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COEXISTING > RESTRICTIVE LUNG DISEASE > Flashcards

RESTRICTIVE LUNG DISEASE Flashcards

1
Q

structures of the thoracic cage that surrounds the lungs

A
  • parietal pleura
  • skeleton
  • muscles (intercostals, diaphragm, accessory muscles of respiration)
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2
Q

restrictive disease & lung volumes

A

proportional decrease in all lung volumes w/ preservation of flow

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3
Q

PFTs in restrictive lung disease

A 
decrease in: 
- total lung volume
- FRC
- reserve volume
- VC <70mL/kg
- FEV1
- FVC
no change in: 
- FEV1/FVC ratio
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4
Q

does arterial hypoxemia occur in restrictive lung disease?

A

it can, due to V/Q mismatch NOT due to gas exchange issues

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5
Q

breathing pattern in restrictive lung disease

A

rapid & shallow in attempts to maintain adequate MV

- reduction in lung compliance

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6
Q

classification & examples of restrictive lung diseases

A

acute intrinsic = pulmonary edema, ARDS

chronic intrinsic = diseased lung parenchyma (sarcoidosis)

chronic extrinsic = chest wall, intraabdominal, neuromuscular diseases

disorders of the pleura & mediastinum

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7
Q

what is pulmonary edema

A

leakage of intravascular fluid into the lung interstitium & alveoli

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8
Q

causes of pulmonary edema

A
  1. increased capillary/hydrostatic pressure (ie cardiogenic)

2. increased capillary permeability (ie inflammatory process)

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9
Q

CXR pulmonary edema

A

bilateral symmetrical opacity

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10
Q

s/s cardiogenic pulmonary edema

A

dyspnea
tachypnea
SNS activation = hypertension, tachycardia, diaphoresis

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11
Q

what is aspiration pneumonitis

A

aspirate into the lungs that is rapidly distributed throughout; acidic nature = destruction of surfactant producing cells, injury of the endothelium & capillaries

–> capillary permeability w/ resultant atelectasis & edema (like ARDS)

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12
Q

clinical findings w/ aspiration pneumonitis

A
  • arterial hypoxia
  • tachypnea
  • bronchospasm
  • pulmonary vascular constriction –> pulmonary HTN
  • CXR = RLL
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13
Q

tx of aspiration pneumonitis

A

increase FiO2!

  • PEEP
  • B2 agonists
  • no prophylactic abx
  • steroid controversial
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14
Q

what is negative pressure pulmonary edema

A

2-3hrs after acute upper airway obstruction in spontaneously breathing patient
–> negative pressure generation against obstructed airway pulls fluid from vasculature, interstitial spaces into lungs

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15
Q

causes of negative pressure pulmonary edema

A
  • post extubation laryngospasm
  • OSA
  • hiccups
  • epiglottitis
  • tumors
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16
Q

physiologic results of highly negative intrapleural pressures

A
  • decreased interstitial hydrostatic pressure
  • increased venous return (preload)
  • increased afterload on LV
  • increased SNS outflow
17
Q

s/s negative pressure pulmonary edema

A

tachypnea
cough
failure to maintain SaO2 >95%

18
Q

treatment of negative pressure pulmonary edema

A

usually self-limited 12-24hr duration

supportive care: supplemental O2, maintenance of patent upper airway, occasionally require mechanical ventilation briefly

19
Q

what is sarcoidosis

A

systemic granulomatous disorder that changes the intrinsic properties of the lung due to pulmonary fibrosis

  • -> pulmonary HTN & cor pulmonale
  • -> more fibrosis & loss of pulmonary vasculature
20
Q

areas affected by sarcoids

A

OFTEN: thoracic lymph nodes & lungs

Other areas:

  • laryngeal - ETT issues
  • myocardial (rare) - conduction defects
  • liver
  • spleen
  • optic
  • unilateral facial nerve
21
Q

presentation of sarcoidosis patient

A 
dyspnea
cough
rapid shallow breathing
often present for mediastinoscopy (diagnosis)
often on corticosteroids (stress dose)
22
Q

cardiac implications of chronic extrinsic restrictive lung disease

A

chronic compression of pulmonary vasculature –> right ventricular dysfunction

23
Q

neuromuscular disorders that can prevent the generation of normal respiratory pressures

A
  • diaphragmatic paralysis
  • spinal cord transection
  • guillian-barre
  • myasthenia gravis
  • myasthenic syndrome
  • muscular dystrophy
24
Q

pulmonary implications of neuromuscular disorders that can prevent the generation fo normal respiratory pressures

A
  • impaired clearance of secretions
  • impaired cough –> chronic infection –> COPD
  • impaired ability to swallow –> aspiration
  • PNA
  • respiratory failure may result
  • very sensitive pulm system to CNS depressants
25
Q

physiologic implications of mediastinal tumors

A
  • progressive airway obstruction
  • loss of lung volumes
  • compression of pulmonary artery, myocardium, or SVC
  • **may occlude in supine position and/or obstruct airway if muscle relaxant given during induction
  • -> review imaging
26
Q

preop assessment of the patient w/ restrictive lung disease

A
  • exercise tolerance
  • baseline dyspnea
  • PFTs, flow volume loops, ABG may be helpful

Factors that signal increased risk:

  • decrease in VC<15mL/kg
  • resting hypercarbia
27
Q

optimization preop of the patient with restrictive lung disease

A 
treat pulmonary infection
improve sputum clearance
treat cardiac dysfunction
attempt to improve resp muscle strength
smoking cessation
28
Q

mechanical ventilation guidelines for restrictive lung dz

A

lower Tv
higher rr
PPV = high airway pressures

29
Q

anesthestic management considerations for restrictive lung dz

A
  • caution w/ respiratory depressant medications = very little reserve
  • caution w/ regional anesthesia >T10 = loss of accessory muscles
  • caution w/ N2O = pneumothorax
  • shorter acting IV/maintenance agents preferred to minimize postop respiratory depression
  • volatile agents have accelerated uptake
  • low FRC = less safe apnea time after preoxygenation
  • expect high PIP
30
Q

extubation criteria for restrictive lung dz

A 
adequate PaO2 >60
PaCo2 <50
rr <30
Tv >300
VC >10-15mL/kg
adequate consciousness
 &amp; muscle strength
full NMB reversal
31
Q

critically ill patients w/ restrictive lung disease & anesthetic management

A

cancel elective surgery w/ ARDS, pulmonary edema

if emergency surgery:

  • diuretics
  • vasodilators/inotropes for cardiac failure
  • consider pleural effusion/ascites drainage preop
  • may require ICU w/ ventilator
  • aggressive hemodynamic monitoring (artline, CVP, PA cath)

COEXISTING (10 decks)

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