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Today's article is about, “Quick Tip for Families in Intensive Care: What’s the Link Between Lung Scarring and Intubation?”
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Quick Tip for Families in Intensive Care: What’s the Link Between Lung Scarring and Intubation?
If you want to know the difference between lung
scarring and intubation, stay tuned! I’ve got news for you.
My name is Patrik Hutzel from intensivecarehotline.com, and I have another quick tip for families in intensive care.
So, today I have a question from Peter who was asking, “Is there a difference between lung scarring and
intubation?”
Now, let’s do a breakdown of the terminology first. Lung scarring basically means that there’s scarring of tissues in the lungs, which is also basically stiffening the lungs because the lungs have basically lost all elasticity, which is important for a gas exchange, i.e. oxygen to go into the lungs and carbon dioxide to come out. That could impact on the breathing ability of a
patient.
Intubation means the insertion of a breathing tube into the mouth or into the nose for mechanical ventilation. So, that’s the terminology.
Is it linked? Well, let’s look at that in more detail today. So, lung scarring and fibrosis can be linked to intubation in a few ways, mainly due to the
effects of prolonged mechanical ventilation and underlying conditions that may worsen during intubations.
Here’s how they connect: Ventilator-induced lung
injury, which means mechanical ventilation can overstretch the lung if the pressure or volume is too high, causing inflammation and microscopic lung damage. Over time, this damage can lead to pulmonary fibrosis, and pulmonary fibrosis is actually lung scarring.
Next, oxygen toxicity. High levels of oxygen for long periods can cause oxidative stress, damaging lung tissue, and promoting
scarring.
Next, being intubated, infections, and pneumonia. Being intubated increases the risk of ventilator-associated pneumonia, also known as VAP, which can lead to inflammation and fibrosis in the lungs. Again, fibrosis leads to lung scarring. Chronic or repeated infections can cause scarring as part of the healing process.
Next, pre-existing conditions. If a patient already had lung disease, i.e., pulmonary fibrosis, which means scarring already is pre-existing, COPD (Chronic obstructive pulmonary
disease), intubation might worsen their condition. Some patients develop post-ARDS (acute respiratory distress syndrome) fibrosis if they had severe
respiratory distress. ARDS stands for acute respiratory distress syndrome, also known as lung failure.
Lastly,
prolonged intubation without weaning. If someone remains ventilated too long without successful weaning, their lungs may become stiff and less able to function independently. This can make extubation or transitioning to a tracheostomy more difficult.
What it all comes down to is that if there’s lung scarring happening during intubation? Would that lead to the inability to wean off the breathing tube and the ventilator? Would that lead to a
tracheostomy?
If it leads to a tracheostomy, what’s the outcome there? Would that lead to ventilation weaning or would it mean that with a tracheostomy a patient can be ventilated for a prolonged period without weaning? And for example, go home then leave ICU with a service like Intensive Care at Home and you can find more
information at intensivecareathome.com.
The question also is, what ventilator settings is the patient on? Do they
have already high oxygen requirements, high PEEP (Positive end expiratory pressure) or high-pressure support? What other pressures are we looking on the ventilator? For example, the mean pressures, are they high? Are they above 30 for example, which then increases the risk for the pneumothorax, i.e. Barotrauma or a hole in the lungs? Because the pressure in the lungs is high and they pretty much pop. So, all those risks need to be assessed.
For example, do you then need to reduce the pressure that someone is being ventilated with? If the pressure is reduced, will that be giving sufficient ventilation? Is that delivering sufficient gas exchange? Are arterial
blood gases then maintained within a physiological level, i.e., is PO2 (partial pressure of oxygen), PCO2 (partial pressure of carbon dioxide) within normal ranges? Is SPO2 (oxygen saturation) above 95% and so forth?
So really, what is the end game here? But if people want to live even if they have scar tissue or pulmonary fibrosis, they
should have a tracheostomy assuming they can’t be weaned off the ventilator. Then they can go home with a service like Intensive Care at Home.
So, I hope that answers your question.
Now, I have worked in critical care nursing in three
different countries for 25 years, where I have worked as a nurse manager for over 5 years in critical care. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can very, very confidently say that we have saved many lives for our clients in Intensive care. You can verify that on our testimonial section and on our intensivecarehotline.com podcast
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.
Take care for now.