Fibrotic Phase (Nursing)

00:01 For those that it doesn't stop and things keep progressing, now they enter the third phase.

00:06 Not everybody goes through the third phase, but some people do.

00:10 So, when we say it's not a universal outcome, that means it not everybody has to go through the fibrotic phase who has ARDS.

00:18 Good thing, but those that do, it is bad news.

00:23 Because it's an increased mortality, you know, that means death, and may also have prolonged.

00:30 Prolonged, prolonged mechanical ventilation.

00:37 Okay, so someone whose lungs become fibrotic, they're stiff, they're not compliant, their gunked up.

00:43 They have an increased risk of dying and we know they're going to be on that mechanical ventilator for a long time because their lungs just can't do it on their own.

00:53 They've got this significant interstitial and intra alveolar fibrosis.

00:59 Now I want you to think back to those pictures, remember where the interstitial space is.

01:05 Think about that alveolar wall.

01:07 Yeah.

01:07 So everything in there is stiff, that's what fibrosis means stiff, thick, dense.

01:15 It's not compliant.

01:17 It doesn't move well and you know, we're not going to have good gas exchange.

01:21 We're not going to have tissue that can expand and contract.

01:23 We've got major lifetime alteration here.

01:28 So, they can also have some collagen deposits as if all this wasn't enough.

01:31 They can also have collagen deposits in the alveoli.

01:35 They can avascular and interstitial areas with microcysts.

01:38 This is crazy change to the lungs.

01:42 So we're glad not everyone goes through this but if they do, they are going to have lifetime risks and complications if they survive this phase.

01:53 Keeping in mind, lung damage is progressive.

01:56 I love I had someone help me with this because I really wanted to see these two things together.

02:02 So you've got fraction of maximum right there, right? So we're talking one equals the maximum of what we usually see.

02:10 Now look along the bottom, those are the number of days Now, we broke it up into phases.

02:15 The exudative phase, the proliferative phase and the fibrotic phase.

02:19 Remember not everybody goes through that, thank goodness.

02:22 So, please just write that in the slide because we all need hope.

02:25 Write down, not everyone goes through this.

02:28 Increased mortality if they do enter this phase.

02:32 But look at the edema, when is it peak? Yeah, early on we're talking about all that fluid and edema that and that interstitial space.

02:39 Now, let's look at the next phase, we're talking about the hyaline membranes.

02:43 You see where they peak.

02:45 Yeah, still in that exudative phase but they peak, and then they kind of drop off because you're gonna have a lot of them built.

02:53 Now, look at the proliferative phase, look at the interstitial inflammation.

03:00 That's a later sign, good you're getting it, I love how you're reading this graph with me.

03:05 Last look at interstitial fibrosis, kind of evens out till that proliferative phase.

03:10 That's where both the interstitial fibrosis in the interstitial inflammation hit their peak is in the proliferative phase.

03:19 So should you be able to recreate this for the exam? No, I just want you to see hey, here's a great snapshot.

03:27 I'm expect my patient to be edematous more in the beginning.

03:29 They were going to have the hyaline membrane is developing.

03:32 Meanwhile that interstitial inflammation and interstitial fibrosis is starting to happen in that exudative phase, but it's going to hit its peak in the proliferative phase.