Critical Care: RF, ARDS & ALI

what is type 1 respiratory failure known as?

hypoxemic RF

what is type 2 respiratory failure known as?

hypercapneic RF

what three values are altered in type 1 RF?

decreased SaO2, decreased PaO2, increased RR

what 5 values are altered in type 2 RF?

increased PaCO2, decreased pH/SaO2/PaO2, RR may go up or down

what are the causes of type 1 RF?

pneumonia, ARDS, pulmonary edema, aspiration, atelectasis

what is the nursing dx for type 1 RF?

impaired gas exchange

what is the nursing dx for type 2 RF?

ineffective breathing

what are the causes of type 2 RF?

COPD, neuro (breathing center) problems, muscular failure

P/F ratio is ___ for ALI

<300

P/F ratio is ___ for ARDS

<200

what can cause direct trauma to respiratory system?

chest trauma, pneumonia

what can cause indirect trauma to respiratory system?

sepsis, burns

what is the most common cause of ARDS (especially r/t pneumonia)?

sepsis

how long does the exudate phase of sepsis last?

2-4 days

what is a hyaline membrane in sepsis-respiratory?

proteins that have infiltrated the alveoli and coalesce into a membrane covering the alveolar wall: prevents gas exchange

what happens when WBCs are let into the alveoli in sepsis?

alevolar wall damage, hyaline membrane destruction, inflammatory mediators released

what causes worsening hypoxemia and increased WOB in sepsis-respiratory?

V/Q mismatch from impaired gas exchange

what can cause lasting damage after ARDS?

formation of inefficent scar tissue in the lungs

what are the initial s/sx of ALI/ARDS?

tachypnea, tachycardia

what are other (lung related) s/sx of ALI/ARDS?

dyspnea, adventitious breath sounds, accessory muscle use, retrosternal discomfort

what are other (hypoxia related) s/sx of ALI/ARDS?

mottling, cyanosis, LOC change, tachycardia, fever, dry cough

what is the key treatment for ARDS?

mechanical invasive ventilation

what is the last resort for ARDS?

ECMO

what are key ventilator changes for ARDS?

decreased TV, increased PEEP, altered I:E (lungs are stiff and wet, odds of trauma are much higher)

what are our med categories to treat ARDS?

anti-inflammatory (corticosteroids), vasodilators, beta-agonists

what anti-inflammatory medication do we favor for ARDS?

solumedrol

what vasodilator (inhaled only) do we favor for ARDS?

nitrous oxide

what beta-agonist do we favor for ARDS?

albuterol

what should our fluid management protocol look like in ARDS?

initially aggressive to maintain vessel patency, then reduced over time to conservative levels

what are our commonly used sedation medications?

propofol, fentanyl, midazolam (Versed)

what neuromuscular blockade drug can we use for paralysis?

cisatracurium (Nimbex)

what type of positioning should we try to achieve in ARDS patients?

prone (shift secretions to recruit more alveoli)

what are the contraindications for prone positioning?

spinal injury, increased ICP, abdominal compartment syndrome, hemodynamic instability