Restrictive Lung Disease Flashcards
(109 cards)
1
Q
What is the hallmark of Restrictive Lung Disease (RLD)?
A
Inability to increase lung volumes proportionate to increases in alveolar pressure.
2
Q
What are common causes of Restrictive Lung Disease?
A
- Connective tissue diseases
- Environmental factors
- Pulmonary fibrosis
- Increased alveolar or interstitial fluid
- Limitations in chest/diaphragm excursion
3
Q
What are the key pulmonary function test findings in Restrictive Lung Disease?
A
- Reduced FEV1
- Reduced FVC
- Normal or increased FEV1:FVC ratio
- Reduced DLCO
- All lung volumes decreased, especially TLC
4
Q
What is the principle feature of RLD?
A
Decrease in TLC
5
Q
How is the severity of Restrictive Lung Disease classified based on TLC?
A
- Mild disease: TLC 65-80% of predicted value
- Moderate disease: TLC 50-65% of predicted value
- Severe disease: TLC <50% of predicted value
6
Q
What are causes of acute intrinsic restrictive disease? (Pulmonary edema)
A
ARDS
Aspiration
Neurogenic Problems
Opioid overdose
High altitude
Reexapansion of collapsed lung
Upper airways obstruction
CHF
7
Q
Chronic Intrinsic RLD Causes
A
Sarcoidosis
Hypersensitivity pneumonitis
Eosinophilic Granuloma
Alveolar proteinosis
Drug induced protein fibrosis
8
Q
What causes Pulmonary Edema?
A
- Increased capillary pressure
- Increased capillary permeability
9
Q
What is the characteristic finding on CXR for Pulmonary Edema?
A
Bilateral, symmetric perihilar opacities.
10
Q
Pulmonary edema caused by increased capillary permeability is assoc w/ a _________
A
high concentration of protein in the edema fluid
11
Q
True of False: Increased-permeability pulmonary edema associated with ARDS leads to diffuse alveolar damage
A
True
12
Q
What is Cardiogenic Pulmonary Edema associated with?
A
- Acute decompensated heart failure
- Dyspnea
- Tachypnea
- Elevated cardiac pressures
*Decreased systolic or diastolic cardiac function
13
Q
Risk factors for cardiogenic pulmonary edema
A
*Increases in preload (aortic or mitral regurg)
*Increased afterload and SVR (HTN, LVOT onstruction, mitral stenosis)
14
Q
What is Negative Pressure Pulmonary Edema?
A
Occurs 2-3 hours after relief of an upper airway obstruction such as laryngospasm, epiglottitis, tumors or OSA
15
Q
How does the relief of an upper airway obstruction cause negative pressure pulmonary edema?
A
attempted spontaneous ventilation during obstructioncreates negative pressure, drawing in fluid from the alveolar capillaries
16
Q
What are the symptoms of Negative Pressure Pulmonary Edema?
A
- Tachypnea
- Cough
- Desaturation
17
Q
What is the treatment for Negative Pressure Pulmonary Edema?
A
- Supplemental oxygen
- Maintaining a patent airway
- Mechanical ventilation occasionally
*Typically resolves in 12-24 hours
18
Q
What is Neurogenic Pulmonary Edema?
A
Develops after acute brain injury due to massive SNS impulses from injured CNS causing vasoconstriction and blood shifting into pulmonary circulation
19
Q
Blood volume shifting in neurogenic pulmonary edema leads to fluid transfer into the ____ and ____
A
Interstitium
alveoli
20
Q
True or False: Pulmonary HTN & hypervolemia can also injure blood vessels in the lungs
A
True
21
Q
What is Re-expansion Pulmonary Edema (REPE)?
A
Occurs after rapid expansion of a collapsed lung.
22
Q
What factors increase the risk of Re-expansion Pulmonary Edema?
A
- Amount of air/liquid in pleural space >1 L
- Duration of collapse >24 hours
- Speed of re-expansion
23
Q
What can cause Drug-Induced Pulmonary Edema?
A
- Opioids (e.g., heroin)
- Cocaine
24
Q
True or False: Naloxone reverses opioid-induced pulmonary edema
A
False
25
How to differentiate between diffuse alveolar hemorrhage (DAH) and drug-induced pulmonary edema?
If pulmonary edema does not respond to diuretics, DAH is likely
26
What is High-Altitude Pulmonary Edema (HAPE)?
Occurs at heights of 2500-5000m and is influenced by the rate of ascent, typically occurs within 48-72 hours at high altitude
27
What is the treatment for High-Altitude Pulmonary Edema?
* Oxygen administration
* Quick descent from high altitude
28
What are the anesthesia implications for patients with pulmonary edema?
* Delay elective surgery
* Optimize cardiorespiratory function
29
Ventilation considerations for pulmonary edema
Low TV
RR-14-18
End-inspiratory pressures <30cmH2O
Titrate PEEP
30
True or False: Delay extubation due to tachypnea in pulmonary edema patients
False: pts with RLD typically have rapid, shallow breathing, tachypnea should not be used as the sole criteria for delaying extubation if gas exchange and other assessments are satisfactory
31
What are the symptoms of Chemical Pneumonitis (aspiration pneumonitis)?
* Abrupt dyspnea
* Tachycardia
* Desaturation
32
What is the best treatment for aspiration pneumonitis?
* Supplemental oxygen
* PEEP
33
When do we consider antibiotics with aspiration pneumonitis?
If the patient is symptomatic after 48 hours and has + culture results
**no evidence that they decrease the incidence of pulmonary infection
34
Where is aspiration pneumonitis normally seen on CXR if patient was in supine position?
superior segment of RLL
35
What is E-Cigarette Vaping Associated Lung Injury (EVALI)?
Associated with pneumonia, diffuse alveolar damage,acute fibrinous pneumonitis, bronchiolitis, and interstitial lung disease (ILD)
36
What additives of vapes/ecigs have been assocaited with EVALI?
THC
CBD
Vitamin E acetate
nicotine
37
Treatment for EVALI
Antibiotics
systemic steroids
supportive care
38
What is the most commonly reported finding of COVID 19 RLD?
Reduced diffusion
It is directly related to the severity
39
What are the symptoms of COVID-19 induced restrictive lung disease?
* Dyspnea
* Ventilator dependence
* Pulmonary fibrosis
40
What characterizes Acute Respiratory Failure (ARF)?
* PaO2 <60 mmHg despite oxygen supplementation in the absence of right to left intracardiac shift
* PaCO2 >50 mmHg without respiratory-compensated metabolic alkalosis
41
Differences ARF v CRF ABGs
ARF: increased PaCO2 and decreased pH
CRF: increased PaCO2 and normal pH (normal pH reflects renal compensation)
42
What are the three treatment goals of Acute Respiratory Failure?
* Patent airway
* Hypoxemia correction
* Removal of excess CO2
43
What is Volume-Cycled Ventilation?
Fixed tidal volume with inflation pressure as the dependent variable.
44
What is a disadvantage of Volume-Cycled Ventilation?
Inability to compensate for leaks in the delivery system.
45
What is the primary mode of Volume-Cycled Ventilation?
* Assisted/Controlled (A/C) ventilation
* Synchronized Intermittent Mandatory Ventilation (SIMV)
46
What does elevated PAP indicated with volume cycled ventilation?
pulmonary edema, pneumothorax, kinked ETT, or a mucous plug
47
Why is maintenance of PaO2>60 adequate?
SPO2>90 at this level
48
Methods of oxygenation for mild to moderate V/Q mismatching
NC
Ventrui
NRB
T-piece
*seldom provide FiO2>50%
49
How does CPAP help with oxygenation and what are it's disadvantages?
CPAP may increase lung volumes by opening collapsed alveoli and decreasing right-to-left intrapulmonary shunting
CPAP mask may increase the risk of aspiration, esp in pts with N/V
50
What are complications of Mechanical Ventilation?
* Infection
* Barotrauma
* Atelectasis
51
True of False: Infection increases the risk of barotrauma, by weakening the pulmonary tissue
True
52
What is the most important predisposing factor for developing nosocomial pneumonia?
Intubation
53
What reflects the adequacy of oxygen exchange across alveolar capillary membranes?
PaO2
54
Which mechanism of arterial hypoxemia has increased PaCO2?
Hyperventilation
55
Which mechanism of arterial hypoxemia has poor to little response to supplemental O2?
Right to Left intrapulmonary shunt
56
What is the PAO2-PaO2 gradient useful for?
evaluating gas exchange, lung function, and distinguishing the cause of arterial hypoxemia
57
True or False: Atelectasis is a common cause of hypoxemia during mechanical ventilation and is responsive to and increase of FiO2
Fasle. It is not responsive to an increase of FiO2
58
How is atelectasis identified on lung ultrasound (LUS) by bronchogram?
Static air
59
What are the three main causes of arterial hypoxemia?
* V/Q mismatch
* Right-to-left pulmonary shunting
* Hypoventilation
60
What is the VD:VT ratio?
Reflects the efficacy of CO2 transfer across alveolar capillary membranes.
61
True or False: Chronic hypoxemia leads to an increase in RBC mass to improve 02 carrying capacity
True
62
Normal VD: VT
Value that indicates increase of dead space ventilation
<0.3
>0.6
63
What does an increased VD:TV occur in?
ARF
Decreased CO
PE
64
What is the criterion for extubation readiness?
* Vital capacity >15 mL/kg
* Alveolar-arterial oxygen difference <350 cmH2O on 100% O2
* PaO2 >60 mmHg on FiO2 <0.5
65
Advantages of SIMV over A/C ventilation
use of respiratory muscles
lower mean airway and pressures
prevention of respiratory alkalosis
improved pt–ventilator coordination
66
Pressure cycled ventilation
provides gas flow until a preset airway pressure is reached. TV varies with changes in compliance and airway resistance
67
What indicates a need for mechanical ventilation weaning?
When determining whether the pt can tolerate extubation, considerations include that the pt is alert and cooperative and can tolerate SV without tachypnea, tachycardia, or respiratory distress
68
What is the normal PaO2 level required for vent weaning?
>60 mmHg on FiO2 <0.5
69
Compensatory responses are stimulated by an acute decrease in _______ and ______In chronic hypoxemia,
Pa02 <60 mmHg
Pa02 is <50
70
Compensatory responses for arterial hypoxemia
1. Carotid body–induced increase in alveolar ventilation
2. Hypoxic pulmonary vasoconstriction to divert blood flow away from hypoxic alveoli
3. Increased SNS activity to increase COP and enhance tissue oxygen delivery
71
What is the normal PaCO2 level for vent weaning?
<50 mmHg
72
What pH level is required for vent weaning?
>7.30
73
List the additional criteria for vent weaning.
* PEEP <5 cmH2O
* RR <20
* VC >15 mL/kg
74
What are the signs that a patient may not tolerate extubation?
Rapid RR with low TV
75
What are the three options considered for a trial of vent withdrawal?
* SIMV
* Intermittent trials of total removal of mechanical support
* Decreasing levels of pressure support ventilation
76
What is Acute Respiratory Distress Syndrome (ARDS) caused by?
Inflammation and manifests as acute hypoxemic respiratory failure
77
What is associated with the highest risk of ARDs?
Sepsis
78
What are the symptoms of ARDS?
* Rapid-onset respiratory failure
* Hypoxemia
* CXR findings similar to cardiogenic pulmonary edema
79
What do proinflammatory cytokines do in ARDS?
Increase alveolar capillary membrane permeability and cause alveolar edema
80
What is the aim of using ECMO in ARDS management?
Rest the lungs until hypoxemia and respiratory acidosis resolve
81
How does proning help ARDS?
Prone positioning exploits gravity and repositioning of the heart to recruit lung units and improve V/Q matching
82
What is interstitial lung disease (ILD)?
A group of lung pathologies leading to diffuse parenchymal disease
83
What is a classic manifestation of sarcoidosis?
Hypercalcemia
84
What test is used to detect sarcoidosis?
Kveim skin test
85
What is pulmonary Langerhans Cell Histiocytosis associated with?
Smoking tobacco
86
What are the symptoms of pulmonary alveolar proteinosis (PAP)?
* Dyspnea
* Hypoxemia
87
What is the treatment for severe cases of PAP?
Lung lavage under general anesthesia
88
What is lymphangioleiomyomatosis?
A rare multisystem disease causing proliferation of smooth muscle of the airways, lymphatics, and blood vessels
89
What is the effect of aging on lung function?
Decreased chest wall compliance and elastic recoil
90
What are common thoracic extrapulmonary causes of chronic extrinsic restrictive lung disease?
* Thoracic deformities
* Ankylosing spondylitis
* Flail chest
* Scoliosis
* Kyphosis
91
What is pectus carinatum?
Deformity of sternum characterized by outward projection of the sternum and ribs
92
What is the treatment for flail chest?
Positive pressure ventilation and stabilization
93
What imaging techniques are used to diagnose pleural effusion?
* CXR
* CT
* Bedside US
94
What is tension pneumothorax?
Medical emergency resulting from gas entering the pleural space during inspiration and not escaping during exhalation
95
What are the symptoms of tension pneumothorax?
* Respiratory distress
* Tachypnea
* SOB
* Hypoxia
* Pleuritic chest pain
* Tachycardia
* Hypotension
96
What is the treatment for tension pneumothorax?
Immediate evacuation through a needle or small-bore catheter
97
What is acute mediastinitis caused by?
Bacterial contamination after esophageal perforation
98
What are the symptoms of acute mediastinitis?
* Chest pain
* Fever
99
What are the types of anterior mediastinal masses?
* Thymomas
* Germ cell tumors
* Lymphomas
* Intrathoracic thyroid tissue
* Parathyroid lesions
100
What are the complications associated with mediastinoscopy?
* Pneumothorax
* Mediastinal hemorrhage
* Venous air embolism
* RLN injury
101
What are extrathoracic causes of restrictive lung disease?
* Neuromuscular disorders
* Abnormalities of spinal cord
* Peripheral nerves
* NMJ
* Skeletal muscles
102
What percentage of Guillain-Barré syndrome patients may require mechanical ventilation?
20-25%
103
What is the most common disease affecting neuromuscular transmission?
Myasthenia gravis
104
What effect does obesity have on lung volumes?
Decreases FEV1, FVC, FRC, ERV
105
What physiological changes occur during pregnancy that affect lung function?
* Increased rib cage circumference
* Diaphragm moves cephalad
* Increased levels of relaxin
106
What is the recommended anesthesia management for patients with restrictive lung disease?
Avoid drugs with prolonged respiratory depressant effects
107
What is a common complication of diagnostic procedures like transbronchial lung biopsy?
Pneumothorax
108
Intrapulmonary shunt
Right-to-left pulmonary shunting: perfusion of nonventilated alveoli with a net decrease in PaO2
109
