Pathophysiology
One of the important anatomical alteration with the ARDS is the Alveolar Damage. The damage of the alveoli is due to the fluid build up as well as the compromised respiratory mechanism. The condition is also correlated with the damage of the lung endothedlium. The ARDS occurs in three phases where the damage for both alveoli as well as the endothelium. The three phases are Exudative, Proliferative, and Fibrotic.
Exudative Phase
Occurs approximately during the first week, usually start within 24 to 48 hours after the direct lung injury. In this phase, the injury of alveolar capillary endothelial cells and type I pneumocytes lead interstitial alveolar edema (non cardiogenic pulmonary edema) and atelectasis. Fluid that contains protein accumulates in the interstitial and alveolar spaces. In this acute phase, massive concentration of cytokines and lipid mediators are present in the lung. In response to proinflammatory mediators, leukocytes move into interstitial and alveoli. In addition, plasma protein accumulates in the air spaces with cellular debris and dysfunctional pulmonary surfactant to form hyaline membrane. Refractory hypoxemia occurs due to Severe V/Q mismatch and shunting of pulmonary capillaries. Respiratory alkalosis and an increase in cardiac output occurs in result of increased respiratory rate and heart rate as compensatory mechanism of Hypoxemia (Levy & Choi., 2012).
Proliferative Phase
This phase of ARDS usually lasts from day 7 to day 21. Some patients recover rapidly and are disconnected from mechanical ventilation during this phase. Regardless the improvement, many patients still suffering from shortness of breathe, tachypnea, and hypoxemia. There are some patients developed lung inj...
... middle of paper ...
...respiratory distress syndrome after pulmonary resection. General Thoracic and Cardiovascular Surgery, 61(9), 504-512. Doi: 10.1007/s11748-013-0276-7
Marini, J. (2013). Mechanical ventilation: past lessons and the near future. Critical Care (London, England), 17 Suppl 1S1. doi:10.1186/cc11499
Villar, J. (2011). What Is the Acute Respiratory Distress Syndrome?... 26th New Horizons Symposium, “ARDS Update,” at the 56th International Respiratory Congress of the American Association for Respiratory Care, held December 6–9, 2010, Las Vegas, Nevada. Respiratory Care, 56(10), 1539-1545. doi:10.4187/respcare.01395
Smith D.A. (2011). Chapter 33. Pulmonary Emergencies. In Stone C, Humphries R.L. (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e. Retrieved March 20, 2014 fromhttp://accessmedicine.mhmedical.com.suproxy.su.edu/content.aspx?bookid=385&Sectionid=40357249.
BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.
Although there is meticulous effort by nurses and other health care professionals in ensuring patient recovery after surgical procedures, many patients experience complications. These post-operative complications include, but are not limited to, wound infection, atelectasis, postoperative ileus, embolism, and deep vein thrombosis. This paper will specifically look at atelectasis, the collapse of lung alveoli due to airway obstruction, and post-operative ileus, the cessation of gastrointestinal movement preventing passage of its contents (Lewis et al., 2014). The purpose of this paper is to provide a greater understanding of the experience of hospitalization for surgical patients by focusing on the two post-operative complications, atelectasis
Facilitating spontaneous ventilation during APRV aids in alveolar recruitment, and improves distribution of lung volume to collapsed lung units. In one year retrospective study, APRV was compeered with pressure support ventilation(PSV) in eighteen patients with ALI and ARDS. Pressure support ventilation is a patient triggered, pressure limited, and flow cycled ventilation, it allows the patient to control the rate and depth of each breath. The effectiveness of spontaneous ventilation was investigated by the use of both computed tomography scan and volumetry for a period of three days.6 This study showed superiority of APRV in providing better gas distribution, pulmonary oxygenation, and decreasing lungs atelectasis faster than PSV. The clinicians recorded the main reason for this finding was derived from alveolar recruitment without overdistention during APRV. Airway Pressure Released Ventilation allows spontaneous ventilation while providing an open lung protective strategy. 6 Dr. Varpula and colleagues also compared APRV with other forms of partial mechanical ventilation, SIMV with PS, to study the effect of spontaneous ventilation in improving gas distribution. They observed no differences in clinical outcome between APRV and SIMV in gas distribution. Authors interpreted the finding due to the long study period and the differences
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
Wildgruber and Rummeny (2012) define tension pneumothorax is a life-threatening condition where air enters the pleural cavity during inspiration but cannot escape during expiration. It is more common in patients with chest traumas and those with mechanical ventilations (Briggs, 2010). Increased the thoracic pressure will compress against the heart and the unaffected lung impairing cardiac functions and ventilation (Pons, & National Association of Emergency Medical Technicians, 2011). Rapid intervention is required to prevent fatal conditions include hypoxia, shock, cardiorespiratory arrest and death (Wildgruber & Rummeny, 2012; Day, 2011; Bethel, 2008).
Pneumonia is an inflammatory response that results in an excess amount of fluid in the interstitial spaces, the alveoli, and the bronchioles. It is caused by the inhalation of organisms or irritants that move into the alveoli when the immune system is not strong enough to combat it. Once these organisms or irritants enter the lungs, they reach the alveoli where they begin to multiply. This multiplication of these organisms results in white blood cells traveling into the area subsequently causing local capillaries to become edematous, leaky, and to create exudate. The combination of this results in thickening of the alveolar wall due to fluid collection within and around the alveoli. Impaired gas exchange, which is the ...
...er with adjacent cells to form a large, multinucleated cell creating large masses of cells” (Cooper, Banasiak, & Allen, 2003). In other words, the virus spreads along the epithelial cells of the respiratory tract through cell-to-cell transfer. The “bronchiole mucosa ultimately begins to swell, and the lumina fill with mucus and exudate. Inflammatory cells infiltrate the area resulting in the shedding of dead epithelial cells” (Cooper, Banasiak, & Allen, 2003). The dead epithelial cells then obstruct the small airway passages. The bronchiole cells normally dilate during inhalation and narrow on exhalation, however since the mucosa is inflamed the there is not good movement of air. With the obstruction of the bronchioles “air trapping, poor exchange of gases, increased work of breathing, and a characteristic expiratory wheeze” occur (Cooper, Banasiak, & Allen, 2003).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
As we are well aware, being a patient at a hospital can prove beneficial or problematic. As it is with the most critical of patients, they require a closer level of surveillance and monitoring than those on other med-surg associated units. As the care of an ICU patient can escalate quickly, it’s critical to assess the needs of your patient in a timely manner. Looking at a ventilated patient who requires many different modalities, assessing the need for such ther...
Acute respiratory distress syndrome (ARDS) is a condition where there is a low oxygen level in the blood this mostly affects the lungs, people who have sepsis will be affected by ARDS as there breathing rate will decrease. Another reason for a multi-organ dysfunctions is that there is a lack of blood being given to the organs this causes low blood pressure or as it’s called hypotension this mostly affects diabetic people which leads them to having sepsis. Also hypoxia which is a lack of oxygen is another pathological physiological outcome of sepsis as less oxygen is reaching the tissue this is due to the fact that there is less oxygen in the blood. This causes confusion and change in heart and breathing rate which can lead to
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Smoke inhalation injury, a unique form of acute lung injury, greatly increases the occurrence of post-burn morbidity and mortality. In addition to early intubation for upper-airway protection, subsequent critical care of patients who have this injury should be directed at maintaining distal airway patency. High-frequency ventilation, inhaled heparin, and aggressive pulmonary toilet are among the therapies available (Cancio , 2009).
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
13. Urden LD, Stacy KM, Lough ME. Thelen's critical care nursing diagnosis and management. St. Louis, Mo: Mosby; 2002:269-270. >466-475>. [Context
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.