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Acute respiratory distress syndrome after pancreatitis — RCPSC EM MCQ

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HardRespiratory emergenciesAcute respiratory distress syndrome after pancreatitisRCPSC EM

A 46-year-old with acute pancreatitis develops worsening hypoxaemia despite high-flow oxygen. Chest radiography shows bilateral diffuse opacities, POCUS shows no cardiogenic pulmonary oedema, and PaO₂/FiO₂ is 95 on PEEP 8 cm H₂O. What is the most appropriate ventilatory strategy?

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Correct answer: E — Intubate for lung-protective ventilation using low predicted-body-weight tidal volumes

The best answer is “Intubate for lung-protective ventilation using low predicted-body-weight tidal volumes”. This presentation meets severe ARDS physiology from an inflammatory insult rather than cardiogenic oedema. Severe hypoxaemia requires ICU-level invasive lung-protective ventilation, with low tidal volumes based on predicted body weight, plateau-pressure limitation and suitable PEEP while pancreatitis is treated. Non-invasive support risks delayed escalation in severe ARDS, and larger tidal volumes worsen ventilator-induced lung injury.

Reference: Emergency Care BC: Acute Respiratory Distress Syndrome—Diagnosis and Initial Management: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-respiratory-distress-syndrome-ards-diagnosis-initial-management/