Review of Acute Respiratory Distress Syndrome
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| What are the names of the phases of ARDS? | show 🗑
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| Which blood cells aggregate after lung injury in the exudative phase of ARDS? | show 🗑
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| Which inflammatory substances are released in the process of the development of ARDS in the exudative phase of ARDS that inflame and damage the alveolar membrane? | show 🗑
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| show | Sepsis
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| show | ARDS
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| show | Trick question ;0(
ARDS is not a disease -- it's a syndrome. You have to identify and treat the underlying cause of ARDS (injury to the lung, sepsis, etc...)
ARDS is the result or consequence of injury to the lung.
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| What is barotrauma? | show 🗑
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| show | Tidal volumes (Vt) are smaller to minimize the risk of barotrauma in ARDS patients.
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| show | Hypercapnia or higher CO2 levels are allowed in ARDS than in "other" patients.
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| show | Positive End Expiratory Pressure.
The increase in end-expiratory volume prevents alveolar collapse on exhalation, thereby maintaining ventilation–perfusion ratios and improving oxygenation. necessary to achieve a given change in volume.
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| show | Amount of air breathed in or out per breath. Also utilized as one of the ventilator settings for the amount of air delivered to patient through mechanical ventilation.
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| show | Higher positive end-expiratory pressure (PEEP) levels may reduce atelectrauma, but increase over-distention lung injury. Whether higher PEEP improves clinical outcomes among patients with acute respiratory distress syndrome (ARDS) is unclear.
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| What is subcutaneous emphysema? | show 🗑
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| What causes subcutaneous emphysema in ARDS? | show 🗑
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| Why are the kidneys at risk in ARDS? | show 🗑
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| show | An attempt to suppress inflammation. Keep in mind - the inflammatory process is what starts the damage to the alveoli capillaries.
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| Are inotropes and/or vasopressors (PNS drugs used for shock) appropriate for ARDS? and why? | show 🗑
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| show | 1. Hemodynamic monitoring (more invasive/accurate than just BP)
2. Fluid balance. Prevent dehydration and Pulmonary Edema
3. Inotropes and Vasopressors
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| show | Yes, if the underlying lung trauma involves a bacterial infection.
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| In which phase of ARDS is there diffuse scarring and fibrosis that can result in decreased lung compliance? | show 🗑
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| show | Diffuse scarring and fibrosis that can result in decreased lung compliance.
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| show | Proliferative phase
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| show | lung compliance is worsened due to the "stiffness" caused by the fibrosis. Characteristic of the Proliferative Phase
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| What is the effect of thickened alveolar membranes in the proliferative phase of ARDS? | show 🗑
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| show | Either! Direct: *Lung contusions, FB aspiration, drowning, smoke inhalation, infection, pneumonia, embolism—fat, thrombus, air.
Indirect: *Severe sepsis, multi-system trauma, shock, drug overdose, pancreatitis, ↑ ICP, radiation therapy
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| show | ARDS
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| Phase of ARDS where long-term ventilator or supplemental oxygen may be required. | show 🗑
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| show | Exudative phase
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| show | Fibroproliferative (proliferative) phase
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| What impact on compliance is there with the following: 1. Loss of surfactant 2. Damage to alveolar capillaries leading to protein/inflammatory rich liquid leaking into alveoli | show 🗑
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| show | a greater pressure ( P) than normal is required to give the same increase in volume ( V). Common causes of decreased lung compliance are pulmonary fibrosis (occurs in ARDS and other syndromes/diseases), pneumonia and pulmonary edema.
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| show | Two factors prevent the lungs from collapsing: surfactant and the intrapleural pressure. Surfactant is a surface-active lipoprotein complex formed by type II alveolar cells.
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| Why would a drug like pancuronium or vecuronium be used in the treatment plan for a patient in the proliferative phase of ARDS? | show 🗑
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| If pancuronium or vecuronium is utilized in ARDS why is a sedative necessary? | show 🗑
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| show | Neither! Patients on neuromuscular blockers have paralyzed diaphragms and are unable to breathe independently which requires mechanical ventilation. (ventilator)
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