TY - CHAP M1 - Book, Section TI - Restrictive Disease of the Respiratory System A1 - Sturek, Jeffrey Michael A1 - Noth, Imre A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSRestrictive lung diseases are comprised of extrinsic disorders involving the chest wall, such as kyphoscoliosis, obesity, or muscle weakness disorders, and intrinsic disorders involving the lung parenchyma.In extrinsic restriction, low tidal volumes and high respiratory rates likely minimize the risk of barotrauma during mechanical ventilation; however, gradual institution of anti-atelectasis measures may improve gas exchange and static compliance.Nocturnal hypoxemia is common and may contribute to cardiovascular deterioration; routine polysomnography is recommended.Strategies for management of patients with chronic ventilatory failure include daytime intermittent positive pressure ventilation, nocturnal noninvasive ventilation, and ventilation through tracheostomy.Acute deterioration in respiratory status can occur from disease progression, upper and lower respiratory tract infections, congestive heart failure, failure to clear secretions, atelectasis, aspiration, and pulmonary embolism.Intrinsic restrictive lung diseases involve parenchymal reduced lung volumes as a defining feature, whereby the underlying disease and antecedent treatment, such as immunosuppression, can impact prognosis and management.Hypoxemia results from ventilation-perfusion mismatch that is accentuated with increased cardiac output and atelectasis associated with sleep.Patients with interstitial lung diseases and pulmonary fibrosis admitted to the ICU with acute respiratory failure have an extremely poor prognosis.If mechanical ventilation (MV) is deemed appropriate, the use of low tidal volumes and high respiratory rates during MV likely minimize ventilator-induced lung injury.Decisions for pharmacotherapy and antibiosis hinge upon accurate diagnosis of underlying pathology and pretest probability for infectious processes.Lung transplantation is a viable option in selected patients with end-stage fibrosis. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/11/03 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201804188 ER -