Card Set Information
What is the common cause for ARDs?
Common features between ARDS and CHF!
Symptoms of anxiety, dyspnea, tachypnea
Reduced lung volumes and decreased compliance
Arterial blood gases intially show respiratory alkalosis and arterial hypoxemia
Chest xray shows diffuse alveolar and interstitial inflitrates
Role of organ to organ interactions
Factors outside lung may play role in initiation & progression of ARDS & multiple organ dysfunction syndrome (MODS)
: selective decontamination, early enteral feeding
The gut-liver-lung axis may be most influential in...
Causing the systemic inflammatory response associated with ARDS and MODS
GI tract & liver function is often compromised in critical illness
wide-spread use of antibiotics leads to overgrowth of antibiotic resistant bacteria in gut
These bacteria & their toxic byproducts escape gut, taken up by reticuloendothelial (RE) cells in the liver which activate & perpetuate systemic inflammatory response & systemic organ injury
Liver is responsible for breakdown of proinflammatory mediators
Exudative Phase of ARDS
Characterized by diffuse damage to alveolar and blood vessels and the influx of inflammatory cells into interstitium
Filled alveolar spaces with cellular debris & plasma proteins; destruction of Type I pneumocytes
The exudative phase of ARDS is often difficult to differentiate from...
Respiratory failure related to hydrostatic pulmonary edema (CHF)
Patients with ARDS have...
THe exudative phase of ARDS may be...
self limited or may progress to a fibroproliferative phase
Fibroproliferative phase of ARDS
3 to 7 days
Process of lung repair
Hyperplasia of alveolar Type II pneumocytes & proliferation of fibroblasts
Fibroblasts form intraalveolar & interstitial fibrosis
Extent of fibrosis formation determines disability in those who survive
Lung remodeling process, degree and reversibility varies greatly
An intact alveolar basement membrane is necessary for normal repair
The clinicals findings in ARDS!
Peripheral infiltrates on chest xray
PCWP< 18 mm Hg
BALF is proteinaceous and inflammatory
Pathologic examination shows diffuse alveolar damange, type ll pneumocyte hyperplasia with or without fibrosis
Ratio of PaO
air bronchograms, normal cardiac size
Know about oxygen delievery and PEEP with ARDS patients!
Recruits additional alveoli
May allow for ↓FIO2 Rule and airway shear trauma
Use the lowest level of PEEP that will maintain adquate oxygenation
Patient tolerance varies due to hemodynamic instability & worsening gas exchange
How much of the lung is not functioning in patents with ARDS?
Thus, in ARDS, the lungs are effectively diminished in size to 20 to 30% of normal
What are some other causes of lung cancer besides smoking?
Occupational and environment exposure
What is the purpose of staging cancer?
Most important prognostic variable in lung cancer, assesses extent of disease & selection of therapy
What does T, M, N stand for in TNM staging?
Status of primary tumor (T1-T4)
Local & regional lymph node involvement (N0-N3)
Presence of metastasis (M) 1A-4
The common organs that lung cancer commonly passes to?
What pulmonary function test are used to determine wheither a person can tolerate a lung recession?
What is the best treatment for non small cells cancer?
Surgical resection offers best survivial
How is small cells cancer staged?
Limited versus extensive
Limited stage for small cell lung cancer
Combination chemothrapy with concurrent hyperfractionated radiotherapy if prformance status is adequate
Prophylactic cranial radiation for those with a complete response to chemoradiotherapy
Extensive stage of small cell lung cancer
Combination chemotherapy if performance status is adequate
What kind of clinicals symptons might a patient have with tumor growth in the central airways?
Features of large airway obstruction
esophageal compression), post-obstructive pneumonitis, hoarseness, SVC syndrome, chest pain if pleura is involved, palpitation, syncope
What systems are affected by metastasize?
Supraclavicular lymph nodes
Symptoms of Metastatic or if lung cancer spreads byond the lung!
Localized bone pain
What is associated with respiratory muscle weakness?
The pulmonary consequences of nuromuscular disease!
Hyper or hypo ventilation
Atelectasis with resulting hypoxemia
Respiratory failure is frequent cause of death
Among the many neuromuscular problems causing pulmonary dysfunction, respiratory muscle weakness that leads to...
Symptoms of respiratory muscle weakness due to nuromuscular disease!
Symptoms of cor pulmonale
A decrease in FEV
and VC greater than 20% when a patient moves from the seated to the supine position indicates...
The inability to generate normal respiratory pressures...
Is reflected in a decreased maximal inspiratory pressure (PImax)
Expiratory muscle weakness is characterized by...
A decreased maximal expiratory pressure (PEmax)
Progressive inspiratory muscle weakness leads to...
Expiratory muscle weakness is associated with what problem?
Production of cough to clear pulmonary secretions
Decreased conduction of CNS impulse to peripheral muscles results in...
Most common peripheral neuropathy
Characerized by paralysis and hyporeflexia,
Is a demyelinating process caused by autoantibodies directed against nerve sheath
Autonomic nervous system problems with guillian barre syndrome!
Intermittent muscle weakness which worsens on repetitive stimulation and improves with anticholinesterase meds (neostigmine, tensilon)
Abnormalities of thymus gland common
Muscle weakness progresses during the day with repetitive use
Myasthenia Gravis typically occurs in...
Yonger female patients
The pulmonary complications of Myasthenia Gravis!
Upper airway obstruction
Decrease in TLC, VC, MIP, MEP
acute event – respiratory failure or loss of airway patency – intubation and PPV required stat
Guillian Barre syndrome can be weaned from mechanical ventilation when...
VC greater than 18 mm/kg
Transdiphragmatic pressure greater than 31 cm H2O
PImax greater than 30 cm H2O
How is paralyzed diaphgram diagnosed?
Phrenic nerve arises form spinal cord at C3-C5
Damage or interruption of this nerve leads to paralysis of ipsilateral hemidiaphragm
Bilateral interruption is seen in high cervical cord injury and results in complete diaphragmatic paralysis
Patients with unilateral diaphragmatic paralysis..
May have a 15 to 20% reduction in VC and TLC in the upright position and a further reduction while supine
Diaphragmatic paralysis is diagnosed...
Most often with chest radiograph
paralyzed side is displaced upward; fluoroscopy – effected side paradoxically rises during “sniff”
Amyotropic lateral sclerosis
Progressive degeneration of upper & lower motor neurons
Onset at mid-to late life with male predominance
Poor prognosis – 80% die within 5 years of onset
Monitor FVC, MIP, MEP – assesses ability to clear secretions, maintain gas exchange
MEP> 40cm needed to generate cough
What are the hallmark signs of diaphragmatic paralisis?
Patients adopt rapid, shallow breathing, using accessory inspiratory muscles
Abdominal paradox or paradoxical breathing is hallmark of significant diaphragmatic weakness – results in orthopnea
Where does a spinal cord injury occur to affect the diaphragm?
Middle to low cervical cord lesions (C3-8)
The diaphgram receives its innervation from C3-5
What are the breathing patterns of a patient who has had a stroke?
Cheyne strokes respirations
What are the complications of flail chest?
Repeated episodes of complete cessation of airflow for 10 seconds or longer
Significant decrease in breathing without complete cessation of airflow
30% airflow decrease and 4% oxygen desaturation
What causes obstructive sleep apnea?
Small or unstable pharyngeal airway caused by
Upper body obesity
Skeletal factors such as small or recessed chin
What are some symptoms of OSA?
Sensations of nocturnal choking, gasping, snorting
Witnessed by bed partner
Fatigue, EDS, irritability
Morning headaches, depression
Nocturnal reflux, nocturia, chronic nasal obstruction
What are some problems with CPAP?
Feelings of claustrophobia
Auto CPAP or smart PAP
Adjusts pressure when abnormal upper airway function is detected
UPPP or palatal surgery
Portions of soft palate, uvula, additional excess tissue are removed
Less than 50% success rate
Not currently recommended
Performed with a standard cold knife technique and or laser
Central sleep apnea
Associated with CHF & stroke
Patients have periodic breathing – waxing & waning of respiratory drive
Cheyne-Stokes is a severe type of periodic breathing
What is the association between sleep apnea and systemic hypertension?
Repetitive upper airway closure & opening increases sympathetic tone
Increased sympathetic tone is caused by...
Episodes of hypoxemia & hypercapnia
arousals & microarousals also increase sympathetic response
Apnea-hypopnea index (AHI) or the respiratory distrubance index (RDI)
Number of apnea / hypopnea events per hour of sleep
AHI >30 = severe sleep apnea
AHI = 15-30 moderate
AHI = 5-15 mild
AHI < 5 = normal
The use of alcohol with sleep apnea?
Decreases the arousal threshold and can increase the duration of apnea
Reduce upper airway muscle tone, causing the airway to be more compliant and more prone to complete or partial closure