Hypercapneic Ventilatory Failure

Question 1

What are causes for hypercapneic respiratory failure?

Answer 1

Copd
Neuromuscular disease (MG, ALS, MS)
Restrictive lung disease (parenchymal lung disease, obesity)
Depressed respiratory drive (opioids)

Question 2

Patient found to have restriction on spirometry but normal diffusing capacity, what should be done when having daytime sleepiness, morning headaches, waking up gasping for breath?

Answer 2

Likely have neuromuscular disorder….Polysomnography since disorder of ventilation occur w hypoventilation during REM sleep

Question 3

70 m presents to ED with hypotension, dyspnea, hypoxia, impending respiratory failure, fat stranding around pancreas with fluid collection, diagnosis, treatment?

Answer 3

ARDS, lung protective strategy volume control, tidal volume <=6 mL/oh of ideal body weight.

Plateau end pressure <30, allow permissive hypercapnia and acidosis

PEEP (decrease)

Question 4

In patient with ARDS, what has mortality benefit?

Answer 4

Prone positioning

Not limiting fluids nor diuretics

Question 5

A patient w ARDS and normal BP, are steroids recommended to prevent further lung injury?

Answer 5

No

Question 6

65 M h/o CAD, pleural effusions, s3 sound, lower extremity edema post MI, PCWP >=18 mmHg

Answer 6

Diuresis or afterload reduction

Question 7

45 M w h/o hsct p/w dyspnea, pulmonary crackles. bAL showed hemosiderin-laden macrophages, Dx?

Answer 7

Diffuse alveolar hemorrhage

Question 8

59 F h/o smoker p/w cough, fever, pleuritic chest pain, s/p BAL >15% eosinophils, diagnosis?

Answer 8

Acute eosinophilic pneumonia

Question 9

37 M likes to visit saunas and over the course of weeks developed dyspnea, X-ray show bilateral lung opacities, diagnosis?

Answer 9

Hypersensitivity pneumonia is

Question 10

Which disease process is almost impossible to distinguish from ARDS?

Answer 10

Acute interstitial pneumonia