Chapter 29 - Acute Respiratory Distress Syndrome

What is the name of the period that follows the exudative phase in ARDS? a. Fibroproliferative b. Transudative c. Proliferative d. Intraalveolar

a

What time does the exudative phase of ARDS typically presents? a. Between days 1 and 7 b. After 1 week c. After 3 weeks d. After 1 month

a

What range is now recommended for tidal volumes (VT) in a patient with ARDS who is being mechanically ventilated? a. 4 to 6 ml/kg b. 6 to 10 ml/kg c. 6 to 8 ml/kg d. 10 to 12 ml/kg

A

Which of the following complications has been associated with the use of PEEP in patients with ARDS? a. Lung infection b. Reduced cardiac output c. Hepatic failure d. Myocardial infarction

b

Which of the following factors are associated with a higher risk for ARDS? 1. Gastric aspiration 2. Multiple transfusions 3. Septic shock 4. Burn injury a. 1 and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 only

a

Which of the following is the likely cause of nonhydrostatic pulmonary edema? a. Injury to the vascular endothelium and/or alveolar epithelium b. Abnormalities in intravascular hydrostatic pressures c. An influx of polymorphonuclear neutrophils d. Medication overdose

a

Which of the following is the primary system for removing filtered fluid and protein from the lungs? a. Lymphatic b. Renal c. Circulatory d. Respiratory

a

Which of the following mechanisms ultimately leads to ARDS regardless of the etiology? a. Disruption of the endothelial and epithelial barriers b. Alveolar flooding c. Interstitial damage d. Increased oncotic pressure

a

What time does the fibroproliferative phase of ARDS typically present? a. Between days 1 and 7 b. After 3 days to weeks c. After 3 weeks d. After 1 month

b

What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS? a. Prolonged expiratory time b. Permissive hypercapnia c. Inverse ratio ventilation d. Intermittent mandatory ventilation

b

Which of the following are common causes of volume overload in patients with hydrostatic pulmonary edema? 1. Renal failure 2. Hepatic failure 3. Hypoalbuminemia 4. Hyperkalemia a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

b

Using which of the following medications carries the greatest risk of persistent memory and cognition problems in the survivors of ARDS? a. Benzodiazepines b. Beta-2 agonists c. Exogenous surfactants d. Corticosteroids

a

What is recommended in terms of fluid management of patients with ARDS? a. Conservative b. Aggressive volume replacement c. Increased dieresis d. Only administer colloids

a

Which of the following are clinical features that favor congestive heart failure over ARDS? 1. Elevated PA catheter wedge pressure 2. Asymmetric, peripheral infiltrates on chest x-ray 3. Prompt (<12 to 24 hr) and lasting response to diuretics 4. Bronchoalveolar lavage fluid low protein and minimally increased cellularity a. 1 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

a

Which of the following are ways to prevent further lung injury in an ARDS patient? 1. Avoid barotrauma and volutrauma 2. Permissive hypercapnia 3. Keep plateau pressure between 30 and 40 cm H2O 4. Tidal volume ideally between 6 and 8 ml/kg IBW a. 1 and 2 only b. 1, 2, and 4 only c. 3 and 4 only d. 2, 3, and 4 only

a

Which of the following statements is true about prone positioning of patients with ARDS? a. May be beneficial to patients with sustained severe ARDS (P/F ratio < 150 for more than 12 to 24 hr on stable ventilator settings). b. It dramatically reduces the mortality of patients with ARDS. c. It is easy to do and helps morbidity rates of patients with ARDS. d. It does not improve gas exchange at all.

a

Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)? a. BALF is proteinaceous and inflammatory. b. Diffuse alveolar and interstitial infiltrates in chest radiograph. c. Pleural effusions on chest radiograph. d. Recent history of trauma.

b

How does the Berlin Criteria define the "mild" category of ARDS? a. P/F ratio = 300 to 400 b. P/F ratio = 201 to 300 c. P/F = 101 to 200 d. P/F ?4= 100

b

What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS? a. Inverse ratio ventilation b. High-frequency ventilation (HFV) c. Intermittent mandatory ventilation d. Airway pressure-release ventilation

b

Which of the following explains the basis for permissive hypercapnia as a ventilator strategy for ARDS? a. Introduction of CO2 into the breathing circuit to stimulate spontaneous breaths. b. Use of lower tidal volumes and accepting a gradual rise in PCO2 to avoid associated hazards of high Paw. c. Allow patients with ARDS to breathe spontaneously to build their respiratory muscular endurance. d. To use exhaled CO2 to increase residual volume and improve gas exchange.

b

Which of the following is another term for hydrostatic pulmonary edema? a. ARDS-related pulmonary edema b. Cardiogenic pulmonary edema c. Exudative pulmonary edema d. Fibroproliferative pulmonary edema

b

In most ARDS patients, PEEP levels below __________ are generally preferred. a. 10 cm H2O b. 15 cm H2O c. 20 cm H2O d. 25 cm H2O

c

What is the maximal inspiratory pressure that should be targeted when using pressure-control ventilation in patients with ARDS? a. 20 to 25 cm H2O b. 25 to 30 cm H2O c. 30 to 35 cm H2O d. 35 to 40 cm H2O

c

Which of the following parameters are important in the management of patients with ARDS? 1. Keep systolic blood pressure below 90 mm Hg. 2. Keep hemoglobin saturation above 90%. 3. Ensure adequate urine output. 4. Keep mean arterial pressure above 60 mm Hg. a. 1 and 2 only b. 1 and 4 only c. 2, 3, and 4 only d. 1, 3, and 4 only

c

Which of the following parameters is important in determining the optimal level of positive end expiratory pressure (PEEP) in a patient with ARDS? a. PaO2 b. SaO2 c. DO2 d. CaO2

c

Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS? a. Eosinophils b. Monocytes c. Neutrophils d. Lymphocytes

c

What mode of mechanical ventilation is designed to increase the mean airway pressure to allow recruitment of alveoli while allowing the patient to spontaneously breathe? a. Inverse ratio ventilation b. High-frequency ventilation c. Intermittent mandatory ventilation d. Airway pressure-release ventilation

d

When administering oxygen, which of the following should be considered regarding oxygen toxicity? 1. It is only a concern with premature infants. 2. The longer the exposure, the worse the injury. 3. The higher the FiO2, the worse the injury. 4. The target SpO2 is in the range of 88% to 95%. a. 1 and 2 only b. 2 and 3 only c. 3 and 4 only d. 2, 3, and 4 only

d

Which of the following is an indirect injury that can cause ARDS? a. Pneumonia b. Lung contusion c. High concentrations of oxygen d. Transfusions

d

Which of the following risk factors for ARDS is classified as a nonpulmonary cause? a. Toxic inhalation b. Gastric aspiration c. Near drowning d. Sepsis

d