RT Book, Section
A1 Corbridge, Thomas
A1 Wood, Lawrence D.H.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2288964
T1 Chapter 42. Restrictive Disease of the Respiratory System and the Abdominal Compartment Syndrome
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accesssurgery.mhmedical.com/content.aspx?aid=2288964
RD 2023/09/24
AB Scoliotic  curves  greater  than  100°  may  cause  dyspnea;  curves  greater  than  120°  are  associated  with  alveolar  hypoventilation  and  cor  pulmonale.Most  patients  with  chest  wall  deformity  survive  their  first  episode  of  acute  respiratory  failure.  Common  precipitants  include  upper  and  lower  respiratory  tract  infections  and  congestive  heart  failure.Biphasic  positive  airway  pressure  may  be  effective  in  patients  with  acute  hypercapnic  respiratory  failure.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.Abdominal  compartment  syndrome  (ACS)  is  caused  by  an  acute  increase  in  intra-abdominal  pressure  resulting  from  a  number  of  surgical  and  medical  conditions.By  elevating  the  diaphragm  and  decreasing  respiratory  system  compliance,  ACS  causes  a  restrictive  defect.  However,  ACS  affects  a  number  of  other  organs  and  may  cause  multiorgan  system  failure.Diagnosis  relies  on  measurement  of  intra-abdominal  bladder  pressure  and  identification  of  organ  dysfunction.The  abdomen  should  be  decompressed  before  critical  organ  dysfunction  develops.Failure  to  recognize  and  treat  ACS  portends  a  poor  prognosis.Acute  deterioration  in  respiratory  status  can  occur  from  disease  progression  or  a  number  of  other  infectious  and  noninfectious  processes.Patients  with  idiopathic  pulmonary  fibrosis  admitted  to  the  ICU  with  acute  respiratory  failure  have  an  extremely  poor  prognosis.If  mechanical  ventilation  is  deemed  appropriate,  the  use  of  low  tidal  volumes  and  high  respiratory  rates  during  mechanical  ventilation  likely  minimizes  ventilator-induced  lung  injury.Idiopathic  pulmonary  fibrosis  is  typically  refractory  to  drug  treatment.Lung  transplantation  is  a  viable  option  in  selected  patients  with  end-stage  fibrosis.