Pulmonary Disorders I

Learning Objectives

Recommend an evidence-based therapeutic plan to

manage critically ill patients with acute respiratory

distress syndrome.

cheal intubation, including agents for premedication,

induction, and neuromuscular blockade.

Evaluate key variables and commonly used modes

for treatment with mechanical ventilation.

Acute respiratory distress syndrome

COVID-19 Coronavirus disease 2019

CVP

Central venous pressure

ECMO

Extracorporeal membrane oxygenation

ICU

Intensive care unit

MAP

Mean arterial pressure

MV

Mechanical ventilation

PEEP

Positive end-expiratory pressure

PS

Pressure support

RSI

Rapid sequence intubation

SIMV

Synchronized intermittent mandatory

ventilation

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Which best describes the category of acute respi-

ratory distress syndrome (ARDS) that most

benefits from prone positioning and cisatracurium

administration?

erate to severe ARDS. Which of the following

partial pressure of arterial oxygen (Pao2)/ fraction

of inspired oxygen (Fio2) parameters best describes

this ARDS subpopulation?

Which of the following parameters best describes

“low tidal volumes” for invasive mechanical venti-

lation in ARDS?

A 65-year-old man presents to the emergency

department with severe shortness of breath, tachy-

pnea, altered mental status, and diaphoresis. A chest

radiograph reveals diffuse, bilateral opacities. His

vital signs are as follows: blood pressure 94/54 mm

Hg, respiratory rate 26 breaths/minute, heart rate

120 beats/minute, pain score 2/10, and temperature

105.8°F (41.0°C). The patient’s wife states that his

symptoms began about 2 days ago and gradually

worsened over the past day. The patient is trans-

ferred to the ICU, where he is intubated. His arterial

blood gas values are pH 7.30, partial pressure of

arterial carbon dioxide (Paco2) 50 mm Hg, Pao2 50

mm Hg, and oxygen saturation (Sao2) 85% while

receiving Fio2 100%. Which is the best therapy plan

for the next 24 hours?

resuscitation, and vasopressors for shock; low

tidal volume (4–8 mL/kg) ventilation strategy;

deep sedation to achieve a Richmond Agitation-

Sedation Scale (RASS) score of −4; and prone

positioning.

resuscitation, and vasopressors for shock; low

tidal volume (4–8 mL/kg) ventilation strategy;

deep sedation to achieve a RASS score of −5

and cisatracurium administration to limit pla-

teau pressures; and prone positioning.