Anaesthesiology - Respiratory Failure Flashcards
Acute severe asthma
Features
Management
Acute COPD exacerbation
Features
Management
Pneumothorax
Features
Management
Tension Pneumothorax
Features
Management
Pneumonia
Features
Management
Pulmonary embolism
Features
Management
Acute pulmonary edema
Features
Management
List neuromuscular causes of respiratory failure
Grey matter:
* Brainstem herniation
* High C-cord compression
Neuron:
* Motor neuron disease
* Polio
* Lead poisoning
* GBS
* CIPD
* Muscular/ myotonic dystrophies
* Inflammatory dystrophies
NMJ:
* MG
* Botulism
* Lambert-Eaton myasthenia syndrome
Respiratory suppressants:
- Propofol
- Opioids
- BDZs
Paralytics:
- Depolarizing and non-depolarizing muscle relaxants
Causes of poor lung compliance
Pulmonary edema
Pulmonary embolism/ nfarct
Interstitial lung diseases
Respiratory distress syndrome
Surfactant deficiency
Visceral pleura thickening secondary to TB, Asbestos, Hemothorax
External compression:
- Pneumothorax
- Pleural effusion
- Massive ascites
Causes of high airway resistance
Obstructive lung diseases:
- Asthma
- COPD
- Central airway obstruction
- emphysema
- Bronchospasm/ laryngospasm
Airway compression:
- upper airway inflammation
- mediastinal masses
Devices in ICU to assist breathing
Devices to avoid dry air induced airway inflammation
Ventilation types:
* Mechanical ventilator/ Positive pressure ventilation (PPV)
* Non-invasive ventilation (NIV): Continuous positive airway pressure (CPAP) or Bilevel positive airway pressure (BIPAP)
Devices for oxygen delivery
- Nasal cannula
- Standard face mask
- Venturi mask
- Partial rebreather mask
- Non-rebreather mask
Humidifiers:
- active humidification with respiratoryu humidifier
- Passive humidification with Heat and Moisture Exchanger (HME)
Basic mechanical ventilator modes/ IPPV
- Continuous Mandatory Ventilation (CMV)
- Volume Control (VC)
- Pressure Control (PC)
- Synchronised Intermittent Mandatory Ventilation (SIMV)
- Pressure Support (PS)
Compare volume control and pressure control ventilators
Advantages
Volume control
- Set tidal volume for each breath
- Inspiration ends after delivered of set tidal volume, at set respiratory rate or on demand
- Variable pressure
Advantage: Guaranteed volume and minute volume (Vt x RR)
Pressure control
- Set pressure for each breath
- Delivered at set RR or on demand
- Guaranteed airway pressure
- Volume and minute volume variable
Advantage:
o Increased patient comfort requiring less sedation
o Improved patient-ventilator synchrony
o Early liberation from mechanical ventilation
o More homogeneous gas distribution (less regional alveolar overdistension)
Mechanical ventilation/ PPV
- Advantages
- Indications
Advantages of mechanical ventilation
Improves gaseous exchange
- ↑ Oxygenation by improving V/Q matching
- ↑ Alveolar ventilation
- Reverse acute respiratory acidosis
Relieve respiratory distress
- ↓ Work of breathing
- ↓ Respiratory muscle fatigue
General indications:
· Respiratory failure not adequately controlled by other means
· Cardiac or respiratory arrest
· Failure to protect airway with GCS < 8
· Hemodynamic instability (severe hypotension)
Laboratory criteria
Lung function test (LFT)
- Vital capacity < 10 mL/kg
- FEV1.0 < 10 mL/kg
Arterial blood gas (ABG)
- PaO2 < 7.3 kPa despite O2 supplementation
- PaCO2 > 6.7 kPa with pH < 7.32
Indications and contraindications of non-invasive PPV