ILD case history Flashcards
Interstitial filtrates acronym is
SHIT FACED, what does that stand for?
S: sarcoid
H:Hypersensitivity penumonitis
I:interstitial lung disease
T: tumor, TB
F: fungal
A: asbestosis
C: collagen vasc
E: eosinophil granuloma
D: drugs
Chest xray: scratchy lung fields =
interstitial involvement of suppporting tissue of lung parenchyma: see fine or coarse reticular opacities or small nodule
With interstitial infiltrates on xray, what kind of biopsy will we do?
we will use transbronchioal biopsy and do 6, get 95% dx of interstitial infiltrates
Diagnostically we see granuloma and you can see large granuloma
Submucosa dominated by granulomas. See interstitium w/ granulomas as well. Look like sarcoidosis but call it non-necrotizing granulomas. Pathologists can’t call this sarcoidosis, need what two things to compare it to?
Need microbiology correlation before you make definitive dx as well as comparing to clincal picture
What do you see on histology?
Well circumscribed, non-necrotizing epitheliod cell granuloma with multinucleate giant cells
Descibe this open lung biopsy
Granulomas w/ lymphatic distribution pattern; discreate and well-circumscribed following broncovascular bundles and interstitial septa
Describe Stage I Sarcoidosis:
Nodes: looks like jumbo shrimp.. get lateral chest xray
Jumbo shrimp = Stage I
Describe Stage II sarcoid on xray
Stage II sarcoid: nodes and scrathy lungs
Describe Stage III sarcoidosis
Very scratchy, NO NODES
What do we see in stage IV sarcoidosis
very bad fibrosis
Therapy recommendation for sarcoidosis?
dyspnea, with decreased FVC below 70% and cough/wheezing
prednisone or inhaled corticosteroids
What do fluffy markings on xray indicate?
Consolidation- any pathologic process that fills the alveoli
What is the pneumonic for alveolar infiltrates?
Pecan Pie:
PCPIE
P = pus
C- cells (RBS/eosinos/tumor)
P-protein
I-inflammatory
E-edema (cardiac or non cardiac)
Berlin Criteria for ARDS
ARDS while on PEEP >/= to 5 cm H20
Timing: acuteness of illness 7 days
Fluid overload assessed by clinical judgement- echo if no risk factor
CXR or CT findings: bilateral infiltrates
What does Lung Protective Ventilation consist of?
Low Tidal Volume and Low Plateau Pressure
In the Acute Lung injury randomized trial, patients were given two different tidal volumes:
12 ml/kg or 6 ml/kg
Which patients faired better?
Patietns with 6 ml/kg did better. Mortality prior to hospital discharge when from 40% in the 12 ml/kg group to 30% in the 6 ml/kg group and had more ventiliatory free days
In ventilator protocol our tital volume is 6 ml/kg, but what about PEEP? Do you want lower PEEP/Higher FiO2 OR
higher PEEP/lower Fi02?
Doesn’t matter, PEEP being high or low doesn’t contribute significanlty to overall mortality
16 is a nice sweet spot
FACTT; Fluid and Catheter Treatement Trial compared LIBERAL (up to 6 L/day) vs Conservative (no fluid other than daily)
What did we see in ventilatory free results?
Tx with conservative fluid therapy resulted in 14.5 ventilator free days vs 12 ventilator free days in pts with liberal fluid
Key points:
____ tidal volumes preferred
____ fluid management after ‘just right’ early resuscitation is preferred
_____ positioning for more sever ARDS
_____ for pts with severe ARDS
small tidal volumes
conservative fluid volumes
Prone position for more severe ARDS
Paralysis for severe ARDS
Key point on
PEEPS
Nutrition
B-agonists
Surfactant
Statins and salmon
choose your peep, no right or wrong
nutrition; both grandmas right
B-agonists shouls stay in OLD
Surfactant for children, not adults
Statis and fluids shouldn’t be in the water
