Acute and Chronic Respiratory Failure Flashcards by tcarlso 3

What is respiratory failure?

Lungs failing to adequately oxygenate arterial blood or prevents the retention of CO2

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What is acute respiratory failure? (time, reversibility)

Abrupt onset of failure within hours to days

Can reverse or become chronic

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What is chronic respiratory failure? (time, clinical course, reversibility)

Months to years
Can be insidious
Irreversible

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What is the definition of acute on chronic respiratory failure?

Increased baseline oxygen requirements

- Increased CO2 above baseline to drop pH below 7.3

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A pH drop below what level characterizes acute on chronic respiratory failure?

7.3

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What is the usual cause of acute respiratory failure secondary to a ventilatory failure?

Drug overdose

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What is the usual cause of acute respiratory failure secondary to a oxygenation failure?

Pneumonia

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What is the usual cause of chronic respiratory failure secondary to a ventilatory failure?

Neuromuscular disease

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What is the usual cause of acute respiratory failure secondary to a oxygenation failure?

Pulmonary fibrosis

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What is the failure value of PaO2?

Less than 60 mmHg

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What is the failure value of PaCO2?

More than 50 mmHg

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True or false: PaO2 varies by age

True

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What is normal PaCO2?

40 mmHg

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What is the equation for PaO2 to adjust for age?

100.1 - 0.32(age)

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What is the most common cause of respiratory failure? Second?

Malignant neoplasm

COPD and related

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What percent of patients with AECOPD with admission PaCO2 greater than 50 mmHg will die in the hospital? In 6 months

11% in hospital

33% in 6 months

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What are the four classifications of respiratory failure?

Hypoxemic respiratory failure
Hypercapnic respiratory failure
Perioperative
Shock

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What is hypoxemic respiratory failure d/t?

R-L shunt
V/Q mismatch
Diffusion defect

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What is the cause of hypercapnic respiratory failure?

Pump failure
Increased CO2 production
Deadspace

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Blood flow to the respiratory muscles increase by how much in shock? What is the consequence of this?

10x

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What are the four major host causes of hypoxemia?

Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch

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What is the major environmental causes of hypoxemia?

Low FiO2

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If there is not an increase in PaO2 with oxygenation, what type of pathology should you suspect?

Shunting

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What is the usual BP change with tissue hypoxia?

HTN

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What are the CV changes late in the course of hypoxia?

Bradycardia | Hypotension

What is the best diagnostic tool to assess the cause of respiratory failure?

H&P

What is the normal A-aa gradient?

Less than 10 mmHg

What is the equation for the age adjusted A-a gradient?

age/4 +4

What is PaO2/FiO2? Why it it useful?

Determines the severity of respiratory failure

What are the mild, moderate, and severe levels of PaO2/FiO2?

Mild 300-200 Moderat 200-100 Severe less than 100

What do B lines on an US indicate?

Pulmonary edema

What are the three interventions that should be obtained with all patients in respiratory failure?

- Oxygen - IV access - Vital sign monitoring

What are the four aspects of vital monitoring with patients in acute respiratory failure?

- SpO2 - HR - BP - EKG

What is the goal of advanced support for respiratory failure?

Provide adequate oxygen delivery to the tissues

What is the role of vasodilators in CHF?

Reduce workload of the heart

What is the goal Hb level for respiratory support?

More than 7 mg/dL, unless bleeding

What is the goal MAP for respiratory failure?

more than 65 mmHg

What is the amount of IVF that should be administered for advanced respiratory support?

30 ml/kg

What is the goal lactic acid level for advanced respiratory support?

less than 4.0

True or false: assessment and treatment occur simultaneously with respiratory distress?

True

What is ventilatory failure?

Hypercapnic respiratory failure--alveolar ventilation becomes inadequate in relation to CO2 production

Acute changes in PaCO2 developes rapidly enough to decreased pH to less than what level in hypercapnic respiratory failure?

7.3

What are the two major causes of hypercapnic respiratory failure?

- Ventilatory capability (pump failure) | - Ventilatory effort (drive failure)

What is the equation for PaCO2?

K(VCO2/VA) | VA = alveolar ventilation, VE = minute ventilation VCO2 = CO2 output

What are the three major hypoventilation (drive) causes of hypercapnia?

- Neuromuscular - Body habitus - Drugs

What are the causes of increased CO2 production that can lead to hypercapnia?

- sepsis - burns - seizures

What are the three major components of the pump that can cause hypercapnia?

- Airway obstruction - Respiratory muscle issue - V/Q mismatch

An acute change in CO2 level of 10 decreases pH by how much?

0.08

A chronic change in CO2 level of 10 decreases pH by how much? Why is this different from acute?

0.03 Kidney compensation by increased bicarb

For every 10 rise of CO2 in *acute* respiratory acidosis, bicarb increases by how much?

For every 10 rise of CO2 in *chronic* respiratory acidosis, bicarb increases by how much?

For every 10 *decrease* of CO2 in *acute* respiratory acidosis, bicarb increases by how much?

For every 10 *decrease* of CO2 in chronic respiratory acidosis, bicarb *decreases* by how much?

What causes the CNX issues with hypercapnia?

Increased cerebral blood flow

What are the three major clinical manifestations of ventilatory pump failure?

- Dyspnea - Respiratory distress - CNX activation

What are the two major clinical manifestations of ventilatory drive failure?

Bradypnea | Apnea

GSC***

***

What is the lab that is needed for a diagnosis of respiratory distress?

ABG

True or false: intubation and mechanical ventilation aids in airway protection and secretion clearance

True

What are the causes of hypercapnia from oxygen administration? (3)

- Increased V/Q mismatch - attenuated hypoxic ventilatory drive - Haldane effect

What is the Haldane effect?

Oxygen released bound CO2 increases PaCO2.

Normal pH with elevated PaCO2 is suspicious for what?

Chronic respiratory failure

What is the treatment for chronic respiratory failure?

- Vaccination - Oxygen therapy - Mechanical ventilation

What are the three major vaccines that should be administered to patients with chronic respiratory failure?

- TDaP - Flu - Pneumococcal

What percent of middle aged smokers have a sustained cessation effort after 5 year f/u?

22%

What does oxygen administration not improve?

-lung function

Oxygen administration for chronic respiratory failure does not improve survival in what patients?

- Moderate hypoxemia (56-65 mmHg) | - Nocturnal hypoxemia

What qualifies someone for home oxygenation?

PaO2 less than 55 mmHg or SaO2 less than 88%

Patients with a PaO2 or 56-59 with what other factors qualify for home oxygen?

- P pulmonale - pedal edema - Secondary erythrocytosis

Is there a survival benefit with pulmonary rehab?

What does pulmonary rehab improve?

- Strength - Weaning outcomes - Functional status

What is the 5 year survival rate for a lung transplant?

50%

What are the two rate limiting steps for lung transplantation?

- Chronic rejection | - infection

What age do you need to be under to receive a lung transplant?

What are the chronic infections that are absolute contraindications for a lung transplant?

- HIV - Hep C - Hep B

What type of musculoskeletal disease is an absolute contraindication for a lung transplant?

Kyphoscoliosis

True or false: patients with major organ dysfunctions cannot receive lung transplants

true

True or false: osteoporosis is an absolute contraindication for a lung transplant

False-- relative

True or false: BMI greater than 30 is an absolute contraindication for a lung transplant

False-- relative

True or false: steroid use is a relative contraindication for a lung transplant

True

What are the PaO2 and PaCO2 findings with: hypoventilation?

Increased PaCO2 | Decreased PaO2

What are the PaO2 and PaCO2 findings with: ILDs?

Pure decrease in PaO2 with no change in PaCO2

What are the PaO2 and PaCO2 findings with: ARDS?

Decrease in both PaO2 and PaCO2

What are the PaO2 and PaCO2 findings with: COPD

Increased PaCO2 Decreased PaO2 Similar to hypoventilation, but less severe