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20 Cards in this Set

  • Front
  • Back
What are the clinical diagnostic dcriteria for a diagnosis of ARDS?
This will be a test question:

4 of them:
-Acute (6 hrs - 3 days0
-Diffuse bilateral infiltrates on CXR
-Hypoxic: PaO2/FiO2 < 200
-Non-cardiogenic: PCWP<18
What are common causes of direct lung injury that can lead to ARDS?
Pneumonia (any cause)
Aspiration of gastric contents

Uncommon:
Pulmonary confusion
Fat embolism
Amniotic fluid embolism
Near-drowning
Inhalational injury
Reperfusion injury post-transplant
What are common causes of indirect lung injury that can lead to ARDS?
Common causes:
SEPSIS!
Severe trauma with shock
Acute pancreatitis

Uncommon:
Multiple transfusions
Drug overdose
Diffuse intravascular coagulation
What other pulmonary conditions can present acutely with bilateral infiltrates and hypoxemia?
CHF
Pneumonia
Alveolar hemorrhage
Aspiration
What is the pathogenesis of ARDS?
1. Acute insult to the lungs
2. Invasion of inflammatory cells
3. Damage of the alveolar surface (epithelium, type 1 cells)
4. Inactivation of surfactant --> increased surface tension
5. LEAKAGE OF PROTEIN-RICH FLUID INTO THE ALVEOLI
6. Matrix formed on surface of alveoli of fibrin: "Hyaline membrane"
What does ARDS look like on CT?
Heterogenous white infiltrates on CT
What features of ARDS are present on this slide?
Thickened alveoli
Hyaline deposits
What are the phases of ARDS?
Exudative
Proliferative
Fibrotic

All are a week apart
What processes occur during the exudative phase of ARDS?
1. Damage to capillary membranes--> alveolar flooding
2. Oxygenation falls
3. Decreased compliance of lungs

All of this leads to bilateral infiltrates on CXR
What processes occur during the proliferative phase of ARDS?
1. Lung repair
2. Resolution of the infiltrates

You can't really distinguish this clinically from the exudative phase
What processes occur during the fibrotic phase of ARDS?
Permanent remodeling of the lung--> loss of long term function
What do you need to keep in mind for patients with ARDS on a vent?
Lungs have less volume, are less compliant

Give them a smaller tidal volume
With ventilating patients, what is a problem of high respiratory rates? What do you have to do sometimes to achieve this?
Hypercapnea

This is acceptable due to the fact that damaging their lungs is worse than having them have a low blood pH

Sedate them.
How should you decide on PEEP for a patient? Why is this a concern"
Titrate to the level at which you have the best O2 sats

You can impair venous return
What position is best for improving oxygenation in patients? Why?
Prone position

Best matches V and Q
What is the ventilation limit for RR in ARDS? Pressure? TV?
35 bpm

30 cm H20

6 cc/kg
What is a risk of keeping someone on 100% O2 for too long?
Oxygen toxicity long term
What are some ways not related to ventilator settings that you can improve oxygenation?
Prone positioning
Inhaled NO
What are some medications that you can give to people for improving the symptoms from ARDS? What is the effect of doing this?
Diuretics to decrease the amount of lung water

Gets them off the vent earlier, but doesn't improve mortality

Only give this to patients if they're hemodynamically stable! If they're super hypotensive, don't do it!
When in the course of ARDS should you consider giving systemic steroids?
Late in the course.