OBL Controversy

Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.

According to the American Lung Association, “Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill patients.” ARDS is an extreme manifestation of a lung injury that can be associated with an acute medical problem. This occurs as a result of direct or indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is not extremely common (“Acute Respiratory Distress Syndrome”). Most people who acquire this disease are critically ill patients within the hospital. The most common predisposing medical problems of ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe syndrome and even with prompt and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who survive have a longer hospital stay along with recurring hospital admissions throughout their lifetime (“Acute Respiratory Distress Syndrome”). Acute respiratory distress syndrome is a rapidly progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment measures in order to successfully respond to the disease process.

During mechanical ventilation, patients are at risk of injuries to their lungs caused by improper settings on ventilators. Mechanical ventilator induced lung injury (VILI) can affect the lung in several ways. Some of the ways the lung become affected is by excessive pressure, excessive volume, and not enough volume. When the lungs are affected by excessive pressure its termed pulmonary barotrauma. On the other hand, if the lungs receive too much volume it’s called volutrauma. However, when the lungs don’t receive enough volume its termed atelectrauma. This paper describes how pulmonary barotrauma, pulmonary volutrauma, and pulmonary atelectrauma affects the lungs during mechanical ventilation and ways to prevent them from happening.

Combinations of various criteria to establish a diagnosis in patients with VAP have been suggested and validated (Table 1). The National Nosocomial Infection Surveillance (NNIS) system was developed in the 1970s by the Centers for Disease Control as a tool to describe the epidemiology of hospital-acquired infections and to produce aggregated rates of infection suitable for inter-hospital comparison, but was never compared to pathological results. The NNIS system was compared to bronchoalveolar lavage (BAL) fluid cultures in 292 trauma patients and had a sensitivity of 84% and a specificity of 69% [15]. More recently, the Clinical Pulmonary Infection Score (CPIS) was proposed by Pugin et al. [16], based on six variables (fever, leukocytosis, tracheal aspirates, oxygenation, radiographic infiltrates, and semi-quantitative cultures of tracheal aspirates with Gram stain) [16]. The original description showed a sensitivity of 93% and specificity of 100%, but this study included only 28 patients and the CPIS was compared to quantitative culture of BAL fluid using a 'bacterial index ' defined as the sum of the logarithm of all bacterial species recovered, which is not considered an acceptable gold standard for the diagnosis of VAP. Compared to pathological diagnosis, CPIS had a moderate performance with a sensitivity between 72 and 77% and specificity between 42 and 85% [11,17]. Likewise, CPIS was not sufficiently accurate compared to a BAL fluid-established

Ineffective airway clearance related to adventitious lung sounds, rhonchi auscultated bilaterally at the patient’s bases as evidence by CT scan displaying pleural effusion and basilar atelectasis. Y.B.’s ability to clear his airway is ineffective due to his current disease state. His alveoli are deflated due to pleural effusion. The pleural effusion is a result of blocked lymphatic drainage from the pleural cavity, possible caused by malignant cells (Lewis, Dirksen, Heitkemper, & Bucher, 2014). The goal for Y.B. is to maintain a clear, open airway, and improvement in lung sounds before discharge. Ensuring the patient uses the upright position, maintaining the head of the bead above 30o, will keep his abdominal contents from inhibiting lung expansion. This intervention will be evaluated by assessing lung sounds, pulse oximetry, assessing if Y.B. is using accessory muscles to breath, and a chest X-ray. In the article titled,

Though many advances were made & multiple research done, in 2012 the medical community once again got together. An expert panel agreed that ARDS is a type of acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue. “The clinical hallmarks are hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space, and decreased lung compliance. The morphological hallmark of the acute phase is diffuse alveolar damage (ie, edema, inflammation, hyaline membrane, or hemorrhage).”3 It was at this conference that the Berlin definition was put into existence. Though it is to note that most research to date has been done using the AECC definition, the Berlin definition removed what was known as acute lung injury. Under the new Berlin definition patients with a PaO2/FiO2 ratio of 200-300 while on a PEEP of +5 would now be classified as mild ARDS, while patients with a PaO2/FiO2 ratio of 100-200 would be classified as moderate & anything under 100 would be classified as severe. With pulmonary capillary wedged pressures under 18mm HG. The Berlin definition defined acute stating that the maximum period between risk factor exposure and ARDS

Etiology of acute bronchitis include airway edema, airway wall thickening, excess mucus production and loss of ciliary function resultsource. Airflow is obstructed during both inspiration and expirations. Widespread bronchial narrowing with mucus plugging produces hypoxemia because of the mismatching of ventilation and perfusion (Papadakis et al., 2015). The most common presenting symptoms is dyspnea on exertion which usually develops late in the course of the disease. Lungs are diminished and crackles are more common than wheezes. The

Acute on chronic respiratory failure with severe hypoxemia can cause serious complications. The respiratory system is responsible for the bodies gas exchange of O2 and CO2. All the organs of the body need oxygen rich blood to function correctly. The lungs are a very delicate sponge like organ that consist of capillaries for oxygen transport and alveolar air-filled sacs. the patients have been exposed to a toxic inhalant chemical and has a history of tobacco use, this correlate with his current state of health. The patient was originally brought into an ER with his oxygen saturation at 51%, when he was stabilized he was brought to this facility.

One lung ventilation (OLV) or lung isolation is a common term used in the practice of thoracic anesthesia. OLV refers to ventilation of one lung, while the other one is intentionally collapsed; thus, allows adequate surgical access for the surgeons (1- 6). Some indications for OLV are bronchopleural fistula, lung resection, single-lung transplantation, esophageal surgery, and open-chest aneurysm repair (3, 6). OLV can be accomplished by diverse techniques, two of which are either by using Double Lumen Tube (DLT) or Univent tube (3, 6- 10). the complications of using these tubes are vocal cord injuries, postoperative hoarseness, and sore throat (11). This dissertation will compare between the two tubes in terms of effectiveness in adult thoracic surgery.

The patient is a 69-year-old woman who has COPD, and asthmatic bronchitis; who presents for evaluation of increasing shortness of breath, cough, and increased sinus congestion and pressure. She has been on steroids because of exacerbation of asthma now for some time, is actually on 40 mg daily. In spite of this she notes ongoing wheezing, and shortness of breath when doing her exercise tolerance. She has had no high fevers, no localized chest pain. She is using her inhalers as prescribed. Others at time in [Place] have also had an upper respiratory illness. She wanted to make sure she would not need antibiotics. She has had some facial pain, that seems to better today. She had some yellow discharge that now seems to be clear. The patient did

Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the bloodstream. According to Kacmarek, Stoller and Heuer, “ it has been proposed that ARDS can develop via different mechanisms and the risk factors for ARDS should be categorized either by direct injury to the alveolar space or indirect injury initiated by systemic disease (2014, p. 601)”. Common direct injuries to the lungs can include pneumonia, lung transplant, trauma, septic shock and aspiration among others. Without enough oxygen, an individual’s brain and other organs can be severely damaged. The brain is what controls the rate and depth of respiration. ARDS can lead to a buildup of fluid

According to the AECC, this disease is characterized by severe features of acute lung injury, in a form of diffuse alveolar injury, bilateral pulmonary infiltrate, and severe hypoxemia with no evidence of cardiogenic pulmonary edema.1 However, the severity of the hypoxemia conditions is crucial diagnosing of ARDS. This is because this disorder was defined by the ratio of the partial pressure of oxygen in the patients’ arterial blood (PaO2) to the fraction of oxygen in the inspired air (FIO2).1-6 ARDS is believed to be the most severe form of acute lung injury (ALI) based on the form of diffuse alveolar injury. Though, ARDS described based on the PaO2/FIO2 ratio less than 200 while ALI is defined by the ratio of PaO2/FIO2 less than

The indication of tracheostomy includes (1) needed or long-term ventilator dependent due to acute respiratory failure (2) traumatic injury or neuromuscular disease requiring airway, or mechanical ventilator support or both(Cheung & Napolitano, 2014). However, we should also consider the patient's physiological needs, the patient's expectations, the characteristics of the disease, and the side effects and surgical risk posed by intubation vs. tracheostomy.

A are maintaining a patent airway, ensure adequate ventilation and adequate tissue perfusion. The prevention of complications from the mechanical ventilator by maintaining vent settings, and medication administration; neuromuscular blocking agents (NMBAs) of Norcuron (vecuronium) and Ativan (lorazepam) infusing to help the patient tolerate the vent, and help with adequate oxygenation. The client’s hemoglobin level is low at 8g/dL, indicating this client may need additional blood transfusions to bring the value up to normal range of 14-18g/dL. The initial blood gas had shown the client in metabolic alkalosis most likely due to lack of oxygenation and the client holding on to CO2. Proper oxygenation is a priority in this client because healing could be delayed and further complications from the lack of oxygen are starting to trend. The prevention of secondary infection after abdominal surgery is also a high priority to help ensure the client heals with minimal complications. “Nursing priorities for the patient with artificial airway focus on 1) providing humidification, 2) maintaining cuff management, 3) suctioning, 4) establishing a method of communication and 5) providing oral hygiene” (Urden et al., 2016, p.

Caramez M, Schettino G, Suchodolski K, Nishida T, Harris R, Malhotra A andKacmarek R. Theimpact of endotracheal suctioning on gas exchange and hemodynamics during lung-protectiveventilation in acute respiratory distress syndrome. Respir Care. 2006 May; 51(5): 497-502.