Acute Respiratory Distress Syndrome (ARDS) and Neonatal Respiratory Distress Syndrome

by Carlo Raj, MD

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    On this topic of acute respiratory distress syndrome, students have a hard time figuring out what exactly caused the collapse of the alveoli. Let’s begin. What is ARDS? It used to be, once upon a time, may be called Adult Respiratory Distress Syndrome, but you can no longer do that because it’s very possible that you might find the causes that we will see here commonly for ARDS including sepsis that might also take place in children. A clinical manifestation of a diffuse alveolar damage. The operative word here is alveoli in which it gets damaged. Then what happens? It disappears. It collapses. Results in atelectasis. What does that mean to you in terms of pathophysiology? Is this a dead space or is this a shunt? This is going to be a pulmonary shunt. You will see as to how that become important for us as we move further into our lecture. Diffuse alveolar damage is the final common pathway for a variety of insults to the lung. So, therefore, let’s say that your patient is suffering from a sepsis or septicaemia and that the patient went from having a pneumonia or perhaps even aspiration and there is so much damage that has taken place to the lung and alveoli, resulted in diffuse alveolar damage. We have acute respiratory distress syndrome. Now, this mostly does occur in adults, you can say that. And the only thing is that you need to keep in mind that could insults such as these also affect children? Sure it can. Toxic inhalation, drowning, all of this is then going to cause severe damage to the alveoli resulting in what? Diffuse alveolar damage. Welcome to acute respiratory distress syndrome which is then going to manifest as a pulmonary shunt. The clinical manifestations of diffuse alveolar...

    About the Lecture

    The lecture Acute Respiratory Distress Syndrome (ARDS) and Neonatal Respiratory Distress Syndrome by Carlo Raj, MD is from the course Disorders of the pulmonary circulation and the respiratory regulation. It contains the following chapters:

    • Pathogenesis
    • Differential Diagnosis
    • Three Common Neonatal Respiratory Disorders
    • Signs & Symptoms

    Included Quiz Questions

    1. Alveoli
    2. Bronchioles
    3. Interstitium
    4. Type II alveolar cells
    5. Pulmonary capillaries
    1. …Haman-Rich syndrome.
    2. …Hallerman-Streiff syndrome.
    3. …Reye’s syndrome.
    4. …Meigs syndrome.
    5. …Horner’s syndrome.
    1. Sepsis
    2. Pneumonia
    3. Traumatic burns
    4. Toxic inhalation
    5. Aspiration
    1. Pancreatitis
    2. Small bowel obstruction
    3. Toxic inhalation
    4. Cardiogenic pulmonary edema
    5. Alcoholism
    1. Transudative pulmonary edema
    2. Increased pulmonary dead space units
    3. Refractory hypoxemia
    4. Reduced pulmonary compliance
    5. Right to left shunt
    1. PCWP
    2. Total lung volume
    3. Fever
    4. Diffusing capacity
    5. Low cardiac output.
    1. Cardiac output – from high to low
    2. Blood pressure – from high to low
    3. Dead space – from high to low
    4. Respiratory rate – from low to high
    5. PCWP – from high to low
    1. 25 mmHg
    2. 60 mmHg
    3. 0 mmHg
    4. 100mmHg
    5. 80mmHg
    1. It is caused by insufficient surfactant formation
    2. It is most frequently seen in late preterm infants (34-37 weeks gestation).
    3. It is often seen in infants delivered by elective caesarian section.
    4. Lung fluid clearance is impaired in part due to decreased expression of amiloride-sensitive airway epithelial Na+ channels
    5. Onset of symptoms usually occurs within 2 hours of delivery.
    1. Retinopathy of prematurity
    2. Persistent pulmonary hypertension
    3. Cephalohematoma
    4. Jaundice
    5. Hypoglycemia
    1. Pulmonary hemorrhage
    2. Nasal flaring
    3. Intercostal muscle retractions
    4. Tachypnea
    5. Expiratory vocal gord grunting
    1. Bronchopulmonary dysplasia
    2. Patent ductus arteriosus
    3. Chylothorax
    4. Persistent pulmonary hypertension
    5. Pediatric pneumonia
    1. NO = vasodilation, endothelin = vasoconstriction
    2. NO = vasodilation PGI2 = vasoconstriction
    3. PGI2 = vasodilation, NO = vasoconstriction
    4. Endothelin = vasodilation, NO = vasoconstriction
    5. Endothelin = vasodilation, PGI2 = vasoconstriction
    1. Persistent pulmonary hypertension
    2. Transient tachypnea of the newborn
    3. Subglottic stenosis
    4. Bronchopulmonary dysplasia
    5. Neonatal respiratory distress syndrome
    1. Tachycardia
    2. Productive cough
    3. Jugular venous distention
    4. Hepatomegaly
    5. Hypotension
    1. Left ventricular systolic pressure > 140
    2. A-aO2 gradient > 20
    3. Restrictive pattern on pulmonary function testing
    4. Diffuse bilateral infiltrates on CXR.
    5. PaO2/FiO2 ratio < 200
    1. Low tidal volume with high PEEP.
    2. Low tidal volume and high respiration rate.
    3. High PEEP with low respiration rate.
    4. High tidal volume with high PEEP.
    5. Pressure support alone.

    Author of lecture Acute Respiratory Distress Syndrome (ARDS) and Neonatal Respiratory Distress Syndrome

     Carlo Raj, MD

    Carlo Raj, MD

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