Clinical Perspective of Respiratory Failure & ARDS

Question 1

What are the treatment steps for acute respiratory distress?

Answer 1

1 - establish an airway
2 - administer O2
3 - maintain ventilation
4 - hemodynamic support
5 - treat underlying cause

Question 2

For every 1L increase in O2, how much is FiO2 increased?

Answer 2

By 3%

Question 3

What are the Berlin criteria for acute respiratory distress syndrome?

Answer 3

Develops within a week of insult, bilateral opacities on CXR, not fully explained by cardiac failure or hypervolemia

Question 4

These disorders present with failure of oxygenation and an abnormal (“white”) chest x-ray.

Answer 4

Lung infection, congestive heart failure, atelectasis, pleural effusion, pulmonary edema not related to the heart

Question 5

The V/Q ration measure ventilation and perfusion of the lungs. What would be the ratio in a patient with adequate ventilation, but poor perfusion.

Answer 5

V/Q > 1

Question 6

These factors shift the oxyhemoglobin curve to the left, indicating an increased O2 affinity.

Answer 6

Increased pH

Decreased temperature, CO2, 2,3-DPG

Question 7

These disorders prevent with a failure of oxygenation, but normal chest x-ray.

Answer 7

Pulmonary embolism, COPD/asthma exacerbation, R to L shunt, low cardiac output, microatelectasis

Question 8

What immune cells mediates acute respiratory distress syndrome?

Answer 8

Neutrophils

Question 9

What is a venturi mask?

Answer 9

A type of oxygen mask that allows delivery of a specific FiO2 independent of patient RR

Question 10

What is the most common cause of death in patients with acute respiratory distress syndrome?

Answer 10

Sepsis and multiorgan dysfunction

Question 11

What does a V/Q < 1 indicate?

Answer 11

Poor ventilation with adequate perfusion

Question 12

What are the indications for intubation?

Answer 12

Respiratory failure, airway protection, hypothermia, hyperventilation

Question 13

While PEEP is helpful to treat ARDS patients, a higher PEEP is not always best. How does PEEP help improve outcomes?

Answer 13

Opens atelectatic, fluid-filled alveoli

Question 14

True/False. When treating patients with acute respiratory distress syndrome, a low tidal volume is preferred.

Answer 14

True - this prevents damage to the alveoli and capillaries

Low TV has been shown to lead to better outcomes

Question 15

This type of acute respiratory failure is due to a decreased respiratory drive.

Answer 15

Type 2 - Hypercapnia

CO2 increases, and O2 decreases

Question 16

True/False. Placing a patient in a prone position improves V/Q.

Answer 16

True - this is sometimes used in patients with ARDS. Improvements are seen within 30mins

Question 17

BIPAP is used to treat patients in acute respiratory failure. How does BIPAP differ from CPAP?

Answer 17

BIPAP delivers a continuous positive pressure, but decreases pressure when the patient exhales for more ease

Question 18

These factors shift the oxyhemoglobin curve to the right, indicating a decreased O2 affinity.

Answer 18

Increased temperature, CO2, 2,3-DPG

Decreased pH

Question 19

True/False. A hypercapnic patient with present with blueish discoloration.

Answer 19

False - they appear red. Hypoxic patients appear blue

Question 20

What are the two classifications of acute respiratory failure?

Answer 20

Type 1 - hypoxemic respiratory failure

Type 2 - hypercapnic respiratory failure

Question 21

True/False. Corticosteroids have been shown to improve outcomes in patients with ARDS.

Answer 21

False - but could administered as a last resort option