5532822
Description
Flashcards by Aaron Samide, updated more than 1 year ago
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Created by Aaron Samide
over 8 years ago
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| Question | Answer |
| Primary mechanism of ARDS | Diffuse inflammatory process due to neutrophil activation in systemic or pulmonary circulations |
| 2012 Berlin criteria for ARDS (4) | 1. Acute onset (<1 week) 2. Bilateral infiltrates on imaging 3. Pulmonary edema not otherwise explained 4. Abnormal PaO2/FiO2 ratio |
| Stratification of ARDS based on PaO2/FiO2 ratio (2012 Berlin definition) | PaO2/FiO2 ratio: 200 to 300 = mild ARDS 100 to 200 = moderate <100 = severe |
| How do ARDS and cariogenic pulmonary edema differ in terms of cause? | ARDS is caused by increased alveolar capillary permeability Cariogenic pulmonary edema is caused by congestive hydrostatic forces |
| Massive intrapulmonary ________ is a key pathophysiologic event in ARDS. | Shunting |
| Shunting in ARDS is secondary to what 3 events? | Wide-spread atelectasis Collapse of alveoli Surfactant dysfunction |
| How does shunting in ARDS manifest clinically? | Severe hypoxia with no significant improvement on 100% oxygen |
| ARDS requires high _____ to prop airways open | PEEP |
| Which patients have highest risk of developing ARDS? | Sepsis or septic shock patients |
| In addition to massive shunting, what are 3 other pathophysiologic features of ARDS? | - Decreased pulmonary compliance - Increased dead space - Low vital capacity & FRC |
| With ARDS, improvement on CXR lags behind clinical improvement by ________. | 1 to 2 weeks + |
| Most useful parameter in differentiating ARDS from cariogenic pulmonary edema | Post-capillary wedge pressure (PCWP) Low PCWP (<18) suggests ARDS Higher suggests cardiogenic edema |
| T/F: Routine placement of pulmonary artery catheters to determine PCWP has been shown to benefit ARDS patients. | False |
| Treatment of ARDS | - Oxygenation (to >90% sat) - Mechanical ventilation with high PEEP and low tidal volumes - Fluid management; maybe pressors - Treat underlying cause |
| 7 possible complications of ARDS | 1. Permanent lung injury 2. Mechanical ventilation-related problems: barotrauma, nosocomial PNA 3. Line-associated infections 4. Renal failure 5. Ileus, stress ulcers 6. Multi-organ failure 7. Critical illness myopathy |
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