Acute Respiratory failure

Question 1

What are the types of respiratory failure?

Answer 1

• Type 1 = ‘Acute hypoxamic’ resp failure

* Type 2 =’Ventilatory’ resp failure

Question 2

What is type 1 respiratory failure? Diagnosed?

Answer 2

Acute hypoxaemic respiratory failure
=not getting oxygen in
*PaO2 low
*PaCO2 normal or low

Question 3

What are the common causes of type 1 respiratory failure?

Answer 3

*Disease that damage lung tissue
>Cardiogenic pulmonary oedema
>Pneumonia
>Acute lung injury
>Lung fibrosis

Question 4

What is type 2 respiratory failure?

Answer 4

Ventilatory failure
*PaO2 low
*PaCO2 high
Occurs when alveolar ventilation is insufficient to excrete the volume of CO2 being produced by tissue metabolism

Question 5

What is the common cause of type 2 respiratory failure? Other causes?

Answer 5

*Most common = COPD

*Others:
>Chest wall deformities
>Respiratory muscle weakness (Gullain-Barre syndrome)
>Depression of respiratory centre

Question 6

What are the signs of acute respiratory failure?

Answer 6

• Use of accessory muscles
• Intercostal recession
• Paradoxical respiration
• Inability to speak
• Orthopnoea
• Tachypnoea
• Tachycardia
• Sweating
• Pulsus paradoxus
• Agitation
• Diminished consciousness

Question 7

What are the symptoms of acute respiratory failure?

Answer 7

Depends on cause:
**Dyspnoea

Other possible:

• Cough -productive/dry
• Fever
• Heart failure symptoms (palpitations etc)
• COPD symptoms

Question 8

What investigations are done in respiratory failure?

Answer 8

• Pulse oximetry

* ABG!!

Question 9

What is the management of respiratory failure?

Answer 9

1. A-E assessment
2. ABG = diagnosis
3. Oxygen
   >titrate to target sats
   >COPD may have targets of 88-92%
4. Treat underlying cause
5. Non-invasive ventilation:
   >CPAP (expiratory positive pressure)
   >BiPAP (inspiratory & expiratory positive pressure)
6. Invasive ventilation:
   endotracheal tube/tacheostomy

Question 10

When is non-invasive ventilation considered?

Answer 10

• COPD patients with resp acidosis ph <7.35
• Hypercapnic resp failure secondary to chest wall deformity or neuromuscualr disease
• Weaning from tracheal intubation
• Cardiogenic pulmonary oedema
• Obstructive sleep apnoea
• Pneumonia ceiling of care

Question 11

How does CPAP work?

Answer 11

Positive expiratory airway pressure

Question 12

What type of oxygen device is often used in COPD? Why?

Answer 12

Venturi masks to control the exact % oxygen delivered to no over-oxygenate the patient

Question 13

“Better When Your Right Good”

Venturi mask colours and oxygen deliverance?

Answer 13

Blue =24%
White =28%
Yellow =35%
Red =40%
Green =60%