chronic ventilatory failure

Question 1

what is type l ventilatory failure?

Answer 1

dysfunctional gas exchange (i.e. oxygen and carbon dioxide)

-> chronically low oxygen levels and/or chronically high carbon dioxide levels.

occurs on a background of COPD, chronic bronchitis, or idiopathic interstitial pneumonia

Question 2

What is type ll ventilatory failure?

Answer 2

Elevated PCO2 (6.0 kPA)

Normal blood pH

low pO2 <8 kPA

elevated bicarbonate (HCO3)

Question 3

What are the causes of chronic ventilatory failure?

Answer 3

Airways disease
- COPD
- bronchiectasis

Chest abnormalities
- kyphoscoliosis

central hypoventilation
- obesity hypoventilation syndrome
- congenital central hypoventilation syndrome (odines curse)

respiratory muscle weakness
- motor neuron disease
- muscular dystrophy
- glycogen storage disease (pompe)

Question 4

What are the symptoms of chronic ventilatory failure?

Answer 4

ankle swelling (oedema)
- due to hypoxic cor pulmonale

breathlessness

disturbed sleep

morning headache

orthopnoea( breathless lying down)

paradoxical abdominal wall motion
- neuromuscular disease
- weak diaphragm sucked into chest during inspiration

recurrent chest infections

Question 5

What investigations is used for lung function

Answer 5

Spirometry (assess lying and standing vital capacity)

Mouth pressures / Sniff Nasal Inspiratory Pressure (SNIP) to assess inspiratory muscle strength

Question 6

what investigations is used for hypoventilation?

Answer 6

Early morning Arterial Blood Gas (ABG)

Overnight oximetry

Transcutaneous CO2 monitoring

Question 7

What treatment is used for chronic ventilatory failure ?

Answer 7

• non invasive ventilation
• oxygen therapy
• tracheostomy ventilation

Question 8

what investigations is used for Diaphragm movement ?

Answer 8

Fluoroscopic screening of diaphragm