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Respiratory > ARDS + Respiratory Failure > Flashcards

ARDS + Respiratory Failure Flashcards

1
Q

What is adult respiratory distress syndrome

A

Fluid accumulation in alveoli due to increased permeability caused by inflammation
Non cardiac pulmonary oedema

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2
Q

What are pulmonary causes of adult respiratory distress

A 
Pneumonia
Direct lung injury 
Smoke inhalation
Vasculitis
Aspiration
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3
Q

What are other causes of RDS

A 
Sepsis
Shock
Massive haemorrhage
Blood transfusion - within 6 hours usually known as TRALI
Trauma
Head injury = sympathetic = pulmonary hypertension
DIC
Pancreatitis
Ovarain hyperstimulation 
Liver failure
Bypass
Drugs / toxins
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4
Q

What are symptoms of RDS

A 
Acute + severe
SOB
Tachycardia
Tachypnoea
Cyanosis
Bilateral crackles - fine
Low sats
Hyperaemia
Type 1 resp failure as gas exchangedoesnt occur in inflamed lung 
CO2 normal as can compensate by tachypnoea 
Multi-organ failure
Signs of hypercapnia if rises
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5
Q

What are symptoms if on ventilatory

A

Rising ventilatory pressure

Normal capillary wedge pressure excludes cardiac cause

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6
Q

What is the criteria for diagnosing RDS

A

Within 1 week of trigger
Pulmonary oedema on CXR (not explained by collapse or effusion)
Non-cardiogenic cause
PaO2 <40kPa

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7
Q

How do you treat RDS

A 
ITU
Oxygen
Negative fluid balance - diuretic / haemodialysis 
Ventilation - low TV 
CPAP but most need ventilation
Organ support 
Vasopressor to maintain CO 
Nutrition
Treat cause
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8
Q

What are complications of RDS

A

Scarring

Decreased lung function

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9
Q

What causes atelectasis (collapse)

A

Post-op

Obstructed airway - COPD / asthma

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10
Q

When should you consider atelectasis post op

A

72 hours

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11
Q

What are the symptoms

A 
SOB
Hypoxaemia
Resp difficulty 
Decreased expansion
Decreased breath sounds
NO FEVER - more likely infection
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12
Q

How do you treat

A

Chest physio

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13
Q

What is type 1 respiratory failure

A

PaO2 <8

PaCo2 normal

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14
Q

What causes type 1 respiratory failure

A

V/Q mismatch
Abnormal diffusion
R-L shunt
Hypoventilation = type 2

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15
Q

What can cause a V/Q mismatch (poor perfusion due to barrier to gas exchange)

A 
Pneumonia
Pulmonary oedema
PE
Asthma
Emphysema
RDS
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16
Q

What are the symptoms of type 1

A 
Features of cause 
Features of hypoxia
Restless
SOB
Agitated
Confusion
Cyanosis
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17
Q

What happens in long standing type 1

A

Polycythaemia
Pulmonary hypertension
Cor pulmonale

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18
Q

How do you Dx respiratory failure

A 
FBC, U+E, CRP
ABG
CXR
PFT 
Sputum and blood 
Spirometry - restrictive
19
Q

How do you treat type 1

A 
Treat cause 
Oxygen 
Monitor O2 with ABG and increase if CO2 stable
Assisted ventilation if PaO2 <8
CPAP
20
Q

Why do you want to control O2 delivery even in type 1

A

As want to be able to see if condition worsens and sats drop

21
Q

Why is CPAP only indicated in type 1

A

Decreases ventilation as no pressure differenece
Can’t be used in type 2 which is due to decreased ventilation
Useful for pulmonary oedema as pushes fluid out

22
Q

What does CPAP do

A

Stops lungs collapsing as keeps alveoli open so increases O2 delivery
Can be delivered through high flow nasal cannula - 40l

23
Q

What is O2 a good marker of

A

Diffusion i.e. in oedema / infection

24
Q

What is CO2 a good marker of

A

Poor ventilation

Very soluble so shouldn’t be affected by diffusion issues

25
Q

What is type 2 resp failure

A

PaO2 <8

PaCO2 >6

26
Q

What causes type 2 respiratory failure

A 
Alveolar hypoventilation with or without V/Q mismatch
Ventilation issue 
Asthma
COPD
OSA
Fibrosis 
Drugs
CNS tumour
Trauma 
Neuromuscular
Thoracic wall disease
27
Q

How does type 2 present

A 
Hypercapnia 
Headache
Peripheral vasodilation
Tachycardia
Bounding pulse
Tremor
Papilloedema
Confusion
Drowsy
Coma
28
Q

How do you treat type 2

A 
Treat underlying cause
Beware of hypoxic drive
Controlled O2
Check ABG regularly
Consider NIPPV if CO2 rising
Bipap (2 diff pressures) 
Intubation if this fails
ECMO
29
Q

Consequences

A

Acidosis

30
Q

Indications for non-invasive ventilation

A

COPD with pH 7.25-7.35
Type 2 res failure
Cardiopulmonary oedema resistant to CPAP
Weaning from tracheostomy

31
Q

What excludes cardiac cause for ARDS

A

Normal capillary wedge pressure

32
Q

When is ventilation indicated

A

pH <7.25

33
Q

What is CPAP

A

Continuous +Ve airway pressure

Keeps airway expanded so air can move in and out

34
Q

What are indications for CPAP

A

Type 1 resp failure
OSA
CCF
Acute pulmonary oedema as push fluid out

35
Q

What is BiPAP

A 
Bilevel +Ve airway pressure
Involves high or low pressures to correspond to ventilation
Can give
- Nasal
- Full face mask
- Hood
36
Q

When is it used

A

Type 2 resp failure
Usually due to COPD
If pH <7.35 despite medical therapy

37
Q

What should you always do if on NIV

A

ABG

38
Q

What causes obstructive pattern on PFT

A

COPD
Asthma
Bronchiectasis
Bronchiolitis obliterans

39
Q

What is an obstructive pattern

A 
FEV1 = significantly reduced 
FVC = reduced or normal
RAtio = reduced
40
Q

What causes restrictive pattern on PFT

A 
Pulmonary fibrosis
Asbestosis
Sarcoidosis
ARDS
Infant respiratory distress
Kyphoscoliosis e.g. AS
Neuromuscular
Severe obesity
41
Q

What is a restrictive pattern

A 
FEV1 = reduced
FVC = significantly reduce
Ratio= normal or increased
42
Q

ABG

A

OK

43
Q

What suggests chronic resp acidosis e.g. due to COPD

A

Elevated bicarb (as compensating)

Respiratory (23 decks)

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