Restrictive Pulmonary Disease Overview
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Restrictive Pulmonary Disease Overview

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Questions and Answers

Which of the following disorders are considered acute intrinsic pulmonary disorders?

  • Infectious pneumonia (correct)
  • Pulmonary edema (correct)
  • Pneumothorax
  • Interstitial lung diseases
  • Which of the following are extrinsic restrictive pulmonary disorders?

  • Aspiration pneumonitis
  • Pleural effusions (correct)
  • Mediastinal masses (correct)
  • Arterial blood gases
  • What happens to the total lung capacity (TLC) in restrictive pulmonary disease?

    Decreased

    The FV Loop in restrictive pulmonary disease shows a ______ pattern.

    <p>Witch's hat</p> Signup and view all the answers

    In restrictive pulmonary disease, FEV1/FVC is typically decreased.

    <p>False</p> Signup and view all the answers

    What is a clinical feature of restrictive pulmonary disease?

    <p>Dyspnea on exertion</p> Signup and view all the answers

    What is the recommended tidal volume for ventilation in patients with acute intrinsic pulmonary disorders?

    <p>4-6 mL/kg</p> Signup and view all the answers

    Study Notes

    Restrictive Pulmonary Disease Overview

    • Characterized by decreased lung volumes and reduced lung expansion
    • Can be caused by intrinsic lung disorders or extrinsic factors affecting the chest wall, pleura, or neuromuscular function
    • Gas exchange usually remains normal until the disease is advanced

    Types of Restrictive Pulmonary Disease

    • Acute Intrinsic Pulmonary Disorders
      • Pulmonary edema, including acute respiratory distress syndrome (ARDS)
      • Infectious pneumonia
      • Aspiration pneumonitis
    • Chronic Intrinsic Pulmonary Disorders
      • Interstitial lung diseases
    • Extrinsic Restrictive Pulmonary Disorders
      • Pleural effusions
      • Pneumothorax
      • Mediastinal masses
      • Kyphoscoliosis
      • Pectus excavatum
      • Neuromuscular disorders
      • Increased intraabdominal pressure from ascites, pregnancy, or bleeding
      • Marked obesity

    Clinical Features

    • Dyspnea on exertion
    • Nonproductive cough
    • Symptoms of cor pulmonale only with advanced disease

    Diagnostic Tests

    • Spirometry
      • FEV1/FVC is normal or increased
      • FEV1, FVC decreased
      • FV Loop shows a "witch's hat" pattern
    • Lung Volumes
      • TLC and RV are decreased
      • Lung compliance is decreased
    • DLCO
      • Decreased

    Chest Radiograph

    • Progression from "ground-glass" appearance to prominent reticulonodular markings, and finally, to a "honeycomb" appearance

    Arterial Blood Gases

    • Mild hypoxemia with normocarbia

    PFTs

    • Typical of a restrictive ventilatory defect

    Management of Acute Intrinsic Pulmonary Disorders

    • Elective surgery should be postponed
    • Optimize oxygenation and ventilation preoperatively
    • Treat fluid overload with diuretics
    • Consider drainage of large pleural effusions
    • Relieve massive abdominal distention with nasogastric compression or drainage of ascites
    • Persistent hypoxemia may require mechanical ventilation

    Anesthesia Management

    • Intravenous and inhalation agents combined with a neuromuscular blocking agent
    • Decreased lung compliance increases the risk of barotrauma and volutrauma during positive-pressure ventilation

    Ventilator Strategy

    • Tidal volume: 4-6 mL/kg
    • Respiratory rate: 14–18 breaths/min
    • Airway pressure: no more than 30 cm H2O
    • PEEP: High may be needed with caution
    • FiO2: High

    Airway Pressure Release Ventilation (APRV)

    • May improve oxygenation in patients with ARDS
    • Superior to conventional ventilation modes
    • Reduces peak airway pressure without compromising oxygenation
    • Promotes alveolar recruitment and improves oxygenation
    • Allows for spontaneous breathing
    • Improves V/Q matching and oxygenation in severe ARDS
    • Allows for less sedation, improved cardiopulmonary function, and decreased time on ventilators

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    Description

    This quiz provides an overview of restrictive pulmonary diseases, highlighting their characteristics, types, and clinical features. Learn about various intrinsic and extrinsic factors that can affect lung volumes and expansion. Test your knowledge on the pathophysiology and clinical symptoms associated with these conditions.

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