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How can ventilator parameters be adjusted for high or low PCO2?
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For high PCO2, increase the respiratory rate or tidal volume. For low PCO2, decrease the respiratory rate or tidal volume.
What criteria must be met to consider liberation from the ventilator in ARDS patients?
Criteria include resolving the reason for intubation, minimal FiO2, low PEEP, and acceptable respiratory rate and tidal volumes.
What are the Berlin criteria for diagnosing ARDS?
Acute hypoxemia (SpO2 < 90% or PaO2 < 60 mmHg), PF ratio < 300, onset within less than one week, diffuse bilateral infiltrates on imaging, and excluding cardiogenic pulmonary edema (PCWP < 18 or normal echo).
What are the signs of pulmonary hypertension in ARDS?
Signs include jugular venous distention (JVD), hepatomegaly, ascites, and pedal edema.
What direct lung injuries can cause Diffuse Alveolar Damage (DAD) in ARDS?
Pneumonia, aspiration, and inhaled toxins are direct lung injuries that can lead to DAD.
List some complications associated with ARDS.
Complications include pulmonary hypertension, ventilator-associated pneumonia (VAP), ventilator-induced lung injury, and hyperoxia.
Why might prone positioning be beneficial in ARDS management?
Proning is used for PF ratio < 150 to reduce dependent atelectasis and improve oxygenation.
What distinguishes ARDS from cardiogenic pulmonary edema?
ARDS is characterized by non-cardiogenic causes and assessed using the Swan-Ganz catheter showing PCWP < 18 or a normal echocardiogram.
What are the clinical features of ARDS?
Clinical features include rapid breathing, increased work of breathing, shortness of breath, and signs of profound hypoxemia and respiratory distress.
What is the role of neuromuscular blockade in ARDS treatment, and when is it indicated?
Neuromuscular blockade is used for PF ratio < 150 when initial measures fail, helping to achieve better ventilatory control.
How is the severity of ARDS determined based on PF ratio?
ARDS severity is classified as: Mild (PF ratio 200-300), Moderate (PF ratio 100-200), Severe (PF ratio < 100).
What advanced management techniques can be used for severe ARDS cases?
Advanced management techniques include neuromuscular blockade, proning, pulmonary vasodilators, and VV ECMO (venovenous extracorporeal membrane oxygenation).
What ventilator modes are used in ARDS management and their main features?
CMV (Controlled Mechanical Ventilation) for non-spontaneous breaths and PSV (Pressure Support Ventilation) for spontaneous breaths.
Describe the role of PEEP in the ventilator management of ARDS.
PEEP (positive end-expiratory pressure) keeps alveoli open to improve ventilation and gas exchange.
How does damage to Type 1 alveolar cells contribute to ARDS?
Type 1 alveolar cell damage allows fluid, proteins, and immune cells to leak into the alveolus, leading to the exudative phase and poor ventilation (shunt).
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