Lec 14 ARDS Flashcards Preview

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Flashcards in Lec 14 ARDS Deck (28):
1

What characterizes ARDS?

- PaO2/FiO2 < 200
- hypoxemia
- bilateral lung infiltrates
- no left atrial HTN

2

What characterizes acute lung injury [ALI]?

Pao2/FIO@ < 300

less severe hypoxemia

3

What is most important cause of ARDS?

sepsis

4

What are some things that cause ARDS?

sepsis
pneumonia
aspiration
pancreatitis
trauma
burn
trasnfusion

5

What is incidence of acute lung injury? ARDS?

acute lung injury = 80 / 10,000
ARDS = 59 / 10,000

6

What do you see on pathology in ARDS?

diffuse alveolar damage [DAD}
failure of alveolar capillary membrane and flooding of alveolar airspaces with proteinaceous fluid

oxygen derived free radicals cause microvascular injury and multi-organ failure

7

What inflammatory cytokines involved in development of ARDS?

TNF-alpha
IL-1
IL-8

8

What happens to surfactant in ARDS?

have depletion of surfactant --> atelectasis, gas exchange disturbance and decreased pulmonary compliance

9

What happens to microcirculation in ARDS?

altered NO and cytokine induced activation of coagulation cascade

10

What happens to fibroblasts in late phase ARDS?

fibroblasts proliferate

11

What is VILI?

ventilator induced lung injury = caused by us; we give positive airways pressure ventilation

since ARDS is patchy --> there are patches of normal lung that get injured by the ventilation

cause barotrauma and volutrauma --> cytokines released

12

What is history of ARDS?

edema phase = 1st 2 days --> alveolar capillary basement membrane broken down; proteinacious fluid exudes into alveolar space

hyaline membranes organizing = starts day 2; peaks day 4 and declines by day 7

fibroblast proliferation = starts day 7 --> leads to interstitial fibrosis

13

What is exudative vs proliferative phase of ARDS?

exudative = 1st week; have edema + hyaline membranes

proliferative = 2nd week; have interstitial inflammation + fibrosis due to fibroblast proliferation

14

What is triad for ARDS diagnosis?

bilateral lung infiltration
hypoxemia
no LA hypertension

15

What does imaging tell you in ARDS?

- necessary for diagnosis to see bilateral lung infiltrate
- tells you nothing about the stage

16

What is treatment for ARDS?

treat underlying cause [sepsis, pneumonia, etc]

due low tidal volume ventilation to avoid VILI

17

What is the only ARDS treatment with known mortality benefit?

low tidal volume ventilation

18

What is mortality of ARDS?

28-42%

19

How does ARDS mortality differ with diagnosis?

worse prognosis if sepsis related compared to trauma/transfusion related

20

What are predictors of ARDS mortality?

- advanced age
- sepsis
- degree of other organ dysfunction
- co-morbidities

21

What happens to lung function after ARDS?

- survivors can have persistent restrictive impaired lung function

22

What are some non=pulmonary sequelae in ARDS?

- muscle wasting
- polyneuropathy
- neurocognitive impairment
- depression
- anxiety
- PTSD

23

What happens in neonatal respiratory distress syndrome?

- happens in premature babies < 37 wks
- have lack of surfactant --> rapid shallow breathing, flaring, retraction, cyanosis within minutes of birth
- ground glass on chest xray

24

What are findings in neonatal RDS?

- hypoxemia, hypercapnea
- ground glass on chest xray

25

Who is most at risk for neonatal RDS?

- premature babies
- mother with diabetes

26

How do you prevent neonatal RDS?

steroids to induce surfactant production between 24-34 wks of pregnany

27

What is treatment for neonatal RDS?

- CPAP
- vent support
- minimize O2 tox
- artificial surfactant

28

What is clinical course of neonatal RDS?

worse over 2-4 days then improved