A 56-year-old female with idiopathic pulmonary fibrosis (IPF) is transferred to your ICU from a regional hospital having presented with an acute exacerbation and hypoxic respiratory failure. She has been intubated and ventilated, with SP02 88% on a Fi02 1.0.
Outline how you would optimise lung function in this patient. (50% marks)
Outline the barriers to weaning from mechanical ventilation in this patient. (50% marks)
a) Optimise lung function
b) Outline the barriers to weaning in this patient with IPF?
As far as "optimise lung function" goes, there are three main domains: try to control the disease process, get some gas exchange happening and control the pulmonary hypertension.
Specific management of the disease process
Manipulation of gas exchange
Management aimed to control pulmonary hypertension
Barriers to weaning:
Due to the disease process
Due to side effects of therapy
Sequelae of prolonged ICU stay
Hilariously, the college has included "negative attitudes to a bad prognostic disease" as one of the barriers to weaning, implying that an intensivists' natural apathetic nihilism will sabotage the process of respiratory recovery. Presumably, a vigorous and positive attitude towards IPF influences survival by virtue of generating fewer palliative care referrals.
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