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11 Cards in this Set

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ARDS definition
- Acute onset of hypoxemic resp failure w/ bilateral infiltrates on CXR
– PA wedge pressure <18 or no evidence of left atrial hypertension (no cardiogenic back pressure)
– if PaO2/FIO2 < 300, Acute Lung Injury
– if PaO2/FIO2 < 200, ARDS
Systemic Inflammatory Response Syndrome (SIRS)
systemic response to a variety of processes and fever, tachypnea, tachycardia, leukocytosis
ARDS etiology - direct lung injury
- Pneumonia and Aspiration are the main ones
– also from Pulmonary Contusion, Fat Emboli, Inhalational Injury, or Near Drowning
ARDS etiology - indirect lung injury
- Sepsis, Multiple Trauma, and Other Shock are the main ones
– also from Acute Pancreatitis, Multiple Transfusions, Drug Toxicity
Systemic Inflammatory Processes and SIRS
- Endotoxin and other bacterialproducts ->
- Release of 2o inflam mediators and Activation of coagulation and Complement activation ->
- Hypotension and Tissue damage
– you have a runaway immune system
Activated protein C and ARDS
- APC does antithrombotic effect (Va and VIIIa) and an indirect anti-inflam
– it inhibits proinflamm cytokine production, (TNF-a from monocytes), & selectins
– a profibrinolytic effect by inhibiting PAI-1 and preventing TAFI activation
Septic shock (warm shock)
– Inflam Cytokines -> NO from Vasc. Endothelium -> Low Systemic Vascular R -> high CO Hypotension
- Wide pulse pressure, Brisk capillary refill, Hyperdynamic
– there is Decreased urine output, decreased mental status, and lactic acidosis
Acute or exudative phase of ARDS
- exposure to a RF -> alveolar cap Injury or Epi Cell Injury -> Leak of Protein Rich Fluid into Interstitium and Alveolus
- Arterial hypoxemia refractory to oxygen, Bilateral patchy infiltrates, Decreased lung compliance, and rapid onset respiratory failure
Proliferative or Fibrotic Phase of ARDS
- Fibrosing Alveolitis in procollagen III peptide present day 1 or 2, Histologic changes day 5-7
- Clinical Evidence Day 5-10 is persistant hypoxemia, ↑ dead space, Further ↓ in compliance, Pulmonary hypertension, and Obliteration of pulmonary capillary bed
Recovery phase of ARDS
Gradual resolution of hypoxemia, improved lung compliance, resolution of radiographic abnormalities, and normalization of PFT’s (DLCO delayed resolution)
ARDS treatment
Treat the underlying source and support the pt w/ low pressure/low stretch ventilation