Acute lung injurySupervised by

Haifa

Out line • Objectives• Introduction• PATHOPHYSIOLOGY• s/s• Most common causes• Risk factors• Diagnoses test• Treatment• Management• Complications• Drug therapy• DIAGNOSES• EVALUATION• Summary• references

Objectives•Define ALI and describe the pathological

process•Know causes of ALI, and differential

diagnosis.•Understand mechanical ventilation of

patients with ALI .•Most common causes ALI.•What Diagnostic test do.•And know nursing care plane.

Introduction• Acute lung injury (ALI) and (ARDS) describe

clinical syndromes of acute respiratory failure with substantial morbidity and mortality. Even in patients who survive ALI, there is evidence that their long-term quality of life is adversely affected.(1,2) Recent advances have been made in the understanding of the epidemiology, pathogenesis, and treatment of this disease.

• However, more progress is needed to further reduce mortality and morbidity from ALI and ARDS

PATHOPHYSIOLOGY

It is thought ALI patients follow a similar pathophysiological process independent of the aetiology. This occurs in two phases; acute and resolution, with a possible third fibrotic phase occurring in a proportion of patients

Acute lung injury•is the sudden failure of the respiratory

(breathing) system person with ALI has rapid breathing, difficulty getting enough air into the lungs and low blood oxygen levels.

S/S• Rapid breathing; trouble getting enough air• Abnormal breathing sounds, such as a crackling

noise or decreased breathing sounds• Cough• Fever• Low blood pressure• Confusion• Extreme fatigue• Bluish lip or skin color• Anxiety or agitation•  

Table 2 Direct and Indirect triggers for ALI

Risk factors for ALI•Age•Family history•Smoking•COPD •ARDS•Preexisting lung disease•Chronic alcohol use•Low serum pH•Sepsis

▫40% of patients with sepsis develop ALI

And laboratory Diagnoses test• physical exam•Echo (Echocardiogram)•Oximetry•Bronchoscopic biopsy•Chest CT•chest X-ray Laboratory :CBC , ABG , electrolytes test

Treatment• Mechanical Ventilation(is conventionally delivered as positive pressure ventilation with PEEP via a tracheal tube)• Fluid Management (fluid restriction could lead to improvement in clinically important outcomes)• SteroidsSteroids exert an anti-inflammatory effect by inhibiting arachidonic acid metabolism and reducing eosinophil activity• Prone Positioning(to enhance oxygenation by improving alveolar ventilation/perfusion AND improves lung mechanism)

Management of ALI•Treat underlying illness

Sepsis, etc•Nutrition parenteral nutritionPhysiotherapy Deep breath excise•Suction (as needed )•DVT prophylaxislow molecular weight heparin•GI prophylaxis•Medications(bronchodilators)

Complications in Managing ALI patients•Pulmonary: pulmonary embolism (PE),

pulmonary fibrosis•Gastrointestinal: bleeding (ulcer), bacterial

translocation•Cardiac: abnormal heart rhythms, myocardial

dysfunction•Renal : (ARF)•Mechanical: vascular injury, pneumothorax (by placing pulmonary artery catheter) tracheal injury/stenosis (result of intubation and/or irritation by endotracheal tube•Malnutrition : electrolyte deficiency

Drug therapy•Agents studied:

▫Corticosteroids▫Ketoconazole▫Inhaled nitric oxide▫Surfactant

•No benefit demonstrated

1 -Nursing DIAGNOSES1-Ineffective breathing pattern related to Decreased lung

expansionGoal :Establish a normal/effective respiratory pattern with ABGs within

patient’s normal rangeNursing interventions1. • Monitor vital signs every 1 to 2 hours2. Auscultate breath sounds , chest excursion every 1 to 2

hours.3. Check out respiratory function, noting rapid or shallow

respirations, dyspnea, reports any abnormal4. • Monitor oxygen saturation and ETCO2 levels every 30 to

60 min

2-Nursing DIAGNOSES•2- Impaired gas exchange related to effects

of near-drowningGoal :• Maintain adequate cardiac output and tissue perfusionNursing interventions 1. Suction via endotracheal tube as needed to

maintain clear airways.2. Obtain ABGs as ordered or indicated; monitor

and report results.3. Allow periods of rest.

3-Nursing DIAGNOSES•3- Anxiety related to hypoxemiaGoal•reduced anxiety levels•ability to restNursing interventions

1. • Explain the purpose and procedure of intubation.2. Answer questions and provide Reassurance3. • Administer analgesics and/or sedatives as

ordered.

EVALUATIONreduce anxiety. METoxygen saturation improve. MET PEEP is added to ventilator settings. After

3 days of mechanical ventilation begins to improve. placed on SIMV course of another 3 days CPAP. eventually recovers fully, with minimal apparent long-term effects.

Summary•ARDS is a clinical syndrome characterized by

severe, acute lung injury, inflammation and scarring

•Significant cause of ICU admissions, mortality and morbidity

•Caused by either direct or indirect lung injury•Mechanical ventilation with low tidal volumes

and plateau pressures improves outcomes•So far, no pharmacologic therapies have

demonstrated mortality benefit•Ongoing large, multi-center randomized

controlled trials are helping us better understand optimal management

ReferencesRubenfeld GD, et al. Incidence and outcomes of acute

lung injury N Engl J Med. 2005;353:1685-93.Luhr OR, et al. Incidence and mortality after acute

respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF study group. Am J Respir Crit Care Med. 1999;159:1849061,

Bersten AD et al. Australian and New Zealand Intensive Care Society Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med. 2002;165:443-8.

Connors AF Jr, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT investigators. JAMA. 1996;276:889-97.