Respiratory pathophysiology 8 Flashcards
What are the MOST important strategies for managing mechanical ventilation in the patient with acute respiratory distress syndrome? (select 2)
a. low tidal volume
b. reducing plateau pressure
c. high-frequency oscillatory ventilation
d. permissive hypocapnia
a. low tidal volume
b. reducing plateau pressure
ARDS is a form of
non-cardiogenic pulmonary edema
We make the ARDS diagnosis with the
Berlin definition of ARDS
The most common pulmonary etiology of ARDS is
pneumonia
The most common extra-pulmonary etiology of ARDS is
sepsis
ARDS is caused by
inflammation injury (mediated by neutrophils and platelets) leading to diffuse alveolar destruction
Key pathophysiologic features of ARDS include:
protein-rich pulmonary edema
loss of surfactant
hyaline membrane formation
possible long-term lung injury
The ______ position may improve V/Q matching allowing a higher PaO2 for a given FiO2.
prone
CXR in the ARDS patient reveals
bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules
Strategies and tactics for mechanical ventilation include:
pressure control ventilation
low Vt (4-6 mL/kg IBW)
PEEP titrated with FiO2 (keep FiO2 below 50% if possible)
Plateau pressure <30 cm H2O
RR 6-35 BPM (permissive hypercapnia if needed)
I:E ratio 1:1-1:3
The target oxygenation goals for the patient with ARDS is
PaO2 55-80 mmHg or SpO2 88-95%
The Berlin definition of ARDS includes
time of onset
diagnostic imaging results
origin of edema
classifies patients based on disease severity
Mild ARDS is defined as
PaO2/FiO2 ratio <201-300 mmHg
Moderate ARDS is defined as
PaO2/FiO2 ratio <101-200 mmHg
Severe ARDS is defined as
PaO2/FiO2 ratio <100 mmHg
