Pulmonary risk factors CC

Question 1

Risk factors for ARDS

Answer 1

• Sepsis (most common)
• Pneumonia
• Aspiration
• Trauma
• Transfusion
• Transplant
• Medications and drugs of abuse

Question 2

Pneumothorax

Answer 2

Ventilator settings:

• Pre-LPV era
• Pplat > 35
• No clear relation to PEEP, Ppeak, prone positioning, HFOV

Lung factors:

• Compliance < 30 cc/cmH2O
• Necrosis
• Trauma
• No paralytic?: 11.7 vs 4.0%; p=0.01 (yet not seen in ROSE)
• Iatrogenic

Question 3

Venous air embolism during gastrointestinal endoscopic procedures risk factors

Answer 3

• Previous surgery, intervention, or injury of the bile duct system (eg, TIPS, blunt or penetrating liver trauma, percutaneous transhepatic biliary drain, postsurgical gastrointestinal fistula)
• Inflammatory conditions (eg, cholangitis, hepatic abscess, inflammatory bowel disease, necrotizing enterocolitis)
• Procedural issues (eg, sphincterotomy, metal stent, cholangioscopy, biliary sphincterotomy, high pressure or rate of gas insufflation)

Question 4

Risk factors for primary graft dysfunction (PGD) post lung transplant

Answer 4

Donor risk factors:

• smoking,
• aspiration,
• lung contusion,
• undersized donor relative to recipient,
• heavy alcohol use,
• fat embolism,
• thromboembolism

Recipient factors:

• female gender,
• elevated recipient BMI (≥25 kg/m²), and
• African American

Pretransplant diseases with increased risk of PGD:

• idiopathic pulmonary fibrosis,
• sarcoidosis,
• pulmonary arterial hypertension (PAH)

Intraoperative risk factors:

• large volume intraoperative blood product transfusion,
• prolonged ischemic time,
• use of cardiopulmonary bypass (CPB)

MCQs

Question 5

Risk factors for hypoxemia during one lung ventilation

Answer 5

• Left-sided OLV: Right-sided OLV is better tolerated than left-sided OLV.
• Normal Baseline Spirometry: Patients with better spirometric lung function are more likely to desaturate during OLV.
• Low Baseline PaO2: Abnormally low arterial oxygen tension (PaO2) during two lung ventilation is an indicator of abnormal lung function and a predictor of hypoxemia during OLV.
• Position: The non-dependent position of the ventilated lung can influence oxygenation during OLV.

Question 6

Poor prognostic factors for PAH

Answer 6

• Age > 45 yrs old at presentation
• NYHA class 3 – 4
• Raynaud’s
• High nt-BNP
• 6MWD < 332m (from ISHLT transplant guidelines)
• Pericardial effusion
• Hemodynamic parameters
• RAP > 15 mmHg, mPAP > 85 mm Hg, CI < 2, large RA size, septal shift in diastole
• Failure to improve to lower NYHA after 3 months with Flolan
• CTD associated
• HIV associated
• VO2max < 10.4, SBP < 120 on CPET

MCQs

Question 7

Prognostic factors for PAH in pregnancy

Answer 7

• early clinical deterioration
• severe RV dysfunction
• BNP elevation
• FC III or IV symptoms