Pulmonary Disorders II

Learning Objectives

Design a treatment plan for a cystic fibrosis (CF)

exacerbation.

artery hypertension using a risk assessment–based

strategy.

Describe classifications and risk factors for increased

severity of asthma exacerbation and treatment plans

for patients with acute respiratory failure caused by

asthma exacerbation.

Recognize evidence-based treatment options for

acute exacerbations of chronic obstructive pulmo-

nary disease (COPD).

Arterial blood gas

BNP

B-type natriuretic peptide

CF

Cystic fibrosis

CFTR

Cystic fibrosis transmembrane conductance

regulator

COPD

Chronic obstructive pulmonary disease

CRP

C-reactive protein

hypertension

CVP

Central venous pressure

ECOPD Exacerbation of chronic obstructive pulmo-

nary disease

ED

Emergency department

ET

Endothelin

ERA

Endothelin receptor antagonist

FEV1

Forced expiratory volume in the first second

of expiration

Fio2

Fraction of inspired oxygen

ICU

Intensive care unit

MDI

Metered dose inhaler

mPAP

Mean pulmonary artery pressure

MV

Mechanical ventilation

Pao2

Partial pressure of oxygen

PAH

Pulmonary artery hypertension

PDE5i

Phosphodiesterase type 5 inhibitor

PEEP

Positive end-expiratory pressure

PH

Pulmonary hypertension

PVR

Pulmonary vascular resistance

RV

Right ventricular

SABA

Short-acting β-agonist

Sao2

Oxygen saturation

Spo2

Functional oxygen saturation

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

A 21-year-old woman (height 62 inches, weight

50 kg) with a medical history significant for cys-

tic fibrosis (CF) is admitted to the intensive care

unit (ICU) with acute respiratory failure requiring

mechanical ventilation (MV). After intubation, her

arterial blood gas (ABG) results are as follows: pH

7.27, Paco2 45 mm Hg, bicarbonate 22 mEq/L, Pao2

55 mm Hg, and oxygen saturation (Sao2) 88%. Her

ventilator settings are as follows: assist control/vol-

ume control (AC/VC) mode, tidal volume 300 mL

(6 mL/kg), respiratory rate 20 breaths/minute, frac-

tion of inspired oxygen 60%, pressure support 5 cm

H2O, and positive end-expiratory pressure (PEEP)

5 cm H2O. Her blood pressure is 110/70 mm Hg

and heart rate is 95 beats/minute. Which is the best

holistic therapy plan?

hours and tobramycin 150 mg intravenously

every 8 hours; intravenous fluid resuscitation to

maintain a central venous pressure (CVP) goal

of 10–14 mm Hg; dornase alfa and hypertonic

saline 7% nebulization.

hours and tobramycin 500 mg intravenously

every 8 hours; intravenous fluid resuscitation to

maintain a CVP goal of 10–14 mm Hg; dornase

alfa and hypertonic saline 7% nebulization.

hours and tobramycin 150 mg intravenously

every 8 hours; intravenous fluid resuscitation to

maintain a CVP goal of 10–14 mm Hg.

hours and tobramycin 500 mg intravenously

every 24 hours; diuresis to maintain a CVP goal

of less than 4 mm Hg while mean arterial pres-

sure is greater than 65 mm Hg; dornase alfa and

hypertonic saline 7% nebulization.