Oxygenation
PEEP that improves oxygenation while preserving cardiac output and lung compliance. This is typically lower than the PEEP that results in the highest PaO2
Optimal PEEP
Cathether used to measure various pressures assoicated with heart and lungs
Swan-Ganz cathether
4 and 6 mL/kg
The tidal volume range used in ARDS patients?
Most common form of ExtraCorporeal Life Support
Extracorporeal membrane oxygenation
P/F ratio ≥ 400
Normal P/F ratio
Hallmark of ARDS
Refactory hypoxemia
The primary system for removing filtered fluid and protein from the lungs
Lymphatic
Allows PaCO2 to rise above normal. CO2 levels of 60 to 80 mm Hg are acceptable as long as pH remains at ≥7.25. This strategy is used to avoid volutrauma and may require sedation or paralysis.
Permissive hypercapnia
Used when the heart is failing or heart and lungs are both failing
VA ECMO
The PaO2/FIO2 is greater than 200, but less than or equal to 300
Mild ARDS
Positioning may improve oxygenation
Prone
The reason for the elevated risk for developing ARDS associated with massive blood transfusions
Blockages in pulmonary blood vessels
Current ventilatory strategies in the treatment of ARDS
Small tidal volume
Rapid respiratory rates
Used when the lungs are failing, but the heart is still working
VV ECMO
The PaO2/FIO2 is greater than 100, but less than or equal to 200
Moderate ARDS
Would be useful in treating an elevated shunt in a patient with ARDS who is being mechanically ventilated
Optimizing PEEP
Would provide necessary information regarding fluid management in a patient with cardiogenic pulmonary edema associated with ARDS
Pulmonary artery catheter
Recommended to treat alveolar consolidation and atelectasis associated with ARDS
Continuous positive airway pressure (CPAP)
Positive end-expiratory pressure (PEEP)
Primary goal is the removal of carbon dioxide as opposed to the delivery of oxygen
ECCO2 removal
The PaO2/FIO2 is less than or equal to 100
Severe ARDS
Which of the following indicates the optimal PEEP setting?
PEEP PaO2 CO
A. 5 cmH2O 53 mmHg 4.5 L/min
B. 10 cmH2O 60 mmHg 4.3 L/min
C. 15 cmH2O 74 mmHg 3.8 L/min
D. 20 cmH2O 88 mmHg 3.4 L/min
B. 10 cmH2O 60 mmHg 4.3 L/min
White blood cells is most commonly implicated in the inflammatory process of ARDS
Neutrophils
During rounds, the physician alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse understands that proning is
An optional treatment if the PaO2 /FiO2 ratio is less 100
•Blood is pumped from the right side of the heart to the lungs, where oxygen and carbon dioxide are exchanged
•From the lungs, blood is returned to the left side of the heart
•The left heart then pumps oxygenated blood to the major organs and tissues
•The amount of oxygen contained in blood leaving the heart is the arterial oxygen content
Normal Circulation
An adult patient with pneumonia was intubated and placed on pressure control ventilation with a FiO2 of 40% and a PEEP of 10 cm H2O. The chest x-ray shows bilateral infiltrates. After being on the ventilator for 30 minutes, an ABG is obtained with the following results: pH 7.47 PaCO2 33 torr PaO2 60 torr SaO2 90% HCO3 25 mEq/L BE +2 MEq/L You would describe the patient’s condition as being consistent with which of the following
Moderate ARDS