RT Book, Section
A1 Sturek, Jeffrey Michael
A1 Noth, Imre
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201804188
T1 Restrictive Disease of the Respiratory System
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accesssurgery.mhmedical.com/content.aspx?aid=1201804188
RD 2024/10/03
AB KEY  POINTSRestrictive  lung  diseases  are  comprised  of  extrinsic  disorders  involving  the  chest  wall,  such  as  kyphoscoliosis,  obesity,  or  muscle  weakness  disorders,  and  intrinsic  disorders  involving  the  lung  parenchyma.In  extrinsic  restriction,  low  tidal  volumes  and  high  respiratory  rates  likely  minimize  the  risk  of  barotrauma  during  mechanical  ventilation;  however,  gradual  institution  of  anti-atelectasis  measures  may  improve  gas  exchange  and  static  compliance.Nocturnal  hypoxemia  is  common  and  may  contribute  to  cardiovascular  deterioration;  routine  polysomnography  is  recommended.Strategies  for  management  of  patients  with  chronic  ventilatory  failure  include  daytime  intermittent  positive  pressure  ventilation,  nocturnal  noninvasive  ventilation,  and  ventilation  through  tracheostomy.Acute  deterioration  in  respiratory  status  can  occur  from  disease  progression,  upper  and  lower  respiratory  tract  infections,  congestive  heart  failure,  failure  to  clear  secretions,  atelectasis,  aspiration,  and  pulmonary  embolism.Intrinsic  restrictive  lung  diseases  involve  parenchymal  reduced  lung  volumes  as  a  defining  feature,  whereby  the  underlying  disease  and  antecedent  treatment,  such  as  immunosuppression,  can  impact  prognosis  and  management.Hypoxemia  results  from  ventilation-perfusion  mismatch  that  is  accentuated  with  increased  cardiac  output  and  atelectasis  associated  with  sleep.Patients  with  interstitial  lung  diseases  and  pulmonary  fibrosis  admitted  to  the  ICU  with  acute  respiratory  failure  have  an  extremely  poor  prognosis.If  mechanical  ventilation  (MV)  is  deemed  appropriate,  the  use  of  low  tidal  volumes  and  high  respiratory  rates  during  MV  likely  minimize  ventilator-induced  lung  injury.Decisions  for  pharmacotherapy  and  antibiosis  hinge  upon  accurate  diagnosis  of  underlying  pathology  and  pretest  probability  for  infectious  processes.Lung  transplantation  is  a  viable  option  in  selected  patients  with  end-stage  fibrosis.