ICU Vivas · ARDS & lung protection
The ARDS chest radiograph
A CICM imaging viva on the chest radiograph of ARDS. The candidate describes the film systematically, recognises bilateral confluent airspace opacification, confirms the imaging criterion of the Berlin definition, and discriminates ARDS from cardiogenic pulmonary oedema, pneumonia and atelectasis using the radiographic signs and the clinical context.
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Target exams
CICMFFICMEDIC
Prompt
A portable chest radiograph of a ventilated patient with rapidly worsening hypoxaemia — describe it systematically, then give a differential for bilateral pulmonary opacification and state how you distinguish ARDS from its mimics.
Stimulus
You are shown a portable anteroposterior chest radiograph of an intubated 62-year-old man who, over 48 hours of a flu-like illness, has become profoundly hypoxaemic (PaO2/FiO2 75 on PEEP 12). Describe the film systematically, then interpret. The relevant findings are:[1]
References4ShowHide
- [1]Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 2012.PMID 22797452
- [2]Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA, 2016.PMID 26903337
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.