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Patho 1 (PATH 254) > Mod 8 ARDS > Flashcards

Mod 8 ARDS Flashcards

1
Q

What happens when there is increased membrane permeability?

A

Fluid shifts and spilling out into the alveoli

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2
Q

What happens when there there is a loss of surface area for gas exchange?
- what causes it?

A

Caused by atelectasis, causing blockages.

  • Meaning there is increased intrapulmonary shunting
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3
Q

Berlin criteria: Timing

A
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4
Q

Main aims of supportive care for ARDS?

A

Oxygen therapy

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5
Q

Most important principle of ARDS treatment

A

Identify the underlying causes!

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6
Q

What are treatment workflow should you follow for ARDS on a ventilator?

A

High PEEP/ Low FiO2

or

Low PEEP and High FiO2

Lung protective strategies as well (Pplat < 30cmH2O)

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7
Q

Extra treatment on top of O2 + PEEP

A

Prone positioning

  • helps to improve oxygenation [V/Q]
  • Used for severe patients with P/F ratio <150
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8
Q

Extra lung protective strategies

A

vv-ECMO for severe patients to help with gas exchange and improve oxygenation

  • usage of NMBA’s can help with oxygenation (helps lower oxygen uptake)
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9
Q

What is the development time of ARDS?

A

Acute resp. disease that develops within 7 days of onset.

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10
Q

what symptoms are typical w/ARDS?

A
  • Diffuse inflammatory lung injury
  • Increased membrane permeability
  • Loss of SA for gas exchange
  • Bilateral Opacities on CxR, leading to hypoxemia
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11
Q

The Berlin criteria for ARDS comprises of [4]?

A
  1. Timing
  2. Imaging
  3. Origin of edema
  4. Oxygenation
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12
Q

Berlin criteria for ARDS: What’s timing?

A

Within one week of a known clinical insult or new/worsening resp.symptoms

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13
Q

Berlin criteria for ARDS: Imaging

A

Bilateral opacities

  • not fully explained by effusions, local/lung collapse or nodules
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14
Q

Berlin criteria for ARDS: Origin of Edema?

A
  • Resp. Failure not fully explained by cardiac failure or fluid overload
  • Requires an objective assessment (echo) to exclude hydrostatic edema if risk factors are not present
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15
Q

Berlin criteria for ARDS: Mild ARDS

A

PaO2/FiO2 = P/F Ratio

[300 - 200] w/PEEP > 5cmH2O

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16
Q

Berlin criteria for Moderate ARDS

A

P/F Ratio < [200-100] w/PEEP > 5

17
Q

Berlin criteria for Severe ARDS

A

P/F Ratio < 100

w/PEEP > 5 cmH2O

18
Q

How often should the ARDS criteria be reevaluated?

A

24 hrs after onset

  • Pt persistence is essential for the correct diagnosis of ARDS
19
Q

Is the incidence of ARDS known?

A

nope

20
Q

Annual mortality rate for ARDS?

A

Estimated to be > 30000 pts per year

21
Q

Mortality rates in very severe ARDS

A

25 - 45%

22
Q

ARDS is believed to cause what to the body?

bonus
- what are 6 complications that can be seen with ARDS?

A

systemic manifestations; leading to multi-organ failure/death

such as:

  1. severe difficulty in breathing (Leads to decreased oxygenation of the blood and reduced delivery of oxygen to the body’s tissues.)
  2. Systemic inflammation (cause damage to other organs)
  3. Hypoxemia (decreased arterial O2 lvls)
  4. Alveolar damage (fluid accumulation)
  5. Increased WOB -> fatigue -> resp. muscle failure
  6. Reduced lung compliance (difficult to expand and contract)
23
Q

ARDS may be caused by which 2 main etiologies?

A
  • Direct lung injury
  • Indirect lung injury
24
Q

What is a direct lung injury? (5)

A
  • Pneumonia aspiration
  • Toxic inhalation
  • Chest/lung trauma
  • near drowning
  • Aggressive mech. ventilation
25
Q

What is indirect lung injury

A
  • Sepsis
  • Burns
  • non-thoracic trauma
  • Massive blood transfusion
  • drug overdose
26
Q

What is the leading cause of ARDS?

A

Pneumonia and Sepsis

27
Q

ARDS pathology is related to what 3 traits?

hint

  • what is affected on the body?
A
  1. Altered pulmonary capillary permeability (increased)
  2. Atelectasis
  3. Increased intrapulmonary shunt

All associated w/impaired gas exchange

28
Q

The histological correlation of ARDS consists of diffuse alveolar damage consisting of what conditions?

A
  • Atelectasis
  • intra-alveolar hemorrhage
  • intra-alveolar and interstitial edema
  • hyaline membrane formation
29
Q

ARDS progresses via 3 distinct phases

A
  • Exudative phase
  • fibroproliferative phase
  • Fibrotic phase
30
Q

ARDS Pathophysiology: Exudative phase traits?

A
  • Innate immune cell mediated cell damage (Severe inflammation)
  • Altered composition/quantity of pulmonary surfactant
  • Bacterial or viral infection
  • Shock
  • combined resp. and metabolic acidosis
31
Q

What are aspects of cell-mediated cell damage bc of ARDS?

  • think severe inflammation
A
  • Impaired fluid clearance
  • Influx of neutrophils, macrophages, lymphocytes into the alveoli
  • exudative of plasma and debris into alveolar spaces
  • unregulated release of potent cytosine mediators and immune cells enter the lungs
32
Q

ARDS Pathophysiology: fibroproliferative phase traits
edit/add stuff
slide 12

A
  • Lung repair processes trying to restore alveolar functions

-

33
Q

Look at ARDS.net via interventions link

A
34
Q

How do you know if progression of a disease pathology is indicative of ARDS?

A

ARDS = Compliance issue.

  • if there is a decrease in compliance.
35
Q

Secretions in the ETT is indicative of what type of problem?

A

Resistance

36
Q

How do you know if a pneumothorax has occured?

A

Pneumo is a sudden development.

Patho 1 (PATH 254) (17 decks)

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