Question

38-year-old patient. Chronic musculoskeletal deformity.

■ How is it likely to affect respiratory function?

Fig. 1.70 Quiz case.

Fig. 1.71 Quiz case.

Fig. 1.70 Quiz case.

Answer Kyphoscoliosis

Respiratory function can be affected by scoliosis. Breathing may be impaired by the chest wall deformity, resulting in alveolar hypoventilation. The chance of impairment in respiratory function is related to the maximum angle of the curvature (Cobb angle). Atelectasis and segmental collapse can occur. Chest wall deformity is seen in patients who were treated for pulmonary tuberculosis with thoracoplasty (see Fig. 1.72). Thoracoplasty was a treatment used prior to the widespread use of antibiotics. Marked chest wall deformity occurs often with considerable volume loss and sometimes with other stigmata of TB such as pleural calcification. Type II respiratory failure (hypoxia and hypercapnia) with subsequent cor pulmonale can occur. Selected patients with chronic ventilatory failure are appropriately treated with long-term domiciliary ventilation. Patients (with kyphoscoliosis and thoracoplasty) treated with non-invasive positive pressure ventilation can have improved prognosis. A nasal mask and continuous positive pressure ventilation is the usual method employed (Table 1.13).

Table 1.13 Causes of chronic respiratory failure

■ Type I respiratory failure (hypoxia)

• Pulmonary fibrosis

• Pulmonary vascular disease

■ Type II respiratory failure (Hypoxia and Hypercapnoea)

■ Airways disease

• Chronic obstructive pulmonary disease

• Cystic fibrosis and bronchiectasis

• Obstructive sleep apnoea

■ Neuromuscular disorders

• Motor neurone disease

• Muscular dystrophy

■ Thoracic cage and pleural abnormality

• Kyphoscoliosis

• Thoracoplasty

• Extreme obesity

Fig. 1.73 Quiz case.

34-year-old drug addict. Homeless.

Cough and haemoptysis. Tachypnoea, hypoxia. You are asked to assess with view to ventilatory support.

(Fig. 1.73) show? ■ What risk factors should be considered?

Fig. 1.73 Quiz case.

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