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Duke PA Acute Respiratory Distress/ Respiratory Failure

Acute hypoxemic respiratory failure that occurs after a direct or indirect pulmonary insult that cannot be attributed to heart failure ARDS
ARDS chest x-ray is characterized by bilateral widespread pulmonary infiltrates
ARDS is characterized by PaO2/FIO2 <= ____ 200
Aspiration, Lung contusion and trauma, Inhalational injury, Pneumonia, Near -drowning primary causes of ARDS
Sepsis, Pancreatitis, Hypotension (shock) secondary causes of ARDS
associated with a poorer outcome secondary causes of ARDS
upon auscultation of lungs in ARDS you will hear crackles
Indications for Mechanical Ventilation typically involves a PaO2 <__mmHg, SaO2 <90% with a elevated PCO2 60
Treatment of ARDS induced hypoxemia usually requires positive pressure ventilation
ARDS: Mechanical Ventilation Lung Protective Strategies use small tidal volumes
ARDS: Mechanical Ventilation Lung Protective Strategies consider _____ to minimize elevated lung pressures High Frequency Ventilation
Normal mechanical ventilator tidal volume (___ ml/kg IBW) 10-15
Large tidal volumes cause _____ in stiff lungs high inflation pressures
mechanical ventilator tidal volume in ARDS patient (___ ml/kg IBW) 6
Positive End Expiratory Pressure PEEP
Used to keep alveoli open during the exhalation phase of respiration PEEP
Maintains the Functional Residual Capacity (FRC). The FRC prevents atelectasis PEEP
Too much PEEP can lead to decreased cardiac output and high airway pressure
ARDS has a ___% mortality rate 30-40
ARDS has a 90% mortality rate in those with sepsis
Respiratory dysfunction resulting in abnormal oxygenation and ventilation severe enough to threaten the function of vital organs respiratory failure
Arterial blood gas values consistent with RF: PaO2 value < 60 mmHg, PaCO2 value > __ mmHg, SaO2 value < 90% 50
The tip of the endotracheal tube should rest at the level of the aortic arch
The tip of the endotracheal tube should rest at the level of the 2 cm above the carina
Does not allow the patient to breathe between ventilator delivered breaths Controlled Mechanical Ventilation
Ideal mode for patients that are sedated and paralyzed Controlled Mechanical Ventilation
low VT and respiratory rates – allow hypercapnia – minimize high inflation pressures – oxygenation is maintained) permissive hypercapnia
method employed to decrease the incidence of barotrauma permissive hypercapnia
results when the lung can no longer accomplish adequate gas exchange, often fatal if left untreated acute respiratory failure
respiratory compromise is evident whe the PaO2 is < __mm Hg on room air 60
respiratory compromise is evident whe the PaCO2 is > __mm Hg 45
patients in respiratory failure with evidence of severe distress, mental deterioration, or hemodynamic instability usually require _____ intubation and mechanical ventilation
the adequacy of ventilator settings needs to be determined with repeated ____ arterial blood gas levels
the current preferred mode of ventilation is assisted-control ventilation
in ____ the clinician sets the tidal volume and the lowest allowed respiratory rate, however each spontaneous breath is supported assisted-control ventilation
considered the more physiologic ventilatory mode and is associated with a decreased work of breathing assisted-control ventilation
the most popular mode of ventilation in the 1980's. often associated with asynchrony of spontaneous breaths and assisted breaths intermittent mandatory ventilation
Created by: bwyche