ARDS

Question 1

• Pulmonary edema caused by increased pulmonary capillary permeability
• Severe lung injury with respiratory distresspossible respiratory failure
• Criteria for diagnosis is within 7 days of trigger
• May occur within 2 hours of a trigger, often 12-48 hours
• Bilateral pulmonary opacities—*within the alveoli
• Noncardiogenic
• Impaired gas exchange
• PaO2/FiO2<300mm Hg, with PEEP >/= 5cm H2O
• 3 inclusion and 1 exclusion criteria
• Not a specific disease, clinical syndrome that can result from a variety of disease
  states—we don’t know how to specifically prevent it

Answer 1

ARDS

Question 2

ARDS risk factors

Answer 2

sepsis**

Question 3

Severity of ARDS is based on the level of oxygenation impairment

Answer 3

• Mild= PaO2/FIO2 ratio between 200 and 300mm Hg
• Moderate=PaO2/FIO2 ratio between 100 and 200mm Hg
• Severe=PaO2/FIO2 ratio less than 100mm Hg

Question 4

steps of ARDS

Answer 4

Inflammation–> cytokines–> damage to pulmonary capillary endothelial
cells and alveolar epithelial cells–> increased vascular
permeability–> decreased production and activity of surfactant –> interstitial and alveolar edema –> alveolar collapse –> hypoxemia

Question 5

• Profound dyspnea, cyanosis, tachypnea, intercostal retractions,
  crackles
• CXR—diffuse patchy infiltrates that proceed rapidly and become
  confluent
• Air bronchograms
• Heart size normal
• Marked hypoxemia that is refractory to oxygen supplementation
• Multi-organ system failure is common
• Try to r/o something treatable
• PNA, autoimmune problem, alveolar hemorrhage, acute heart problem

Answer 5

ARDS symptoms

Question 6

characteristic of ARDS

Answer 6

Air bronchogram—air-filled bronchi surrounded by alveoli filled with fluid, pus or other material. It is highly sensitive and specific for the presence of lung consolidation.

Question 7

ARDS treatment

Answer 7

• Usually requires mechanical ventilation with PEEP
• Lowest levels of PEEP and O2 required
• Prone positioning
• Central venous catheter
• Fluid management
• ECMO—for very severe cases

Question 8

Mortality with ARDS usually associated with

Answer 8

multiple organ failure of sepsis