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ARDS Part 1 Flashcards

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1
Q

A syndrome of clinical findings that is characterized by diffuse lung injury and non-cardiogenic pulmonary edema

A

Acute Respiratory Distress Syndrome (ARDS)

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2
Q

Is ARDS a syndrome or a disease?

A

A syndrome

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3
Q

What is ARDS caused by?

A

Any insult that causes severe, systemic, inflammatory response in the lungs

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4
Q

How does ARDS progress?

A

Rapidly

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5
Q

What type of respiratory failure is ARDS?

A

Hypoxemic

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6
Q

What causes the hypoxemic respiratory failure with ARDS?

A

Intrapulmonary shunting of blood resulting from airspace filling or collapse

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7
Q

What is ARDS also called?

A

Shock lung or Wet lung

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8
Q

Is ARDS usually accompanied by hypercapnea?

A

NO

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9
Q

Is ARDS the primary illness or is it secondary?

A

SECONDARY

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10
Q

What is the mortality rate?

A

40-50%

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11
Q

How long does it usually take ARDS to develop after the precipitating event?

A

48 hours

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12
Q

What happens to the alveolar capillary membrane with ARDS?

A

Increase in permeability

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13
Q

What direct injuries cause ARDS?

A
  • Aspiration
  • Pulmonary infections or contusions
  • Toxic inhalation
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14
Q

What direct injury causes about 1/3 of ARDS cases?

A

Aspiration

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15
Q

What indirect injuries can cause ARDS?

A
  • Sepsis
  • Hyper-transfusion of blood
  • Trauma
  • Pancreatitis
  • Cardiopulmonary bypass
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16
Q

What indirect injury causes about 1/3 of ARDS cases?

A

Sepsis

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17
Q

What do some people think that ARDS has a lot to do with?

A

Systemic Inflammatory Response Syndrome (SIRS)

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18
Q

What is usually the first organ to go in multiple organ failure?

A

Lungs

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19
Q

What does increased permeability of the alveolar-capillary membrane lead to?

A

Pulmonary interstitial and alveolar edema

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20
Q

Why do patients have too much fluid in the interstitial spaces with ARDS?

A

It is a MEMBRANE problem (alveolar capillary membrane permeability)

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21
Q

What does the lung tissue of someone who has ARDS look like?

A
  • Wet
  • Heavy
  • Mushy
  • Thickened
  • Edematous
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22
Q

What is NOT the cause of the pulmonary edema with ARDS?

A

A volume problem

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23
Q

What signs of dyspnea does an ARDS patient present with?

A

Rapid shallow respiration

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24
Q

Do ARDS patients initially present with respiratory alkalosis or acidosis?

A

Respiratory Alkalosis

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25
What does refractory hypoxemia mean?
Their SaO2 and SPO2 remain low even after administration of oxygen (unresponsive to oxygen)
26
What does the term refractory mean?
Resistant to treatment
27
What does the chest x-ray look like with ARDS?
Uneven patchy distribution of pulmonary edema (fluffy lungs that look like clouds)
28
Is ARDS unilateral or bilateral?
ALWAYS BILATERAL
29
Where is the fluid at in ARDS?
Alveoli spaces not pleural space
30
What happens to functional residual capacity with ARDS?
Continually lowers (lungs get stiff and lose compliance)
31
How will a pulmonary artery catheter help rule out pulmonary edema from HF?
Because the PCWP will be normal indicating that it is a lung issue
32
What do they base the diagnosis of ARDS on?
Clinical presentation
33
When does stage one of ARDS occur?
Within the first 24 hours of ARDS
34
Is ARDS still reversible at stage one?
Yes if you can reverse the triggering event
35
What are the 4 clinical signs in stage one of ARDS?
- Dyspnea - Tachypnea - Neutrophils sequester - Crackles
36
What is stage two of ARDS and when is it?
Proliferative phase that begins 3-6 days after onset
37
What is happening to interstitial and alveolar edema in stage two of ARDS?
It is increasing
38
What starts to infiltrate the lungs in stage two of ARDS?
Fibroblasts and other inflammatory cells
39
Why do fibroblasts and inflammatory cells enter the lungs during stage two?
Trying to repair the damage but they are really altering the structure of the lungs
40
How long does stage two last?
Until about the 10th day
41
What develops in stage three of ARDS?
Generalized edema and multi-organ involvement
42
What happens to hemodynamics in stage three of ARDS?
Become unstable
43
What happens to CO2 during stage three of ARDS?
Begin to retain CO2 so they become hypercapneic
44
What starts to develop in the alveoli and interstitial spaces during stage three of ARDS?
Diffuse fibrotic scarring that is not reversible
45
What does scarring in the lungs cause?
Pulmonary HTN
46
What does severity of scarring depend on?
Stage of diagnosis and how much change occurs
47
What kind of shunt occurs with ARDS?
Right to Left (unoxygenated blood is being shunted to the left side)
48
What causes the shunt in ARDS?
Pulmonary edema that prevents adequate oxygenation
49
What kind of blood is being sent to systemic circulation?
Unoxygenated
50
What is surfactant?
Phospholipid that produces surface tension in the alveoli
51
What happens to surfactant when fluid fills the alveoli?
It is inactivated and the alveoli collapse
52
What does alveolar collapse cause?
Atelectasis that further decreases gas exchange and worsens hypoxemia
53
What does alveolar hypoxia cause in the pulmonary vasculature?
Pulmonary Vasoconstriction
54
What can develop as a result of increasing pulmonary vascular resistance?
Micro-emboli
55
What increases the work of breathing with ARDS?
Altered lung compliance due to lungs becoming more stiff
56
What is the reduction in lung volumes thought to be due to?
Stimulation of the inflammatory/immune system
57
What is hypothesized to be the culprit causing acute lung injury in ARDS?
Polymorphonuclear Leukocytes (PMN)
58
What would their initial PaO2 and PaCO2 be with ARDS?
Both decreased because they are breathing rapidly and blowing off CO2
59
What is the A-a gradient?
The difference between alveolar oxygen tension (amount of oxygen gas in the alveoli) and arterial oxygen tension
60
What is alveolar O2 tension a result of?
Concentration of O2 the client inspires
61
What is arterial O2 tension a result of?
How much of the O2 in the alveoli is able to cross the alveolar capillary membrane
62
What is the normal PAO2 (alveolar oxygen tesion)?
104 mmHg
63
What is the normal PaO2 (arterial oxygen tension)?
95-100
64
How do you figure the A-a gradient?
PAO2-PaO2
65
What is the normal A-a gradient?
Less than 15
66
What does it mean if the A-a gradient is greater than 15?
Hypoxia
67
What kind of A-a gradient will ARDS patients have?
200-300 mmHg
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