ARDS

Type K

Vraag 1 (MCQ 1.51)The 2012 Berlin definition of ARDS includes the following components:1. Continuous positive airway pressure (CPAP) or positive end-

expiratory pressure (PEEP) >5cm H2O. 2. Murray score >2. 3. Pulmonary artery occlusion pressure <15 cm H2O. 4. pH <7.3.5. Evidence of a direct precipitant occuring within the

preceding week.

Type K

Vraag 1 (MCQ 1.51)The 2012 Berlin definition of ARDS includes the following components:1. Continuous positive airway pressure (CPAP) or positive end-

expiratory pressure (PEEP) >5cm H2O. 2. Murray score >2. 3. Pulmonary artery occlusion pressure <15 cm H2O. 4. pH <7.3.5. Evidence of a direct precipitant occuring within the

preceding week.

True

FalseFalse

False

True

Type K

Vraag 2 (EDIC module)With regard to the Berlin definition of ARDS: In order to diagnose ARDS, which of the following are true?

1. All patients with ARDS must be intubated2. B.PEEP of at least 8 cm H2O is mandatory3. Bilateral opacities must be seen in lung imaging4. Three oxygenation severity stages are defined

Type K

Vraag 2 (EDIC module)With regard to the Berlin definition of ARDS: In order to diagnose ARDS, which of the following are true?

1. All patients with ARDS must be intubated2. B.PEEP of at least 8 cm H2O is mandatory3. Bilateral opacities must be seen in lung imaging4. Three oxygenation severity stages are defined

False

FalseTrueTrue

Type A

Vraag 3 (MCQ 2.65)You are asked to review a 45-year-old man on the ICU with refractory hypoxia. He was admitted several days ago with acute pancreatitis and has subsequently developed severe ARDS. His PEEP and FiO2 have been escalated over the course of the day. He is now saturating at 85% on FiO2 0.65 with PEEP at 15 cm H2O and plateau pressures of 29 cm H2O. There is little to remove on tracheal suction. He is sedated and paralysed and the I:E ratio is currently 1:1. Which of the following options would be the most effective next step?A. Commencing inhaled nitric oxideB. Adjusting the PEEP to 20 cm H2O in line with the ARDSnet high PEEP

ladderC. Placing the patient in prone positionD. Inverting the I:E ratioE. Commencing high-frequency oscillatory ventilation

Type A

Vraag 3 (MCQ 2.65)You are asked to review a 45-year-old man on the ICU with refractory hypoxia. He was admitted several days ago with acute pancreatitis and has subsequently developed severe ARDS. His PEEP and FiO2 have been escalated over the course of the day. He is now saturating at 85% on FiO2 0.65 with PEEP at 15 cm H2O and plateau pressures of 29 cm H2O. There is little to remove on tracheal suction. He is sedated and paralysed and the I:E ratio is currently 1:1. Which of the following options would be the most effective next step?A. Commencing inhaled nitric oxideB. Adjusting the PEEP to 20 cm H2O in line with the ARDSnet high PEEP

ladderC. Placing the patient in prone positionD. Inverting the I:E ratioE. Commencing high-frequency oscillatory ventilation

Type K

Vraag 4 (MCQ 3.8)Evidence-based rescue strategies shown to reduce mortality in severe ARDS include the following:

1. Paralysis using non-depolarising muscle relaxants2. Therapeutic hypothermia3. High-frequency oscillation ventilation4. Airway pressure release ventilation5. Inhaled nitric oxide

Type K

Vraag 4 (MCQ 3.8)Evidence-based rescue strategies shown to reduce mortality in severe ARDS include the following:

1. Paralysis using non-depolarising muscle relaxants2. Therapeutic hypothermia3. High-frequency oscillation ventilation4. Airway pressure release ventilation5. Inhaled nitric oxide

TrueFalseFalseFalseFalse

Type KVraag 5 (question 103)A 45/year old HIV-positive male is admitted tot he hospital because of fever and severe dyspnoea. Physical examination shows tachypnoea and tachycardia. Chest auscultation reveals bilateral crackles. Radiography shows extensive, bilateral patchy lung infiltrates. Atrerial blood gas analysis on room air reveals a PaO2 of 6,0 kPa (45 mmHg) PaCO2 of 1,5 (11 mmHg) and pH of 7,56. He is intubated and positive pressure ventilation is initiated with an inspiratory oxygen fraction of 0,5 and a positive end-expiratory pressure of 6cm H2O. Arterial blood gas analysis after half an hour demonstrates a PaO2 of 6,7 kPa (50 mmHg), a PaCO2 of 3,0 kPa (22 mmHg) and pH of 7,52. Brain natriuretic peptide concentration is normal, and echocardiography shows normal systolic and diastolic function as well as normal respiratory variation in inferior vena cava size. Which of the following statements regarding this patient is/are correct?

1. A diagnosis of acute respiratory distress syndrome can be made2. The alveolar-arterial oxygen tension difference is corrected by oxygen

administration3. The intrapulmonary shunt increases with increasing FiO24. Prone position during possitive pressure ventilation improves survival

Type KVraag 5 (question 103)A 45/year old HIV-positive male is admitted tot he hospital because of fever and severe dyspnoea. Physical examination shows tachypnoea and tachycardia. Chest auscultation reveals bilateral crackles. Radiography shows extensive, bilateral patchy lung infiltrates. Atrerial blood gas analysis on room air reveals a PaO2 of 6,0 kPa (45 mmHg) PaCO2 of 1,5 (11 mmHg) and pH of 7,56. He is intubated and positive pressure ventilation is initiated with an inspiratory oxygen fraction of 0,5 and a positive end-expiratory pressure of 6cm H2O. Arterial blood gas analysis after half an hour demonstrates a PaO2 of 6,7 kPa (50 mmHg), a PaCO2 of 3,0 kPa (22 mmHg) and pH of 7,52. Brain natriuretic peptide concentration is normal, and echocardiography shows normal systolic and diastolic function as well as normal respiratory variation in inferior vena cava size. Which of the following statements regarding this patient is/are correct?

1. A diagnosis of acute respiratory distress syndrome can be made2. The alveolar-arterial oxygen tension difference is corrected by oxygen

administration3. The intrapulmonary shunt increases with increasing FiO24. Prone position during possitive pressure ventilation improves survival

TrueTrue

FalseTrue

Type K

Vraag 6 (K79 paper 1)Regarding the use of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS):

1. High PEEP 9 (> 12cm H2O) reduces ICU mortality compared with low PEEP (5-12cm H2O)

2. PEEP should be set below the lower inflection point on the pressure-volume curve

3. High PEEP improves the PaO2/FiO2 ratio compared with low PEEP

4. PEEP causes atelectrauma

Type K

Vraag 6 (K79 paper 1)Regarding the use of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS):

1. High PEEP 9 (> 12cm H2O) reduces ICU mortality compared with low PEEP (5-12cm H2O)

2. PEEP should be set below the lower inflection point on the pressure-volume curve

3. High PEEP improves the PaO2/FiO2 ratio compared with low PEEP

4. PEEP causes atelectrauma

False

False

True

False

Type A

Vraag 7 (A29 paper 3)The following physiological changes occur in the proned patient with acute respiratory distress syndrome (ARDS) EXCEPT:

A. Perfusion is largely redistributed to the ventral lungB. Ventilation is more homogenously distributedC. A reduction in physiological shunt occursD. Compression of dorsal lung regions by the heart is reducedE. Anterior chest wall compliance is decreased

Type A

Vraag 7 (A29 paper 3)The following physiological changes occur in the proned patient with acute respiratory distress syndrome (ARDS) EXCEPT:

A. Perfusion is largely redistributed to the ventral lungB. Ventilation is more homogenously distributedC. A reduction in physiological shunt occursD. Compression of dorsal lung regions by the heart is reducedE. Anterior chest wall compliance is decreased

Type A

Vraag 8 (voorbereidingsdag EDIC Berlijn 2019)A 54-year old woman (60kg) is intubated and ventilated in the Emergency Department with community-acquired pneumonia. On admission tot he ICU, she is hypoxic (SpO2 90%) and difficult to ventilate. She is paralysed and heavily sedated. You suspect severe ARDS. Her ventilator settings are as follows: SIMV, FiO2 1.0, Vt 400ml, RR 16/min, PEEP 5 cm H2O, inspiratory flow 20 L/min.

A. What is the most appropriate next step in managing her ventilator settings?

B. Change to a spontaneous mode of ventilationC. Reduce respiratory rate to <10/min, aiming for an I:E ratio of 1:3 or 1:4D. Decrease inspiratory flow rateE. Increase tidal volume to 500mlF. Increase PEEP following a PEEP trial recruitment manoeuvre

Type A

Vraag 8 (voorbereidingsdag EDIC Berlijn 2019)A 54-year old woman (60kg) is intubated and ventilated in the Emergency Department with community-acquired pneumonia. On admission tot he ICU, she is hypoxic (SpO2 90%) and difficult to ventilate. She is paralysed and heavily sedated. You suspect severe ARDS. Her ventilator settings are as follows: SIMV, FiO2 1.0, Vt 400ml, RR 16/min, PEEP 5 cm H2O, inspiratory flow 20 L/min.

A. What is the most appropriate next step in managing her ventilator settings?

B. Change to a spontaneous mode of ventilationC. Reduce respiratory rate to <10/min, aiming for an I:E ratio of 1:3 or 1:4D. Decrease inspiratory flow rateE. Increase tidal volume to 500mlF. Increase PEEP following a PEEP trial recruitment manoeuvre

Type K

Vraag 9 (ESICM module)Management of diseases presenting clinically as ARDS:

1. The only consistently demonstrated beneficial effect of inverse I:E ratio is enhanced CO2 removal

2. Increase in oxygenation after changing to prone position is usually seen within minutes or at least the first 1-2 hours

3. Indications for steroids are pneumocystis jiroveci pneumonia, tuberculosis, vasculitis and cryptogenic organizing pneumonia (COP)

4. Is independent of chest wall mechanics

Type K

Vraag 9 (ESICM module)Management of diseases presenting clinically as ARDS:

1. The only consistently demonstrated beneficial effect of inverse I:E ratio is enhanced CO2 removal

2. Increase in oxygenation after changing to prone position is usually seen within minutes or at least the first 1-2 hours

3. Indications for steroids are pneumocystis jiroveci pneumonia, tuberculosis, vasculitis and cryptogenic organizing pneumonia (COP)

4. Is independent of chest wall mechanics

True

True

True

False

Type K

Vraag 10 (ESICM module)Regarding imaging in a patient with ARDS: which of the following are true?

1. Lung ultrasound is an excellent method to evaluate overdistention

2. Electronic impedance tomography (EIT) can be used to measure end-expiratory lung volume

3. Computed tomography of the chest and lungs should be performed in all ARDS patients

4. Lung ultrasound can detect tidal recruitment/derecruitment

Type K

Vraag 10 (ESICM module)Regarding imaging in a patient with ARDS: which of the following are true?

1. Lung ultrasound is an excellent method to evaluate overdistention

2. Electronic impedance tomography (EIT) can be used to measure end-expiratory lung volume

3. Computed tomography of the chest and lungs should be performed in all ARDS patients

4. Lung ultrasound can detect tidal recruitment/derecruitment

False

False

False

True