Pulmonary Disorders II
Pulmonary artery hypertension (PAH) is a chronic, life-threatening disease characterized by vascular
changes, including vasoconstriction, cellular proliferation, and thrombosis. These changes result in
elevations in pulmonary vascular resistance (PVR) with the end result being right ventricular failure.
Thromboxane A2 (potent vasoconstrictor) concentrations are increased.
Prostacyclin (potent vasodilator, inhibitor of platelet aggregation, and antiproliferative properties)
concentrations are decreased.
Endothelin-1 (ET-1; potent vasoconstrictor, mitogenic properties on pulmonary artery smooth
muscle cells) concentrations are increased.
| d. | Nitric oxide concentrations (vasodilator, inhibitor of platelet activation, and inhibitor of vascular |
|---|
smooth muscle cell proliferation) are decreased.
Cellular proliferation occurs because of downregulation of antiproliferative growth factors, which
results in upregulation of the activin pathway, leading to increased vascular proliferation (J Heart
Lung Transplant. 2024:S1053-2498(24)01874-6).
Patient Case
Questions 1 and 2 pertain to the following case.
A 20-year-old woman is admitted to the ICU for an acute CF exacerbation. Before admission, her condition had
been stable. She had maintained her ideal body weight and had just completed a home regimen of suppressive
antibiotics. The patient requires MV for the management of hypoxic respiratory failure. She is initiated on AC/
VC mode with a lung-protective strategy (4–8 mL/kg tidal volume).
Which of the following would be best to manage her acute CF exacerbation?
goal during her acute illness (15 kcal/kg/day).
tion; and tube feedings to target her goal caloric intake (25 kcal/kg/day).
daily; hypertonic saline 7% nebulization; and tube feedings to target her goal caloric intake (25 kcal/
kg/day).
8 hours; hypertonic saline 7% nebulization; and tube feedings to target her goal caloric intake (25 kcal/
kg/day).
medications for 5 days, this patient improved and was extubated. She was moved out of the ICU on day 6 of
her hospitalization. Which duration of antibiotics would be best to recommend for this patient?