Question

J.N. is a 55-year-old white man who was admitted 24 hours ago after emergent surgery for an acutely ischemic bowel. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic BP dropped to 70 mm Hg. Seven units of packed red blood cells and 4 L of 0.9% saline were infused. His pulmonary status worsened within 12 hours of admission to the ICU, requiring an emergent ET intubation. He developed a pneumothorax after intubation and a left-side chest tube was placed at that time. His hypoxemia has rapidly progressed and is currently refractory to 100% FIO2 and high levels of PEEP. His laboratory test results indicate kidney and liver failure. He has an advance directive that indicates he does not want to be kept alive by artificial means, but he has a full code status. He is currently sedated, paralyzed, and unable to communicate. his urinary catheter is draining concentrated urine <30 mL/hr. He has a central line in place and is receiving 0.9% saline at 125 mL/hr. His most recent ABGs are as follows: pH 7.12, PaO2 50 mm Hg, PaCO2 62 mm Hg, HCO3 17 mEq/L, and O2 saturation 84%. His PaO2/FIO2 ratio is <200 and his chest x-ray shows worsening bilateral interstitial infiltrates compatible with ARDS pattern.

what disease is being talked about?

Answer 1

Answer:- Acute respiratory distress syndrome (ARDS) can occur during the treatment of several diseases and in several interventional procedures as a complication. # Acute respiratory distress syndrome (ARDS) is defined as a rapidly progressive acute onset respiratory failure (arterial hypoxemia with P02 / Fi02 ratio less than 200 mmHg regardless of PEEP level), with bilateral radiographic infiltrates, without evidence of left atrial hypertension (or pulmonary artery wedge pressure less than 18 mmHg). This complex syndrome, which is characterized by broad clinical presentations, is caused by a variety of insults, such as bacterial or viral pneumonia # Pathogenesis It is well previously described that pathophysiologically, ARDS is the result of inflammatory lung injury. It is characterized by increased activation of circulating neutrophils, complement cascade and other proinflammatory mediators, increased microvascular permeability and fluid exudation into the lung parenchyma and loss of surfactant resulting in alveolar atelectasis, destruction and eventually fibrin deposition in the lungs.

The development of pneumothorax in patients under mechanical ventilation is closely correlated with the underlying pulmonary pathology and it has been proved that ARDS independently correlated with the appearance of this complication # Portable chest X - ray is the first diagnostic evaluation imaging being used and the procedure of choice for the documentation of lung underlying pathology or the presents of lines, tubes or devices. However, often exhibits diagnostic disadvantages, taking into account that pneumothoraces in ARDS patients may have unusual, as well as subtle features and small sized pneumothoraces or located pneumothoraces, can be missed on chest X-ray. Furthermore, other types of air leaks, such as pneumomediastinumand interstitial pulmonary emphysema, may be more difficulty observed by chest radiograph. Cases have been described in medical literature, referring to patients presenting clinical deterioration but unchanged chest X _ ray and functioning chest drains. This is the reason why, especially in patients under mechanical ventilation, serial and daily chest radiographs are necessary in the evaluation of underlying lung pathology.

LaRIIIY IIILU account that pneumothoraces in ARDS patients may have unusual, as well as subtle features and small sized pneumothoraces or localized _ _ pneumothoraces, can be missed on chest X-ray. Furthermore, other types of air leaks, such as pneumomediastinum and interstitial pulmonary emphysema, may be more difficulty observed by chest radiograph. Cases have been described in medical literature, referring to patients presenting clinical deterioration but unchanged _ _ _ chest X - ray and functioning chest drains. This is the reason why, especially in patients under _ _ mechanical ventilation, serial and daily chest _ _ _ radiographs are necessary in theevaluation of _ _ _ underlying lungpathology. There for, if a pneumothorax is suspected and is unrevealed on chest X-ray, a more specific diagnostic imaging like chest - computed tomography is necessary. # ARDS and pneumothorax during mechanical ventilation # Patients with ARDS undergoing mechanical ventilation are considered to be at highest risk for development of barotrauma, with an incidence varying between 0 - 49% # Positive end expiratory pressure (PEEP) and pneumothorax in ARDS.