Optimizing Outcomes in ARDS and Septic Shock

Up Objectives Schedule Faculty

OBJECTIVES

Differentiate severity levels of ARDS based on a minimum PEEP level and mutually exclusive PaO2/FIO2 thresholds identified in the new Berlin definition of ARDS.

Expand the traditional view of ARDS pathophysiology to include the role of the renin-angiotensin-aldosterone system as a contributory factor to increased pulmonary vascular permeability.

Recognize the importance of a conservative fluid administration strategy in improving oxygenation status and decreasing length of stay in the patient with ARDS.

Discuss the importance of early recognition of ARDS risk factors to allow tailoring critical care interventions to avoid the development of ARDS in critically ill patients.

List five factors often included in critical care management that may contribute to the development of ARDS as a complication of critical illness.

Provide the rationale for a short course of neuromuscular blockade in the patient with early sepsis-induced ARDS and a PaO2/FIO2 ratio of < 150 mm Hg.

Identify potential complications related to administration of neuromuscular blocking agents.

Describe how mechanical ventilation with positive intrathoracic pressure induces salt and water retention, while also impairing the pathways designed to clear pulmonary edema fluid from the alveoli.

Relate the use of mechanical ventilation to the development of Multiple Organ Dysfunction System and sepsis in the critically ill.

Discuss the relationship between ARDS, decreased long-term cognitive functioning, and a persistent decrease in health-related quality of life in survivors of ARDS.

Explain the rationale for adding dobutamine to vasopressor therapy in the patient in septic shock exhibiting ongoing signs of tissue hypoperfusion, despite adequate intravascular volume and mean arterial pressure.

Discuss the rationale for avoiding neosynephrine as a vasopressor in septic shock except in a few specific instances.

 

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