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Question: Case Study Ohoud, A 52-year-old Woman With A History Of Cholelithiasis, Is Admitted To The Hospital For Acute Pancreatitis. She Progresses To Necrotizing Pancreatitis And Develops Shock. She Is Transferred To The Intensive Care Unit (ICU). After Arrival In The ICU, The Patient Develops Cardiorespiratory Failure And Is Intubated. She Is Having Multiple …

Question: Case Study Ohoud, A 52-year-old Woman With A History Of Cholelithiasis, Is Admitted To The Hospital For Acute Pancreatitis. She Progresses To Necrotizing Pancreatitis And Develops Shock. She Is Transferred To The Intensive Care Unit (ICU). After Arrival In The ICU, The Patient Develops Cardiorespiratory Failure And Is Intubated. She Is Having Multiple …

Case Study

Ohoud, a 52-year-old woman with ahistory of cholelithiasis, is admitted to the hospital for acutepancreatitis. She progresses to necrotizing pancreatitis anddevelops shock. She is transferred to the intensive care unit(ICU). After arrival in the ICU, the patient developscardiorespiratory failure and is intubated. She is having multipleepisodes of oxygen desaturation, whereby she was placed onassist-control ventilation of 20 breaths/min, a tidal volume of 6mL/kg with positive end-expiratory pressure (PEEP) of 10 cm H2O.Her breath sounds are clear with no crackles or wheezes. Hertemperature is 38.4°C.

As the day progresses, Ms. Ohoudbecomes difficult to ventilate and is sedated with a fentanylinfusion and midazolam (Versed) infusion. Her heart rate is 120beats/min, central venous pressure is 8 mm Hg, and PAOP is 10 mmHg. Arterial blood gas (ABG) values show PaO2 of 68 mm Hg, PaCO2 of39 mm Hg, pH of 7.36, HCO3 of 18 mEq/L, and O2 saturation of 95.5%.She has been diagnosed with Acute Respiratory Distress Syndrome(ARDS) for which, she was intubated and put on the mechanicalventilator instantly. Nevertheless, Ms. Ohoud continued todeteriorate and developed severe bilateral wheeze in his chest. Thechest radiography shows bilateral effusions. The PaO2 remains lowat 65 mm Hg. Blood, sputum, and urine specimens are sent to thelaboratory for culture. Empiric broad-spectrum antibiotics arestarted.

Seven days after admission, FiO2remains at 100%, with no improvement in oxygenation. Temperatureremains elevated at 39.1°C with a white blood cell count of12,000/mm3. All cultures remain negative. Chest radiography shows acollapsed right upper lung lobe. A bronchoscopy is performed toexamine the right upper lobe, and copious secretions are removed.Ms. Ohoud is placed in the prone position whereby her oxygenationimproved.

please answer the questions below withevidence

1- As ARDS is associated with several pathophysiologicalchanges, explain in detail the pathophysiological process. Supportyour answer must be evidence-based.

2- Based on evidence-based researches, explain why oxygensaturation is not improving despite the use of the mechanicalventilator?   

3- With rationale from evidence, Explain in detail the fourfollowing issues relate to her case:

  1. Increase capillary membrane permeability.
  2. Impaired surfactant production.
  3. Formation of hyaline membrane formation.
  4. Pulmonary fibrosis.

4- Provide three evidence-based researches that support thedevelopment of pulmonary hypertension and how we can manageit?  

5- In order to optimizing oxygenation and ventilation, proneposition appears to be more effective. Explain, with rational fromevidence, the benefit of this positions taking into considerationthe pros and cons

              





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