Chronic Respiratory Failure

Question 1

What is Chronic Respiratory Failure?

Answer 1

Chronic respiratory failure develops over several days or longer, allowing time for
compensation (chronic bronchitis, bronchiectasis diseases). The clinical markers of chronic
hypoxemia, such as polycythemia or cor pulmonale, suggest a long-standing disorder.

Question 2

What are the causes of CRF?

Answer 2

• COPD,
• emphysema of lungs,
• chronic bronchitis,
• pneumoconiosis,
• tuberculosis,
• lung cancer,
• pulmonary fibrosis.
• kyphoscoliosis,
• poliomyelitis,
• myasthenia gravis

Question 3

What are the complaints the patient have?

Answer 3

• dyspnea, shortness of breath (Initially dyspnea is during great physical exertion. Then
  activities previously tolerated well, cause shortness of breath. As the disease progresses,
  shortness of breath may be caused by very ordinary activities such as getting dressed in
  the morning or having a bath. Later it will be present at rest)
• On palpitation, edemas of lower extremities.

Question 4

What can you observe in a physical examination?

Answer 4

The primary physical signs of ventilatory fatigue are:
- vigorous use of accessory ventilatory muscles,
- tachypnea,
- tachycardia,
- declining tidal volume,
- irregular or gasping breathing patterns,
Chronic Respiratory Failure
- paradoxical abdominal motion.
- Cyanosis, a bluish color of skin and mucous membranes, indicates hypoxemia.
- Chronic reduction in Pao is generally well tolerated by patients with adequate
cardiovascular reserve. However, alveolar hypoxia (PA02 < 60 mm Hg) can induce
pulmonary arteriolar vasoconstriction and increase pulmonary vascular resistance,
leading, over weeks to months, to pulmonary hypertension, right ventricular hypertrophy
(cor pulmonale), and eventually right ventricular heart failure. This, in turn, causes
enlargement of the liver and peripheral edema.

Question 5

What can you see in a blood test?

Answer 5

A complete blood count may indicate polycythemia and increased hemoglobin
level

Question 6

What can you see in a chest radiograph?

Answer 6

Increased heart size, vascular redistribution, peribronchial cuffing,
pleural effusions, septal lines, and perihilar bat-wing distribution of infiltrates suggest
hydrostatic edema.

Question 7

What do you see in Echocardiography?

Answer 7

provides an estimate of right ventricular function

and pulmonary artery pressure in patients with chronic hypercapnic respiratory failure.

Question 8

What can you see in Pulmonary function tests?

Answer 8

Patients with acute respiratory failure generally are unable to
perform pulmonary function tests (PFTs). However, PTs are useful in the evaluation of
chronic respiratory failure.
* Normal values of forced expiratory volume in one second (FEV,) and forced vital capacity
(FVC) suggest a disturbance in respiratory control.
* A decrease in FEV1-to-FVC ratio indicates airflow obstruction, whereas
* a reduction in both the FEV, and FVC and maintenance of the FEVp-to-FVC ratio suggest
restrictive lung disease.
* Respiratory failure is uncommon in obstructive diseases when the FEV, is greater than 1 L
and in restrictive diseases when the FVC is more than 1 L.

Question 9

What are the complaints of the patient in mild stage of respiratory failure?

Answer 9

• Dyspnea,
• shortness of breath,
• tachycardia appear only during physical exertion.
• Cyanosis is absent.
• Spirometry shows decreased maximal voluntary ventilation (MVV),
• other parameters are normal.

Question 10

What are the complaints of the patient in moderate stage of respiratory failure?

Answer 10

• Dyspnea,
• shortness of breath,
• tachycardia appear afterlight physical activity.
• Central cyanosis is present.
• Vital capacity (VC) is decreased,
• MVV markedly decreased.
• PaCO, and PaO, are slightly changed.
• Respiratory alkalosis is present

Question 11

What are the complaints of the patient in severe stage of respiratory failure?

Answer 11

Dyspnea,
- shortness of breath,
- tachycardia are experienced at rest.
- Central cyanosis is marked.
- Edemas, enlargement of liver, right ventricular hypertrophy are present as a signs of cor
pulmonale.
- VC is markedly decreased,
- MVV is practically do not measurable.
- PaCO2 is increased,
- PaO2 is decreased,
- respiratory acidosis is present

Question 12

How can i treat Chronic RF?

Answer 12

The goals of treatment for respiratory failure are to increase oxygenation and improve
ventilation.
- Treatment depends on the severity of the respiratory failure and the cause.
- Exacerbation of chronic respiratory failure by infection may require hospitalization, and
treatment may include:
• antibiotics for respiratory infections;
• bronchodilators,including anticholinergics, or beta agonists;
• inhaled steroid medications to decrease inflammation.
• Oxygen therapy is necessary to increase blood oxygen levels oxygenation.
Mechanical ventilation may be used, if oxygen therapy if not sufficient.
• Lung transplantation may be done in rare cases.