resp lung diseases e

8/12/2019 Resp Lung Diseases e

1/24

1

Lung diseases

Respiratory and Lung diseases

H
http://localhost/var/www/apps/conversion/tmp/first_slide_basic.ppthttp://localhost/var/www/apps/conversion/tmp/first_slide_basic.ppthttp://localhost/var/www/apps/conversion/tmp/first_slide_basic.ppt


2/24

2

Lung diseases

COPD

Pneumonia1

2

3 ARDS


3/24

3

Lung diseases

Pneumonia1


4/24

4

Lung diseases

Pneumonia

Def.: infection of the lung tissue

Cause: Pneumonia results from bacterial settlement of the normally sterilelower respiratory tract.Germs can arrive in principle on the following way into the respiratory tract:

aspiration of secretions from the oropharynx inhalation of germs with the inhaled gas with the bloodstream from other settled regions


5/24

5

Lung diseases

Diagnosis: coughingfever >38Cleucocytosisincreased secretion productionpulmonale infitrates

in the case of a ventilated patient these symptoms are caused by other reasons the diagnosis should rely therefor on being present further criteria

positive micro-biological findings in the tracheal secretionauscultation statefestering tracheal secretion

Pneumonia


6/24

6

Lung diseases

Therapy: mucolytic and antitussive drugsfebrifugal drugs - antipyreticantibacterial drugs - antibioticsrespiratory exercises - breathing trainer

in complicated cases: ventilation

Complications: ARDS / ALI

Pneumonia


7/24

7

Lung diseases

Pneumonia: - but now ventilated

Problems: *decreased mucociliary clearence

*risk of atelectasis*decreased oxygenation*decreased CO 2-removal because of increased shunt

Consequences: *ventilation should improve the oxygenation and eliminate CO 2


8/24

8

Lung diseases

Pneumonia: Case report

boy in the age of 11 years dry coughing for 2 weeks subfebrile temperatures till light fever


9/24

9

Lung diseases

Pneumonia: Case report

boy in the age of 11 years dry coughing for 2 weeks subfebrile temperatures till light fever


10/24

1

0

Lung diseases

COPD2


11/24

1

1

Lung diseases

COPD

Def.: COPD an abbreviation for Chronic Obstructive P ulmonary Disease long term inflammatory disease of the bronchus and the lung with an

obstruction of the airways a group of several diseases> chronic obstructive bronchitis> bronchial asthma> lung emphysema

Cause: cigarette smokingair pollutionexposure to particulate matter and gases

Leads to a chronic obstruction of the airways. The result is an extendedexpiration time - no complete exhalation possible because of the increasedresistance of the airways - leads to an INTRINSIC PEEP.


12/24

1

2

Lung diseases

COPDDiagnosis: Spirometry is measuring the volume exhaled forcefully in 1

second (FEV 1) following a deep inspiration, andthe forced vital capacity

Chest X-ray / CT detecting emphysema

Arterial blood gas is showing a compensated respiratoryacidosis

Endoscopy (see below)

Tracheanormal state

Chronic bronchitiswith tram -lines


13/24

1

3

Lung diseases

COPD

Therapy: cessation smoking - will slow the rate of decline in lung function

bronchodilators - will relax the airways and are use in the symp-tomatic treatment

corticosteroids - inhaled, have no effect on the inflammatoryresponse in COPD

- no evidence that they reduce long-term declinein lung function

Complications: exacerbation

ARDS / ALI

Influenza vaccination is recommended for the prevention of acute exacerbationof COPD during the winter months.


14/24

1

4

Lung diseases

COPD

thorax a.p.normal state

thorax a.p.bullous (blistered) emphysema

with over distended areas


15/24

1

5

Lung diseases

COPD: - but now ventilated

Problems: *increased inspiratory and expiratory resistance*increased work of breathing because of the resistance - muscle fatigue

*over distended areas - physiological intrinsic PEEP *decreased oxygenation*decreased CO 2- removal because of the increased resistance*compensated respiratory acidosis*drive of breathing by decreased p aO2 instead of increased p aCO 2 *high risk of infections and atelectasis due the ventilation

Consequences: *avoid intubation - ideal patient for noninvasive ventilation first *avoid application of oxygen - drive of breathing is lacking *ventilation should improve the oxygenation and eliminate CO 2*ventilation could increase the intrinsic PEEP*avoid high gas flows


16/24

1

6

Lung diseases

COPD: - but now ventilated

normal state

COPD

prolonged expiration


17/24

1

7

Lung diseases

COPD: Case report male, age of 56 years strong smoker round about 65 cigarettes per day allergic asthma for 40 years acute decline of respiratory complaints fever >39,0C

acute dyspnoea, cyanosis oxygen mask with 15 l/min thorax a.p. emphysema

Blood gas analysis: pH 7,28p aCO 2 68 mmHgp aO2 55 mmHgBE +8 mmol/lHCO 3- 31,2 mmol/lS aO2 82 %

Diagnosis: acute exacerbation of a long term COPDwith a no compensated respiratory acidosis


18/24

1

8

Lung diseases

3 ARDS


19/24

1

9

Lung diseases

ARDS

Def.: ARDS an abbreviation for Acute R espiratory Distress S yndrome

Cause: pulmonary and non pulmonary infections are the reasons of an ARDS

risk factors:infection: e.g. pneumoniatrauma: e.g. lung contusion (car accident)metabolic reasons: e.g. acute renal failuredrugs: e.g. narcotic intoxication

inhalation trauma: e.g. aspiration, oxygenothers: e.g. pulmonary embolismcomplication in blood transfusion


20/24

2

0

Lung diseases

Diagnosis: acute occurrence ( car accident, aspiration... )disturbed oxygenation

p aO2 < 50 mmHg at F iO 2 = 0,6p aO2 / F iO2 < 200 mmHgincreased alveolar - arterial oxygen difference ( AaDO 2)

atelectasisdyspnoea, tachypnoea, cyanosisdecreased lung compliancebilateral infiltrates due the increased permeability of the blood vessels

ARDS


21/24


22/24

2

2

Lung diseases

ARDS: - but now ventilated

Problems: *decreased compliance because of e.g. interstitial lung edema*decreased oxygenation and CO 2 - elimination due the prolongeddiffusion distance because of the infection

*increased inspiratory and expiratory resistance*high risk of atelectasis because of a wet lung - decreased FRC*ARDS based on multi organ failure as reaction of the lung*course in stages: from dyspnoea until irreversible fatigue

Consequences: *ventilation should improve the oxygenation and eliminate CO 2*find the balance between F iO2 , I:E-ratio, PEEP*lung protective ventilation *ventilation could increase the intrinsic PEEP*treatment of an ARDS includes several other therapy options

e.g. positioning, nutrition, renal replacement therapy


23/24

2

3

Lung diseases

ARDS: - but now ventilated

normal state

ARDS

expiratory flow not zero

small tidal volume


24/24

resp lung diseases e

Documents