release ventilation (APRV)
What is recommended in terms of fluid management of patients with ARDS? Conservative
Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response? Liver
Which of the following risk factors for ARDS is considered a secondary risk factor? Sepsis
The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients with ARDS is not recommended at this time. True
What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS? High-frequency ventilation (HFV)
The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size. True
What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might be useful? Severe elevation of pulmonary vascular resistance.
Which of the following mechanisms ultimately leads to ARDS regardless of the etiology? Disruption of the endothelial and epithelial barriers.
Which of the following assessment tools is most useful in distinguishing ARDS from CHF? Swan-Ganz catheter
Although promising, inhaled NO remains an experimental therapy for patients with ARDS. True
What range is now recommended for tidal volumes (VT) in a patient with ARDS who is being mechanically ventilated? 5 to 7 ml/kg
According to the Starling&apos;s equation, which forces influence the movement of fluid from the bloodstream to the interstitium? I. Microvascular hydrostatic pressure II. Interstitial osmotic pressure
Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS? DO2
Which of the following terms describes programmed cell death? Apoptosis
What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS? Permissive hypercapnia
Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathological conditions? Lymphatic
Which of the following parameters are important in the management of patients with ARDS? II. Keep hemoglobin saturation above 90%.III. Ensure adequate urine output. IV. Keep mean arterial pressure above 60 mm Hg.
Distinguishing between hydrostatic and hydrostatic pulmonary edema is often difficult, even for skilled clinicians. True
Which of the following statements is true about prone-positioning of patients with ARDS? It produces a transient improvement in gas exchange.
What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS? 30 to 35 cm H2O
Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS? Improved venous return
Which of the following complications have been associated with the use of PEEP in patients with ARDS? Reduced cardiac output
What is the name of the period that follows the exudative phase in ARDS? Fibroproliferative
Which of the following tests provides useful information in making the diagnosis of ARDS for patients with inconclusive results on traditional tests? Examination of bronchoalveolar lavage fluid (BALF)