COPD & ARDS (case studies )

By

DR KHALED SALEH ALGARIRI2014

Acute Respiratory Distress Syndrome (ARDS)

FISRST CASE

33-year-old woman developed back pain that worsened over several days. She took several medications, but the pain did not abate. After five days, she developed breathlessness and was hospitalized. The next day her blood pressure dropped and her kidneys failed. The following day, her breathing deteriorated and she required mechanical ventilation. Breathing became more difficult, and the high pressure required by the ventilator to get air into her lungs ruptured the lung alveoli, causing air to escape the lungs and be trapped inside the chest (pneumothorax). This was treated with a tube through the chest wall to allow the lungs to expand. She was deeply sedated to reduce the work required by her respiratory muscles. She developed pneumonia, and, after about three weeks on the ventilator, a new breathing tube was placed directly into the trachea (tracheostomy) in preparation for long-term mechanical ventilation. ortunately, her kidney function returned, and she was able to clear the fluid in her lungs. Antibiotics treated the pneumonia. After four weeks in the hospital, the sedation was stopped, and after nine weeks, the tracheostomy tube was removed.

Acute respiratory distress syndrome (ARDS) is a condition in which the lungs suffer severe widespread injury, interfering with their ability to take up oxygen. A low blood oxygen level and the inability to get oxygen to normal levels is the hallmark of ARDS

Introduction

The term acute reflects the sudden onset—over minutes or hours—of an injury. Acute lung injury (ALI) is a more recently coined term that includes ARDS but also milder degrees of lung injury.

Introduction

ALI and ARDS always result from another severe underlying disease. The range of diseases causing ARDS is broad, and they may also damage organs other than the lungs, but the lung injury usually dominates the clinical picture

Introduction

The lung contains millions of air sacs or alveoli that are lined by 2 types of cells – Type I and Type II. Type II cells secrete a fluid called surfactant. The surfactant forms a thin layer on the alveoli and reduces surface tension. The surfactant prevents the alveoli from collapsing while breathing out.

Introduction

The patient presents with following features:

Sudden breathlessness

Low levels of oxygen in the blood

Lung inflammation

This condition could progress to respiratory failure

Clinical Features of ARDS

Causes of ARDS include sepsis bacterial pneumonia severe trauma multiple transfusions aspiration of gastric contents drug overdosage post cardiopulmonary bypass surgery.

Causes of ARDS

The patient is diagnosed using blood gases estimation and imaging studies like chest x-ray and CT scan. The patient is put on a ventilator during treatment. Fluid and nutrition intake are carefully monitored.

Diagnosis of ARDS

Listening to the chest with a stethoscope (auscultion)reveals abnormal breath sounds, such as crackles, which may be signs of fluid in the lungs. Often the blood pressure is low.(Cyanosis)(blue skin, lips, and nails caused by lack of oxygen to the tissues) is often seen.

Tests used to diagnose ARDS include: Arterial blood gas Blood tests, including CBC and blood chemistries Bronchoscopy Chest X- ray Sputum culture and analysis

Signs and Diagnosis Tests

Typically people with ARDS need to be in an intensive care unit (ICU).

The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve medications to treat infections, reduce inflammation, and remove fluid from the lungs.

Treatment

A breathing machine is used to deliver high doses of oxygen and continued pressure called PEEP (positive end-expiratory pressure) to the damaged lungs. Patients often need to be deeply sedated with medications when using this equipment. Some research suggests that giving medications to temporarily paralyze a person with ARDS will increase the chance of recovery.

SECOND CASE

Chronic Obstructive Pulmonary Disease COPD

A 52-year-old woman sought medical attention for increasing shortness of breath on exertion for over two years. She used to walk 9 holes of golf with her women’s group every Wednesday, but over the last year she has had to use a golf cart. She has attributed this change to getting old. She was told three years earlier that she had “a touch of asthma” and was given an inhaler to use when she was symptomatic. In the last six months, she had three trips to the emergency department for “acute bronchitis.” She had smoked for about 15 years, but stopped 20 years ago. Spirometry showed an FEV of 62 percent of that predicted and an FEV / FVC of 0.58. (Forced expiratory volume (FEV)Forced vital capacity (FVC))

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.

People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction.

Introduction

SmokingPassive smokingFumes and dustAir pollution

Causes of COPD

The symptoms of chronic obstructive pulmonary disease (COPD) usually develop over a number of years.

increasing breathlessness when exercising or moving around

a persistent cough with phlegm that never seems to go away

  frequent chest infections, particularly in winter wheezing weight loss tiredness and fatigue swollen ankles

Symptoms of COPD

1-Spirometry To assess how well your lungs work, a

breathing test called spirometry is carried out. You will be asked to breathe into a machine called a spirometer.

Diagnosing COPD

2-Electrocardiogram (ECG) and echocardiogram An electrocardiogram (ECG) or echocardiogram may be used to check the condition of your heart.

3-CBC Test4-Chest X- ray5-Peak flow testTo confirm you have COPD and not asthma, your doctor might ask you to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out.

There is no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and reduce the symptoms.

If you smoke, the best way to prevent COPD from getting quickly worse is to stop smoking and avoid further damage to your lungs. There is support available to help you quit.

There are also medicines that can help relieve the symptoms of COPD. The type of medicine you take will depend on how severe your COPD is and what symptoms you have. You may have to try different medicines to find which suits you best

Treatment of COPD

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