ARF Flashcards
Type 1 ARF
Acute Hypoxemic Respiratory Failure
This type of respiratory failure occurs with alveolar flooding and subsequent ventilation-perfusion mismatch and intrapulmonary shunt physiology.
Type 1
Avoiding lung injury (volutrauma) through low tidal volume (____)
6 mL/kg of ideal body weight
Type____ respiratory failure occurs in clinical settings such as sepsis, gastric aspiration, pneumonia, COVID-19 (Chap. 199), near-drowning, multiple blood transfusions, and pancreatitis.
I
_____has been shown to improve survival in those with severe ARDS
Prone positioning
In addition, a “____” management strategy ( taining a low central venous pressure [CVP] or pulmonary capillary wedge pressure [PCWP]) is associated with fewer days of mechanical ventilation than a “fluid-liberal” strategy (maintaining a relatively high CVP or PCWP) in ARDS in those patients who have been resuscitated from shock
fluid-conservative
____ from repeated alveolar stretching/overdistention.
Volutrauma
This type of respiratory failure is a consequence of alveolar hypoventilation and results from the inability to eliminate carbon dioxide effectively.
Type II
Type II Respiratory Failure
Hypercapneic Respiratory Failure
The mainstays of therapy for hypercapnic respiratory failure are directed at ____
reversing the underlying cause(s) of ventilatory failure.
This form of respiratory failure results from lung atelectasis.
Type 3 Lung Atelectasis
Type 3 Lung Atelectasis also called ___
Perioperative Respiratory Failure
After general anesthesia, decreases in functional residual capacity lead to collapse of dependent lung units. Such atelectasis can be treated by _____
frequent changes in position
chest physiotherapy
upright positioning
and control of incisional and/or abdominal pain.
This form most often results from hypoperfusion of respiratory muscles in patients in shock.
Type IV Metabolic Demands
Which of the following best describes the pathophysiology of Type I respiratory failure?
A) Hypercapnia due to alveolar hypoventilation
B) Reduced cardiac output causing decreased tissue perfusion
C) Alveolar flooding leading to ventilation-perfusion mismatch and shunt physiology
D) Hypoperfusion of respiratory muscles due to shock
C
Which of the following is a common clinical setting associated with Type I respiratory failure?
A) Myasthenia gravis
B) Brainstem injury
C) Sepsis
D) Drug overdose
C
Which of the following is a cornerstone of management for ARDS in Type I respiratory failure?
A) High tidal volume ventilation
B) Prone positioning
C) Neuromuscular blockade in all patients
D) Fluid-liberal strategy
B
What is the primary concern with mechanical ventilation in ARDS patients?
A) Hypercapnia due to impaired ventilation
B) Alveolar overdistention causing volutrauma
C) Increased risk of spontaneous pneumothorax
D) Development of pleural effusion
B
Type II respiratory failure is primarily caused by:
A) Increased dead-space ventilation
B) Alveolar hypoventilation
C) Ventilation-perfusion mismatch
D) Decreased lung compliance
B
Which of the following conditions is least likely to cause Type II respiratory failure?
A) Guillain-Barré syndrome
B) Pulmonary embolism
C) Drug overdose
D) Myasthenia gravis
B
Which of the following best explains the development of Type III respiratory failure?
A) Hypoperfusion of respiratory muscles
B) Alveolar flooding due to pulmonary edema
C) Lung collapse due to decreased functional residual capacity
D) Increased dead-space fraction from pulmonary embolism
C
Which intervention is least appropriate for managing Type III respiratory failure?
A) Frequent position changes
B) Upright positioning
C) Fluid-liberal strategy
D) Chest physiotherapy
C
Type III respiratory failure is commonly referred to as:
A) Ventilator-induced lung injury
B) Perioperative respiratory failure
C) Cardiogenic shock-induced failure
D) Acute pulmonary embolism failure
B
Which condition commonly associated with Type IV respiratory failure results from lactic acidosis?
A) Hypoperfusion of the lungs
B) Muscle fatigue
C) Respiratory arrest
D) Myasthenia gravis
A
____ are the mainstay of therapy for analgesia in mechanically ventilated patients.
Opiates
_____sedatives are preferred because benzodiazepines are associated with increased delirium and worse patient outcomes.
Nonbenzodiazepine
Amnesia can be achieved reliably with ___ and _____ such as lorazepam and midazolam.
propofol
benzodiazepines
Accordingly, all intubated, mechanically ventilated patients should undergo _____I
daily screening of respiratory function.
The patient has passed the screening test and should undergo a spontaneous breathing trial (SBT).
> oxgenation is stable (i.e., Pao 2 /FIo 2 [partial pressure of oxygen/fraction of inspired oxygen] >200 and PEEP ≤5 cmH 2 O)
cough and airway reflexes are intact
No vasopressor agents or sedatives are being administered
The SAT/SBT trial consists of a period of breathing through the endotracheal tube without ventilator support (continuous positive airway pressure [CPAP] of ___ cmH O with or without low-level pressure support and an open T-piece breathing system have all been validated) for 30–120 min.
5
The spontaneous breathing trial is declared a failure and stopped if any of the following occur: _____
(1) respiratory rate >35/min for >5 min
(2) O 2 saturation <90%
(3) heart rate >140/min or a 20% increase or decrease from baseline
(4) systolic blood pressure <90 mmHg or >180 mmHg,
(5) increased anxiety or diaphoresis.
