Acute lung injury

Acute lung injury

1. Acute lung injury Supervised by Haifa

2. Out line Objectives Introduction PATHOPHYSIOLOGY s / s Most common causes Risk factors Diagnoses test Treatment Management Complications Drug therapy DIAGNOSES EVALUATION Summary references

3. Objectives Define ALI and describe the pathological process Know causes of ALI, and differential diagnosis. Understand mechanical ventilation of patients with ALI . Most common causes ALI. What Diagnostic test do. And know nursing care plane.

4. Introduction Acute lung injury (ALI) and (ARDS ) describe clinical syndromes of acute respiratory failure with substantial morbidity and mortality. Even in patients who survive ALI, there is evidence that their long-term quality of life is adversely affected.(1,2) Recent advances have been made in the understanding of the epidemiology, pathogenesis, and treatment of this disease. However , more progress is needed to further reduce mortality and morbidity from ALI and ARDS

5. PATHOPHYSIOLOGY It is thought ALI patients follow a similar pathophysiological process independent of the aetiology . This occurs in two phases; acute and resolution, with a possible third fibrotic phase occurring in a proportion of patients

6. Acute lung injury is the sudden failure of the respiratory (breathing) system person with ALI has rapid breathing, difficulty getting enough air into the lungs and low blood oxygen levels.

7. S / S Rapid breathing; trouble getting enough air Abnormal breathing sounds, such as a crackling noise or decreased breathing sounds Cough Fever Low blood pressure Confusion Extreme  fatigue Bluish lip or  skin  color Anxiety  or agitation  

8. Table 2 Direct and Indirect triggers for ALI

9. Risk factors for ALI Age Family history Smoking COPD ARDS Preexisting lung disease Chronic alcohol use Low serum pH Sepsis 40% of patients with sepsis develop ALI

10. And laboratory Diagnoses test  physical exam Echo (Echocardiogram) Oximetry Bronchoscopic biopsy Chest CT chest X-ray  Laboratory : CBC , ABG , electrolytes test

11. Treatment Mechanical Ventilation ( is conventionally delivered as positive pressure ventilation with PEEP via a tracheal tube) Fluid Management   (fluid restriction could lead to improvement in clinically important outcomes) Steroids Steroids exert an anti-inflammatory effect by inhibiting arachidonic acid metabolism and reducing eosinophil activity Prone Positioning (to enhance oxygenation by improving alveolar ventilation/perfusion AND improves lung mechanism)

12. Management of ALI Treat underlying illness Sepsis, etc Nutrition parenteral nutrition Physiotherapy Deep breath excise Suction (as needed ) DVT prophylaxis low molecular weight heparin GI prophylaxis Medications ( bronchodilators )

13. Complications in Managing ALI patients Pulmonary : pulmonary embolism (PE), pulmonary fibrosis Gastrointestinal: bleeding (ulcer ), bacterial translocation Cardiac : abnormal heart rhythms, myocardial dysfunction Renal : ( ARF) Mechanical : vascular injury, pneumothorax (by placing pulmonary artery catheter) tracheal injury/stenosis (result of intubation and/or irritation by endotracheal tube Malnutrition : electrolyte deficiency

14. Drug therapy Agents studied: Corticosteroids Ketoconazole Inhaled nitric oxide Surfactant No benefit demonstrated

15. 1- Nursing DIAGNOSES 1-Ineffective breathing pattern related to Decreased lung expansion Goal : Establish a normal/effective respiratory pattern with ABGs within patient’s normal range Nursing interventions • Monitor vital signs every 1 to 2 hours Auscultate breath sounds , chest excursion every 1 to 2 hours. Check out respiratory function, noting rapid or shallow respirations, dyspnea, reports any abnormal • Monitor oxygen saturation and ETCO2 levels every 30 to 60 min

16. 2-Nursing DIAGNOSES 2- Impaired gas exchange related to effects of near-drowning Goal : • Maintain adequate cardiac output and tissue perfusion Nursing interventions Suction via endotracheal tube as needed to maintain clear airways. Obtain ABGs as ordered or indicated; monitor and report results. Allow periods of rest.

17. 3-Nursing DIAGNOSES 3- Anxiety related to hypoxemia Goal reduced anxiety levels ability to rest Nursing interventions • Explain the purpose and procedure of intubation. Answer questions and provide Reassurance • Administer analgesics and/or sedatives as ordered .

18. EVALUATION reduce anxiety. MET oxygen saturation improve. MET PEEP is added to ventilator settings. After 3 days of mechanical ventilation begins to improve. placed on SIMV course of another 3 days CPAP. eventually recovers fully, with minimal apparent long-term effects.

19. Summary ARDS is a clinical syndrome characterized by severe, acute lung injury, inflammation and scarring Significant cause of ICU admissions, mortality and morbidity Caused by either direct or indirect lung injury Mechanical ventilation with low tidal volumes and plateau pressures improves outcomes So far, no pharmacologic therapies have demonstrated mortality benefit Ongoing large, multi-center randomized controlled trials are helping us better understand optimal management

20. References Rubenfeld GD, et al. Incidence and outcomes of acute lung injury N Engl J Med. 2005;353:1685-93. Luhr OR, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF study group. Am J Respir Crit Care Med. 1999;159:1849061, Bersten AD et al. Australian and New Zealand Intensive Care Society Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med. 2002;165:443-8. Connors AF Jr , et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT investigators. JAMA. 1996;276:889-97.