Deck 29: Acute Respiratory Distress Syndrome

Question 1

A therapist is evaluating the progress of a patient with ARDS.The arterial blood gas reveals a PaO? of 55 mm Hg and a PaCO? of 65 mm Hg.The PEEP is set at 12 cm H?O,and the mean airway pressure is 18 on an FiO? of 0.60.What is the OI in this patient?

A)20.7
B)13.1
C)1.31
D)200

Answer 1

20.7

Question 2

Which of the following ventilatory strategies is appropriate when mechanically ventilating a patient with ARDS?

A)PEEP less than 15 cm H₂O and tidal volume (VT)between 8 and 10 mL/kg
B)Peak inspiratory pressure (PIP)less than 40 cm H₂O and Pplateau less than 30 cm H₂O
C)VT less than 6 mL/kg and Pplateau less than 30 cm H₂O
D)A high or low level of PEEP and a VT between 8 and 10 mL/kg

Answer 2

C
The ARDS Network investigated the optimal PEEP-FiO₂ strategy for adults with ARDS.The results of this prospective,randomized,multicenter study indicate that in adult ARDS patients who are ventilated with 6 mL/kg tidal volumes and an end-inspiratory plateau pressure of less than 30 cm H₂O,a "moderately high" or "very high" PEEP strategy produced similar survival rates.It must be noted that this study investigated two relatively aggressive PEEP strategies.Subsequent studies performed outside the United States also showed similar results.In a study involving 30 ICUs and 983 adult patients with ARDS,there was no difference in hospital mortality despite the reduction in the need of rescue therapies in the "high" PEEP group.A recent systematic review on the effect of PEEP in ARDS showed that the subgroup of ARDS patients who may stand to benefit most from a "high" PEEP strategy are those with the worst degree of hypoxemia.

Question 3

What are some of the physical signs of respiratory failure among children?
I)Head bobbing
II)Nasal flaring
III)Crying
IV)Grunting

A)I and II only
B)I,II,and IV only
C)I,III,and IV only
D)II,III,and IV only

Answer 3

B
The physical signs of respiratory failure will vary with age and include subcostal and supraclavicular retractions,grunting (i.e. ,an attempt to generate increased intrinsic positive end-expiratory pressure,PEEP),nasal flaring,and head bobbing.

Question 4

Which of the following pathophysiologic changes seen in ARDS is responsible for the decrease in available surface area for gas exchange?

A)Hyperinflation of the lungs
B)Decreased right ventricular cardiac output
C)Pulmonary hypertension
D)Obliteration of small precapillary vessels

Question 5

Which of the following regions of the lungs is most likely to be unaffected by pathophysiology associated with ARDS?

A)The dependent regions of the lung
B)The nondependent regions of the lung
C)The middle zone of the lung
D)Depends on the etiology

Question 6

Which of the following indirect insults can cause ARDS?

A)Pneumonia
B)Chest trauma
C)Closed head injury
D)Cor pulmonale

Question 7

The therapist is auscultating a 2-year-old patient with ARDS.Which of the following is a common auscultatory finding in ARDS?

A)Wheezing
B)Stridor
C)Crackles
D)Pleural rub

Question 8

During the implementation of permissive hypercapnia,which of the following concepts is the most critical to prevent complications of this strategy?

A)The PaCO₂ should never reach 100 mm Hg.
B)The pH should never remain below 7.30.
C)The rate at which the CO₂ rises may be more important than the actual PaCO₂ .
D)The target PaCO₂ should be reached in 48 hours.

Question 9

What pathophysiologic change accounts for the alteration of the hysteresis curve during ARDS?

A)High transpulmonary pressures
B)High transairway pressures
C)Hyperinflated lungs
D)Refractory hypoxemia

Question 10

What acid-base abnormality does a patient generally display when experiencing stage 2 of ARDS?

A)Mixed acidosis
B)Respiratory alkalosis
C)Respiratory acidosis
D)Metabolic acidosis

Question 11

What level of FiO₂ should the therapist avoid using long term in patients with ARDS?

A)40%
B)50%
C)60%
D)Any level above 30%

Question 12

Which of the following interventions should the therapist implement to decrease mortality in patients with ARDS?

A)High PEEP
B)Alveolar recruitment maneuvers
C)Low tidal volume
D)High respiratory rate

Question 13

The therapist was titrating PEEP levels to maintain an SaO₂ of 85% and found that 13 cm H₂O were required to achieve this goal.What should the most important concern with this level of PEEP?

A)Risk of pneumothorax
B)Decreased cardiac output
C)Auto-PEEP
D)Overdistention

Question 14

Which of the following pathophysiologic conditions contribute to the decreased pulmonary compliance associated with ARDS?

A)Destruction of alveolar type II cells
B)Inactivation of pulmonary surfactant
C)Fluid accumulation in the pleural spaces
D)Rapid removal of fluid by the pulmonary lymphatics

Question 15

How should the therapist use the point on the pressure-volume loop where the shape changes from concave to exponential?

A)To set PEEP
B)To set VT
C)To set Ti
D)To set PIP

Question 16

Which of the following clinical signs characterizes the onset of the third stage of ARDS?

A)Refractory hypoxemia
B)Hypocarbia
C)Increased anatomic dead space
D)Decreased cardiac output

Question 17

What level of Pplₐtₑₐᵤ should the therapist target to improve outcomes in patients with ARDS?

A)35 cm H₂O
B)32 cm H₂O
C)25 cm H₂O
D)20 cm H₂O

Question 18

Radiographically,what features are typically seen in ARDS?

A)Horizontal ribs
B)Bilateral consolidations
C)Flattened diaphragms
D)Pleural effusions

Question 19

On the basis of the Berlin definition of Acute Respiratory Distress Syndrome (ARDS),the definition of moderate acute respiratory distress syndrome comprises which of the following components?
I)PaO₂/FiO₂ £200 mm Hg
II)Onset of respiratory symptoms within 1 week of clinical insult
III)Pulmonary capillary wedge pressure greater than 18 mm Hg
IV)Chest radiograph with bilateral infiltrates not fully explained by effusions or collapse

A)I and II only
B)I and III only
C)II and IV only
D)I,II,and IV only