16. Lung Tissue Disorders - Airleaks + PARDS Flashcards
1
Q
what are the 4 types of pulmonary air leaks?
A
- Pneumothorax
- Pneumomediastinum
- Pneumopericardium
- Pulmonary interstitial emphysema (PIE)
2
Q
- Pulmonary air leak syndromes were common complications of ______ ________ in ________ _____ with _______ _______ _______ before the use of ________.
- what are 4 newborn ventilator strategies used today with air leaks?
A
- mechanical ventilation, premature infants with respiratory distress syndrome, surfactant
- Minimize volutrauma and barotrauma, Permissive hypercapnia, High frequency ventilation, Non invasive ventilation
3
Q
- premature infants at what age are at an increased risk for air leaks?
- what are 2 most frequent risk factors?
- what 3 parameters in MV can cause air leaks if they are high?
- what do term babies occasionally develop shortly after birth? what increases the risk that this can occur at birth?
A
- < 1000g
- PPV and mechanical ventilation
- Positive end-expiratory pressure, Peak inspiratory pressures, Prolonged inspiratory time
- spontaneous airleak, PPV at birth
4
Q
- what is a pneumothorax?
- can also be what?
- what should we be aware of?
- what is the most reliable indicator that a pneumo is present in neonates?
A
- Leakage of air into the pleural space
- tension pneumo
- cardiovascular effects
- transillumination
5
Q
- what is a pneumomediastinum?
- where does the gas originate from?
- the gas can track from _____ to the ______ or _____.
A
- Leakage of air into the mediastinum
- Gas may originate from the lungs, trachea, central bronchi, oesophagus, and peritoneal cavity
- mediastinum to the abdomen or neck
6
Q
- what is a pneumopericardium?
- where does this gas come from?
- what can this condition lead to?
A
- Air enters the pericardial cavity and gets trapped in the pericardial sac
- Air from the lungs, pneumomediastinum
- cardiac tamponade
7
Q
- what is the definition of Pulmonary Interstitial Emphysema (PIE)?
- this is a result of what?
- when is this condition commonly seen?
- what procedure can cause this condition if done incorrectly?
A
- Collection of gases in the interstitial tissue surrounding alveoli and airways
- Result of alveolar and terminal bronchiolar rupture
- overdistention and air trapping in premature patients
- Unilateral surfactant administration
8
Q
what 8 things may commonly be seen on a CXR of a patient who has PIE?
A
- Air trapping and alveolar hyperinflation
- Depressed diaphragm
- Atelectasis
- May show focal or generalized problem areas
- Fine bubbly appearance extending from the hilum to the pleura
- Pneumomediastinum
- Pneumothorax
- Pneumopericardium
9
Q
- what is considered the best treatment for airleak syndromes?
- how can these syndromes be avoided? (hint 5)
A
- PREVENTION
- Ensure PPV pressure are monitored and minimized, Lowest mechanical ventilator pressures (PIP, PEEP), Permissive hypercapnia, Radiologic confirmation of the adequacy of PEEP and lung volume, High-frequency ventilation
10
Q
- what type of ventilation has been considered helpful in treating pulmonary airleaks in infants?
- what type of intubation strategy can be considered in neonates?
A
- High-frequency ventilation (HFJV)
2. Selective intubation of the unaffected or less affected lung may allow the injured lung time to heal
11
Q
- how should a pneumo initially be drained? what should be left in place after this?
- how is a pneumopericardium drained?
- what 2 airleaks can NOT be drained and should be resolved on their own?
A
- Needle thoracentesis for pneumothorax then chest tube left in place
- Pericardiocentesis
- pneumomediastinum and PIE
12
Q
- PARDS is acute lung injury characterized by?…..
2. what 2 things are also seen in these patients?
A
- pulmonary edema and alveolar collapse secondary to the disruption of the alveolar–capillary membrane and surfactant dysfunction
- Hypoxemia and widespread infiltrates on CXR
13
Q
2015 Pediatric Acute Lung Injury Consensus describes criteria for meeting the diagnosis of PARDS…….. (think of the chart)
- what does the age category refer to?
- what is the timing required for PARDS?
- origin of edema?
- what is seen on a CXR?
- NIV oxygenation status? PF and SF ratio?
A
- exclude patients with perinatal related lung disease
- within 7 d of a known clinical insult
- respiratory failure not fully explained by cardiac failure or fluid overload
- new infiltrates consistent with acute pulmonary parenchymal disease
- full face mask bi-level ventilation or CPAP >/= 5cmH2O (PF = = 300, SF = = 264)
14
Q
2015 Pediatric Acute Lung Injury Consensus describes criteria for meeting the diagnosis of PARDS CONT …….. (think of the chart)
- oxygenation status with MV, mild severity? moderate? severe?
- when considering the special populations….. what is said about cyanotic heart disease in relation to oxygenation?
- what is said about chronic lung diseases?
- what is said about left ventricular function?
A
- mild = 4 = OI < 8 and 5 = OSI < 7.5, moderate = 8 = OI < 16 and 7.5 = OSI < 12.3, severe = OI >/= 16 and OSI >/= 12.3
- standard criteria above for age, timing, origin of edema and CXR with an acute deterioration in oxygenation not explained by underlying cardiac diseases
- standard criteria above for age, timing, origin of edema and CXR consistent with new infiltrates and acute deterioration in oxygenation from baseline which meet oxygenation criteria previously mentioned
- standard criteria for age, timing, origin of edema and CXR changes consistent with new infiltrate and acute deterioration in oxygenation which meet criteria above not explained by LVD
15
Q
what 5 strategies are used when initiating lung protective ventilation?
A
- Low tidal volumes (3-6 ml/kg if poor compliance, 5-8 ml/kg if preserved compliance)
- Pplateau < 28 cmH2O
- Permissive hypoxemia (SpO2 88-92%)
- PEEP >10 cm H2O
- Permissive hypercapnia
16
Q
- pediatric HFOV has ____ benefit, and may cause _____ ______ in adult ARDS.
- small RCT’s show improved what? but there was no difference in what?
- when should HFOV be considered in PARDS?
A
- no, potential harm
- improved oxygenation, no difference in mortality, duration of MV, or LOS.
- moderate to severe PARDS and Pplateau >28 cm H2O.
17
Q
- pediatric prone positioning showed a ___ _____ reduction in severe ARDS.
- adult systemic reviews reported improved what? was also considered what? could potentially reduce mortality when coupled with what?
- pediatric RCT reported what? but also reported no what?
- when should proning be considered in PARDS?
- not considered ______ ______.
A
- 50% mortality
- improved oxygenation, considered safe, coupled with lung protective strategies
- reported safety but no difference in patient outcomes
- option in cases of severe PARDS
- routine therapy
18
Q
- lung recruitment maneuvers improve _________ in adults with higher what?
- what is considered safe in ARDS and PARDS? alos helps to improve what?
A
- oxygenation with higher lung compliance
2. incremental PEEP titration is safe and improved oxygenation
19
Q
- nitric oxide helps to improve what? with no impact on what?
- not considered for _______ _____.
- when can iNO be considered? (hint 3)
A
- oxygenation, no impact on mortality
- routine therapy
- patients with known pulmonary hypertension, severe right ventricular dysfunction, or as bridge to ECMO.
20
Q
- surfactant improves overall _______. however, there is no difference in ____, _______, and ______.
- not recommended for _____ ______.
A
- oxygenation. No difference in MV, LOS and mortality
2. routine use
21
Q
- RCTS show potential _________ benefit from ECMO.
2. when should ECMO be considered? (hint 5)
A
- mortality (strong evidence)
- severe PARDS when lung-protective strategies result in inadequate gas exchange, after serial evaluations demonstrate deteriorating trend, Disease process must be deemed reversible or lung transplant suitable treatment, and high OI (20s-30s)
