Acute Resporatory Distress Syndrome Flashcards
ARDS
It is also known as “_______” or ________.
shock lung
acute lung injury.
ARDS
It is characterized by the abrupt onset of significant ______ and bilateral ________ in the absence of ________
hypoxemia
pulmonary infiltrates
cardiac failure
In ARDS
There is diffuse ___________
This is characterised by life-threatening __________,__________, and _________.
alveolar capillary damage
respiratory insufficiency, cyanosis and severe arterial hypoxaemia
ARDS may eventually lead to multisystem organ failure.
T/F
T
Predisposing conditions to ARDS include: - Infections
Physical/Injury
Inhaled Irritants
Chemical Injury
Hematologic conditions
!
Morphology of ARDS
In the acute stage
-the lungs are (light or heavy?), (loose or firm?) , ___ color and _____.
There is _______, ________ and ______ oedema.
The alveolar walls become lined with ___________.
Heavy; Firm; Red; Boggy
congestion
interstitial and intra- alveolar
hyaline membranes
Morphology of ARDS:
In organizing stage
the _________ proliferate to regenerate epithelial lining.
________ is unusual.
The _____ exudates become organized with resultant ___________
type II pneumocytes
Resolution
fibrin
intra-alveolar fibrosis.
Pathogenesis of ALI/ARDS
•is initiated by injury of _______ and ______
•___________ is an important early event.
•In some instances, ________ is secondary to _______, which is sensed by resident ________.
In response, these immune sentinels secrete mediators such as ____ that act on the neighboring endothelium.
Alternatively, _______ may activate pulmonary endothelium directly.
Some of these mediators _____ endothelial cells, while others (notably ______) _______ endothelial cells to express increased levels of adhesion molecules, procoagulant proteins and chemokines.
pneumocytes and pulmonary endothelium.
Endothelial activation
endothelial activation; pneumocyte injury; alveolar macrophages
TNF; circulating inflammatory mediators
injure; cytokines ; activate
Pathogenesis OF ARDS: Adhesion and Extravasation of neutrophils.
Neutrophils adhere to the activated endothelium and migrate into the _______ and _______, where they _______
This followed by release of inflammatory mediators, including proteases, reactive oxygen species, and cytokines.
macrophage _____________ (MIF) released into the local milieu also helps to _______________________
This leads to ____eased recruitment and adhesion of leukocytes.
_______________ and _________ worsens
interstitium and the alveoli; degranulate
migration inhibitory factor
sustain the ongoing proinflammatory response.
incr
Endothelial injury and local thrombosis
Pathogenesis of ARDS: Accumulation of intraalveolar fluid and formation of hyaline membranes.
Endothelial activation and injury make pulmonary capillaries ______, allowing ________ and ________ to form.
Damage and necrosis of __________ leads to ______ abnormalities.
The inspissated ____-rich edema fluid and debris from dead ________ cells _____ into ______, a characteristic feature of ALI/ARDS.
leaky
interstitial and intraalveolar edema fluid
type II alveolar pneumocytes; surfactant
protein; alveolar epithelial ; organize ; hyaline membranes
Pathogenesis of ARDS: Resolution of injury is impeded in ALI/ARDS due to ___________ and ______ damage and poor _______-.
The macrophages remove intraalveolar _____ and release _____ cytokines such as _______ and ________
These factors stimulate ______ growth and _______ deposition, leading to fibrosis of _________
______________ proliferate to replace pneumocytes.
Endothelial restoration occurs through proliferation of ______________
profound epithelial necrosis
inflammatory; edema resorption.
debris; fibrogenic; transforming growth factor β (TGF-β) and platelet derived growth factor (PDGF).
fibroblast; collagen; alveolar walls.
Bronchiolar stem cells; uninjured capillary endothelium.
Clinical Course of ARDS
The affectation of the lungs in areas is _____ and _______ with normal ______ areas.
There is resultant _______/_______ imbalance and ________.
The mortality rate is close to ____% in USA.
The prognosis is worse in ________ and _________
diffuse, and focal; spared
ventilation/perfusion
hypoxaemia; 60
chronic alcoholics and smokers
ARDS
Triggers
•_______ (most common)
• Infection (PNA)
• _______
• Trauma
• Acute ______
• ______________________ (TRALI)
Sepsis
Aspiration
pancreatitis
Transfusion-related acute lung injury
ARDS
Treatment
•_______
• Low _______
• ————- care (fluids, nutrition)
•_______ pneumonia is serious complication
Mechanical ventilation
tidal volume
Supportive
VAP
VAP pneumonia is A serious complication in of ARDS
T/F
T
