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21 Cards in this Set
- Front
- Back
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What is the definition of ARDS?
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1). Acute onset
2). Bilateral disease 3). Non-cardiogenic pulmonary edema 4). PaO2/FiO2 < 200 |
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What are the three phases of ARDS?
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1). exudative
2). proliferative 3). fibrotic |
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What is the exudative phase of ARDS?
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Exudative: Injury to lung endothelial cells and alveolar epithelial cells occurs and results in air spaces filled with exudate and fluid and the development of microvascular thrombi leading to capillary occlusion.
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What is the proliferative phase of ARDS?
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Proliferative: This stage occurs between the first and third week after the initial insult. Type II pneumocytes, fibroblasts, and myofibroblasts proliferate, resulting in widening of the alveolar septa and conversion of intra-alveolar hemorrhagic exudate into cellular granulation tissue.
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What is the fibrotic stage of ARDS?
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Fibrotic: If the patient survives for 3 weeks, the lungs exhibit remodeling and fibrosis.
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The primary gas exchange abnormality in early ARDS is what?
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Oxygenation is the primary problem and hypocapnia is not unusual.
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Involvement is nonhomogeneous and functional residual capacity (FRC) is reduced and the closing capacity is above FRC. What is the consequence?
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Airway closure occurs during normal tidal breathing, leading to alveolar collapse, ventilation/perfusion (V/Q) mismatch, and progressive hypoxemia.
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What best describes the lungs of an ARDS patient: small or stiff?
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Small. Although the total lung compliance is reduced, as little as 25% of the lung may be participating in gas exchange. Those areas that remain viable for gas exchange are normally compliant and subject to overdistension when subject to excessive inflating pressures.
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What is ALI?
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The definition of ALI is the same as ARDS except the Pa02/FiO2 < 300.
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What are the risk factors of a poor outcome in ARDS?
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1). Low initial PaO2/FiO2
2). Dysfunction in 2 or more organ systems 3). CNS dysfunction Higher mortality was seen in sepsis, near-drowning, and heart disease. |
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What is the mortality rate in Pediatric ARDS?
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Flori study:
22% |
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What biomarkers are associated with ARDS?
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TNF alpha, IL beta, IL 10, soluble intercellular adhesion molecule 1 (sICAM-1)
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What is the target PIP and target effective tidal volume in treating ARDS.
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PIP or plateau pressure of 30cm;
An effective tidal volume < or = to 6ml/kg |
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How is PEEP titrated in ARDS?
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PEEP is added and PIP is adjusted down to limit barotrauma.
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In what groups might steroids be beneficial?
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AIDS patients with pneumocystis and patients with fat embolism.
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What is the role of NO in ARDS?
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No study has demonstrated an improvement in outcome but early short term oxygenation improvement is common.
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Is the response to NO in ARDS helpful prognostically?
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Yes. A poor response is associated with mortality.
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What is the role of prone positioning in ARDS?
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A large multicenter study failed to demonstrate a reduction in ventilator free days or mortality.
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What is the role of surfactant in ARDS?
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Wilson's early study with ARDS suggests benefit. No large study exists.
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What are the complications of treatment for ARDS?
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Complications of treatment:
Oxygen toxicity; Ventilator-induced lung injury; Pulmonary barotrauma is common, with air leaks occurring in nearly one half of patients. Death from refractory respiratory failure is relatively uncommon. |
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What are the major causes of death in ARDS?
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The major causes of death are sepsis or failure of other major organs, such as the heart, brain, and liver.
During the proliferative stage, diffuse interstitial fibrosis may develop. |
