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Clinical Medicine > Acute Respiratory Failure > Flashcards

Acute Respiratory Failure Flashcards

1
Q

What is ventilatory capacity

A

Maximal spontaneous ventilation that can be maintained without development of fatigue

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2
Q

What is ventilatory demand

A

Spontaneous minute ventilation that results in a stable PaCO2

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3
Q

What is the ideal situation regarding ventilatory capacity and ventilatory demand

A

Ventilatory capacity greatly exceeds ventilatory demand

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4
Q

How does respiratory failure occur

A
  1. Results from a reduction in ventilatory capacity or an increase in ventilatory demand or all of the above
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5
Q

What is a major immediate threat to vital organ function

A

Hypoxemia

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6
Q

What will be on the ABG of ARF

A

PaO2 under 60mmHg or PaCO2 over 50 mmHG
*not absolute
*hypercapnia ARF
*hypoxemia ARF

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7
Q

Why does hypoxemia and hypercapnia occur in ARF

A
  1. Body cannot transfer O2 to the blood or cannot release CO2 out of the body
  2. Immediate symptoms and signs secondary to this issue eventually begin to affect other organs systems
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8
Q

What is hypoxia

A

Reduction of oxygen supply at the tissue level

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9
Q

What is hypoxemia

A

Condition where arterial o2 or partial pressure of o2 is measured to be below 80mmHg

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10
Q

How is hypoxemic AFR categorized

A

MC
1. PaO2 is under 60mmHG with normal or low PaCO2
*lung disease interferes with O2 but ventilation is maintained

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11
Q

What are some causes of hypoxemic AFR

A
  1. COPD
  2. Pneumonia
  3. ARDS
  4. Asthma
  5. PE
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12
Q

How is hypercapnic AFR categorized

A

PaCO2 >50mmHG
1. Hypoxemia is also present
2. Ph depends on level of HCO3

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13
Q

What does the level of HCO3 depend on

A
  1. Duration of hypercapnia
  2. Renal response occurs over days to weeks
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14
Q

What are some causes of hypercapnic ARF

A
  1. COPD
  2. Drug OD
  3. ARDS
  4. Poisonings
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15
Q

What are the signs of symptoms of hypoxemia RF

A
  1. Dyspnea
  2. Cyanosis
  3. Restlessness
  4. Confusion
  5. HTN or hypotension
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16
Q

What are the S/sx of hypercapnia RF

A
  1. Dyspnea
  2. Headache
  3. Peripheral hyperemia
17
Q

What is the tx and management of ARF

A

REVERSE AND TREAT UNDERLYING HYPOXEMIA
1. Therapy to treat underlying cause
2. Respiratory supportive care to maintain adequate gas exchange and support vital organs
*O2 >88%
3. General supportive care
*control PaCO2

18
Q

What should the O2 sat be at?

A

> 88%
*higher % of PaO2 does not mean better

19
Q

What is noninvasive positive pressure ventilation (NIPPV)

A

First line for COPD patients with hypercapnic ARF who can maintain own airway, clear own secretions
*will decrease the need for intubations and ICU stays

20
Q

What is the Venturi mask use for

A

Treatment of ARF in patients with obstructive lung disease
1. Has higher flow

21
Q

What patient population will need higher concentrations of O2

A
  1. ARDS
  2. Pneumonia
  3. Parenchymal lung disease
22
Q

Should oxygen therapy be withheld due to the fear of progressive respiratory acidemia

A

No

23
Q

How will ventilatory support be administered

A

Via NIPPV or mechanical means

24
Q

What are the indications for tracheal intubation (mechanical ventilation)

A
  1. Hypoxemia despite supplemental O2
  2. Upper airway obstruction
  3. Impaired airway protection
  4. Inability to clear secretions
  5. Progressive general fatigue, tachypnea, use of accessory muscles
  6. Respiratory acidosis
  7. Apnea
25
Q

What are the indications for mechanical ventilation

A
  1. Apnea
  2. Severe hypoxemia
  3. Acute hypercapnia quickly reversed by therapy
  4. Progressive patient fatigue deposit treatment
26
Q

What type of pressure is best for mechanical ventilation

A

Positive pressure
1. CMV
2. A-C
3. SIMV
4. PSV
5. PCV
6. CPAP

27
Q

What is positive end expiratory pressure (PEEP)

A
  1. Critical in diffuse parenchymal lung disease
  2. Increases end expiratory lung volume
  3. Recruits collapsed alveoli
  4. Reverses atelectasis
    *use caution
28
Q

What are the complications of mechanical ventilation

A
  1. Migration of tip of ET tube
    *atelectasis
  2. Barotrauma
    *rupture of alveolar space with positive pressure
  3. Volutrauma
    *physically damage the alveoli without rupture
  4. Acute respiratory alkalosis
29
Q

What is the general supportive care for ARF

A
  1. Nutrition maintenance
  2. Monitor electrolytes
  3. Pressure injury care
  4. Stress gastritis tx
    *PPI or H2 antagonist
30
Q

Who will have a better prognosis of ARF

A
  1. COPD only needing NIPPV without need for intubation and mechanical ventilation
31
Q

Who has a poorer prognosis of ARF

A
  1. ARDS
  2. ARF associated with sepsis
    *90% mortality rate

Clinical Medicine (164 decks)

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