Mod 8 ARDS

Question 1

What happens when there is increased membrane permeability?

Answer 1

Fluid shifts and spilling out into the alveoli

Question 2

What happens when there is a loss of surface area for gas exchange in ards?

• what causes it?

Answer 2

Caused by atelectasis, causing blockages.

• Meaning there is increased intrapulmonary shunting

Question 3

Berlin criteria: Timing

Question 4

Main aims of supportive care for ARDS?

Answer 4

Oxygen therapy

Question 5

Most important principle of ARDS treatment

Answer 5

Identify the underlying causes!

Question 6

Mech Vent approach for ARDS on a ventilator?

Answer 6

High PEEP/ Low FiO2

or

Low PEEP and High FiO2

• Lung protective strategies as well (Pplat < 30cmH2O) with driving pressures < 15

Question 7

Extra treatment on top of O2 + PEEP

Answer 7

Prone positioning

• helps to improve oxygenation [V/Q]
• Used for severe patients with P/F ratio <150

Question 8

Extra lung protective strategies

Answer 8

vv-ECMO for severe patients to help with gas exchange and improve oxygenation

• usage of NMBA’s can help with oxygenation (helps lower oxygen uptake)

Question 9

What is the development time of ARDS?

Answer 9

Ards develops within 7 days of onset.

Question 10

what symptoms are typical w/ARDS?

Answer 10

• Diffuse inflammatory lung injury
• Increased membrane permeability
• Loss of SA for gas exchange
• Bilateral Opacities on CxR, leading to hypoxemia

Question 11

The Berlin criteria for ARDS comprises of [4]?

Answer 11

1. Timing
2. Imaging
3. Origin of edema
4. Oxygenation

Question 12

Berlin criteria for ARDS: What’s timing?

Answer 12

Within one week of a known clinical insult or new/worsening resp.symptoms

Question 13

Berlin criteria for ARDS: Imaging

Answer 13

Bilateral opacities

• not fully explained by effusions, local/lung collapse or nodules

Question 14

Berlin criteria for ARDS: Origin of Edema?

Answer 14

• Resp. Failure not fully explained by cardiac failure or fluid overload
• Requires an objective assessment (echo) to exclude hydrostatic edema if risk factors are not present

Question 15

Berlin criteria for ARDS: Mild ARDS

Answer 15

PaO2/FiO2 = P/F Ratio

[300 - 200] w/PEEP > 5cmH2O

Question 16

Berlin criteria for Moderate ARDS

Answer 16

P/F Ratio < [200-100] w/PEEP > 5

Question 17

Berlin criteria for Severe ARDS

Answer 17

P/F Ratio < 100

w/PEEP > 5 cmH2O

Question 18

How often should the ARDS criteria be reevaluated?

Answer 18

24 hrs after onset

• Pt persistence is essential for the correct diagnosis of ARDS

Question 19

Is the incidence of ARDS known?

Answer 19

nope

Question 20

Annual mortality rate for ARDS?

Answer 20

Estimated to be > 30000 pts per year

Question 21

Mortality rates in very severe ARDS

Answer 21

25 - 45%

Question 22

ARDS is believed to cause what to the body?

bonus
- what are 6 complications that can be seen with ARDS?

Answer 22

systemic manifestations; leading to multi-organ failure/death

such as:

1. severe difficulty in breathing (Leads to decreased oxygenation of the blood and reduced delivery of oxygen to the body’s tissues.)
2. Systemic inflammation (cause damage to other organs)
3. Hypoxemia (decreased arterial O2 lvls)
4. Alveolar damage (fluid accumulation)
5. Increased WOB -> fatigue -> resp. muscle failure
6. Reduced lung compliance (difficult to expand and contract)

Question 23

ARDS may be caused by which 2 main etiologies?

Answer 23

• Direct lung injury
• Indirect lung injury

Question 24

What is a direct lung injury? (5)

Answer 24

• Pneumonia aspiration
• Toxic inhalation
• Chest/lung trauma
• near drowning
• Aggressive mech. ventilation

Question 25

What is indirect lung injury

Answer 25

- Sepsis - Burns - non-thoracic trauma - Massive blood transfusion - drug overdose

Question 26

What is the leading cause of ARDS?

Answer 26

Pneumonia and Sepsis

Question 27

ARDS pathology is related to what 3 traits? *hint* - what is affected on the body?

Answer 27

1. Altered pulmonary capillary permeability (increased) 2. Atelectasis 3. Increased intrapulmonary shunt **All associated w/impaired gas exchange**

Question 28

The histological correlation of ARDS consists of diffuse alveolar damage consisting of what conditions?

Answer 28

- Atelectasis - intra-alveolar hemorrhage - intra-alveolar and interstitial edema - hyaline membrane formation

Question 29

ARDS progresses via 3 distinct phases

Answer 29

- Exudative phase - fibroproliferative phase - Fibrotic phase

Question 30

ARDS Pathophysiology: Exudative phase traits?

Answer 30

- Innate immune cell mediated cell damage **(Severe inflammation)** - Altered composition/quantity of pulmonary surfactant - Bacterial or viral infection - Shock - combined resp. and metabolic acidosis

Question 31

What are aspects of cell-mediated cell damage bc of ARDS? - think severe inflammation

Answer 31

- Impaired fluid clearance - Influx of neutrophils, macrophages, lymphocytes into the alveoli - exudative of plasma and debris into alveolar spaces - unregulated release of potent cytosine mediators and immune cells enter the lungs

Question 32

ARDS Pathophysiology: fibroproliferative phase traits *edit/add stuff* slide 12

Answer 32

- Lung repair processes trying to restore alveolar functions -

Question 33

Look at ARDS.net via interventions link

Question 34

How do you know if progression of a disease pathology is indicative of ARDS?

Answer 34

ARDS = Compliance issue. - if there is a decrease in compliance.

Question 35

Secretions in the ETT is indicative of what type of problem?

Answer 35

Resistance

Question 36

How do you know if a pneumothorax has occured?

Answer 36

Pneumo is a sudden development.