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Extrapulmonary Alveolar Hypoventilation

Alveolar Hypoventilation Syndrome Extrapulmonary


Presentation

  • Presents the contributions of 70% new authors, from all over the world, in a consistent format to make referencing global perspectives quick and easy.[books.google.com]
  • Multiple-case presentations from one source of exposure are common.[aneskey.com]
  • Circumferential airway smooth muscle is also present; constriction of these smooth muscles, as in patients with asthma, may result in narrowing the airways and shortness of breath.[lecturio.com]
Hypothermia
  • Embolism 302 Managing Hemoptysis 311 Pulmonary Hypertension 322 Pleural Disease in the Critically Ill Patient 328 Discontinuation 338 Respiratory Adjunct Therapy and Noninvasive Respiratory 344 Acute Inhalational Injury and Chemical and Biological 350 Hypothermia[books.google.com]
  • V/Q heterogeneity (intrapulmonary shunt or dead space) * Extrapulmonary right-to-left shunt – Ischemia * Arterial/Venous obstruction * Vasoconstriction * Decreased cardiac output – Hemoglobin-related disorders * Anemia * Left-shifted ODC (alkalosis, hypothermia[usmle287.wordpress.com]
  • Bilateral phrenic nerve palsies have been described as an uncommon complication of hypothermia used for cardioplegia during cardiac surgery (particularly when ice slush is used) [ 67 ], trauma [ 67, 91 ], a variety of neurologic diseases (e.g., poliomyelitis[aneskey.com]
Dyspnea
  • License: CC BY 2.0 Definition of Dyspnea Dyspnea — The Shortness of Breath Dyspnea is defined as the subjective sensation of chest tightness or shortness of the breath. It can be caused by pulmonary and extrapulmonary causes.[lecturio.com]
  • Findings Condition History Dyspnea on exertion Cardiac or pulmonary disease, deconditioning Dyspnea during rest Severe cardiopulmonary disease or noncardiopulmonary disease (e.g., acidosis) Orthopnea, paroxysmal nocturnal dyspnea, edema Congestive heart[aafp.org]
  • Central endobronchial tumors cause cough, hemoptysis, wheezing, stridor, dyspnea, and pneumonitis. Peripheral lesions cause pain, cough, dyspnea, and possible symptoms of pulmonary abscess on cavitation.[fundacionmapfre.org]
  • The resultant paradoxic breathing pattern can contribute significantly to abnormal gas exchange and increased dyspnea [ 14 ].[aneskey.com]
  • Severity of respiratory disease was evaluated using Medical Research Council dyspnea score [21] 2 wk before admission by patient's or family's recall.[journals.plos.org]
Tachypnea
  • […] patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF Clinical Manifestations of ARF: CV chest pain, tachycardic, hypertensive, dysrhythmias - may throw PVCs Clinical Manifestations of ARF: Pulmonary tachypnea[quizlet.com]
  • […] combination of one or more findings: altered state of consciousness (from agitation to lethargy), increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea[xlung.net]
  • Autonomic stress responses include tachypnea, tachycardia, hypertension and diaphoresis. Bradycardia and hypotension are ominous signs that occur as respiratory failure progresses.[clinicaladvisor.com]
  • Minor criteria included tachypnea over 35 bpm or increase in the respiratory rate compared to its value at admission, pH 2, or pH did not immediately improve with face mask-delivered NIV, the patient was correctly repositioned in the sitting position,[journals.plos.org]
  • During the exudative phase, the patient presents with tachypnea, restlessness, apprehension, and moderate increase in accessory muscle use.[clinicalgate.com]
Pulmonary Disorder
  • Calculation of the alveolar-arterial (A-a) O 2 gradient (inspired P o 2 [arterial P o 2 5 4 arterial P co 2 ]) can help distinguish pulmonary from extrapulmonary disease; a normal gradient essentially excludes pulmonary disorders.[msdmanuals.com]
  • Mixed cardiac and pulmonary disorders are also common sources of dyspnea 6, 7 and include COPD with pulmonary hypertension and cor pulmonale, deconditioning, pulmonary emboli and trauma.[aafp.org]
  • This chapter focuses on pulmonary disorders commonly seen in the critical care environment.[clinicalgate.com]
  • A thorough history as well as a physical exam looking for evidence of both acute and chronic cardiac and pulmonary disorders are essential.[clinicaladvisor.com]
Exertional Dyspnea
  • , dyspnea, chest pain and leg discomfort.[aafp.org]
Dyspnea at Rest
  • View/Print Table TABLE 2 History and Physical Examination Clues to Conditions That Cause Dyspnea Findings Condition History Dyspnea on exertion Cardiac or pulmonary disease, deconditioning Dyspnea during rest Severe cardiopulmonary disease or noncardiopulmonary[aafp.org]
Hypertension
  • Devices 261 Evaluation of the Low to Intermediate Risk Patient with 267 PULMONARY PROBLEMS IN THE INTENSIVE CARE UNIT 273 Status Asthmaticus 282 Extrapulmonary Causes of Respiratory Failure 292 Pulmonary Embolism 302 Managing Hemoptysis 311 Pulmonary Hypertension[books.google.com]
  • Patients with morbid obesity can suffer hypercapnia, hypoxemia, and subsequently polycythemia, pulmonary hypertension and right heart failure.[fundacionmapfre.org]
  • […] these are also seen in patients who are not getting enough pain medications and in patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF Clinical Manifestations of ARF: CV chest pain, tachycardic, hypertensive[quizlet.com]
  • Mixed cardiac and pulmonary disorders are also common sources of dyspnea 6, 7 and include COPD with pulmonary hypertension and cor pulmonale, deconditioning, pulmonary emboli and trauma.[aafp.org]
Tachycardia
  • 233 Supraventricular Tachycardia 242 Temporary Cardiac Pacing 253 Permanent Pacemakers and Antiarrhythmic Devices 261 Evaluation of the Low to Intermediate Risk Patient with 267 PULMONARY PROBLEMS IN THE INTENSIVE CARE UNIT 273 Status Asthmaticus 282[books.google.com]
  • Tachycardia Anemia, hypoxia, heart failure, hyperthyroidism S 3 Congestive heart failure Murmur Valvular dysfunction Hepatomegaly, hepatojugular reflux, edema Congestive heart failure Cyanosis, clubbing Chronic severe hypoxemia TABLE 2 History and Physical[aafp.org]
  • NIV should usually be continued until pH is normal, and respiratory distress and tachycardia have resolved.[breathe.ersjournals.com]
  • […] increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea (RR 30 bpm), paradoxical breathing], central cyanosis (including lips and tongue), sweating, tachycardia[xlung.net]
  • Guillain–Barré syndrome may be associated with autonomic dysfunction including new-onset hypertension (57%), sinus tachycardia (50%), postural hypotension (43%), or facial flushing (25%) [ 90 ].[aneskey.com]
Cyanosis
  • Clinical Manifestations of ARF: GI decreased GI motility - patient on TF will have residuals, decreased O2 to the stomach, decreased bowel sounds, N&V, and abdominal distention Clinical Manifestations of ARF: Integument initially, won't see anything - cyanosis[quizlet.com]
  • Extremities: looking for evidence of edema, signs of deep venous thrombosis and clubbing (note peripheral cyanosis is not a reliable sign of hypoxemia in the absence of central cyanosis).[clinicaladvisor.com]
  • Tachycardia Anemia, hypoxia, heart failure, hyperthyroidism S 3 Congestive heart failure Murmur Valvular dysfunction Hepatomegaly, hepatojugular reflux, edema Congestive heart failure Cyanosis, clubbing Chronic severe hypoxemia TABLE 2 History and Physical[aafp.org]
  • […] consciousness (from agitation to lethargy), increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea (RR 30 bpm), paradoxical breathing], central cyanosis[xlung.net]
Meningism
  • PROBLEMS IN THE INTENSIVE CARE UNIT 377 Disorders of Plasma Sodium and Potassium 383 Acute Kidney Injury in the Intensive Care Unit 392 Dialytic Therapy in the Intensive Care Setting 400 The Use of Antimicrobials in the Treatment of Infection 414 Bacterial Meningitis[books.google.com]

Workup

Hypercapnia
  • […] of hypercapnia on outcome.[annalsofintensivecare.springeropen.com]
  • V/Q dysfunction mechanisms in the pulmonary parenchyma may cause hypoxemia and/or hypercapnia.[xlung.net]
  • However, 5 of 21 (23.8%) recordings that showed an absence of nocturnal hypoventilation at the chosen threshold showed hypercapnia on mABG.[hal-univ-bourgogne.archives-ouvertes.fr]
  • Significant arterial hypercapnia is unlikely to occur with an inspiratory pressure more negative than -30 cm H 2 O; however, arterial hypercapnia may be present with a vital capacity as high as 55% or as low as 20% of the predicted value [ 15, 16 ].[aneskey.com]

Treatment

  • Emphasizes the treatment of corrected congenital heart disease for coverage of the clinical management of cardiac problems in the adolescent and young adult.[books.google.com]
  • Steroid treatment should be started at the same time as the antimicrobial therapy and withdrawn before antimicrobial treatment is complete.[patient.info]
  • The use of NIV can be considered here but the main focus at this stage should be to optimise medical treatment.[breathe.ersjournals.com]
  • Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline. 4 Brief tobacco dependence treatment is effective.[clinicalgate.com]

Prognosis

  • Prognosis The use of ART has made significant changes to the prognosis of HIV-related pulmonary infections.[patient.info]
  • An AECOPD requiring hospitalisation has a poor prognosis, with an in-patient mortality rate of 7.7% [ 14 ] and a median survival of 3.6 years from the first admission [ 15 ].[breathe.ersjournals.com]

Etiology

  • Hypercapnic (ventilatory failure) PaCO2 45 mmHg with acidosis (pH Etiology: Extrapulmonary causes -Disorders that affect the brain (cause hypoventilation) -The spinal cord -Neuromuscular system -The thorax -The pleura -The upper airways Etiology: Intrapulmonary[quizlet.com]
  • Historical note and terminology Congenital central alveolar hypoventilation syndrome was first described in 1970, and the genetic etiology was finally elucidated in 2003 ( Mellins et al 1970 ; Amiel et al 2003 ).[medlink.com]
  • As the etiology, pathophysiology, and treatment of ALI is the same as for ARDS, the discussion will use the broader term of ALI. 37 Etiology A wide variety of clinical conditions is associated with the development of ALI.[clinicalgate.com]
  • It often has multiple etiologies.[aafp.org]

Epidemiology

  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • Epidemiology DNA studies suggest that P. jirovecii is frequently found in healthy adults in the normal community. It can cause a transient infection in an immunocompetent host.[patient.info]
  • Epidemiology The epidemiology of hypoxemia and hypercapnea parallel the epidemiology of disorders of the lungs, heart and other organ systems which lead to gas exchange abnormalities.[clinicaladvisor.com]
  • Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of dyspnea. New England Journal of Medicine, 333(23), 1547-1553. Stenton, C. (2008). The MRC breathlessness scale. Occupational Medicine,58(3), 226-227.[lecturio.com]
  • Key words: Acute Respiratory Failure, Oxygen therapy, artificial ventilation and pathophysiology.[xlung.net]
  • […] spinal cord -Neuromuscular system -The thorax -The pleura -The upper airways Etiology: Intrapulmonary causes -Disorders that effect the lower airway and alveoli -Pulmonary circulation -The alveolar-capillary membrane (asthma, pulmonary embolism) Type 1: Pathophysiology[quizlet.com]
  • Pathophysiology Hypoxemia is the result of impaired gas exchange and is the hallmark of acute respiratory failure. Hypercapnia may be present, depending on the underlying cause of the problem.[clinicalgate.com]
  • Pathophysiologic basis, clinical presentation, and management. Arch Intern Med. 1990;150:1604–13. 4. Silvestri GA, Mahler DA. Evaluation of dyspnea in the elderly patient. Clin Chest Med. 1993;14:393–404. 5. Cockcroft A, Adams L, Guz A.[aafp.org]

Prevention

  • These patients are at a higher risk of deep venous thrombosis, so they should be recommended to make short trips when driving or many stops in long trips to walk and move their legs, and prevent possible PTE.[fundacionmapfre.org]
  • Desaturation A number of activities can prevent desaturation from occurring.[clinicalgate.com]
  • […] none of the following conditions are met: Intense agitation Altered conscious state levels (Glasgow coma score 8) Hemodynamic instability, shock Severe arrhythmias Inability to protect upper airways, compromised ability to cough Facial injuries that prevent[xlung.net]
  • […] incentive spirometer; coughing if secretions are present -Importance of taking medication -Factor modification (smoking) -Breathing technique (pursed lip breathing) -Pathophysiology of disease -Specific etiology -Energy conservation methods -Infection prevention[quizlet.com]
  • 53, 54 ] Poliomyelitis [ 55, 57 ] Segmental muscle atrophy Hyperreflexia Fasciculations Distal extremity weakness EMG Supportive Polyneuropathy [ 25 ] Viral illness, symmetric ascending distal muscle weakness Elevated CSF protein without pleocytosis Prevention[aneskey.com]

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