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BRS Year 2 > CVR resp failure > Flashcards

CVR resp failure Flashcards

1
Q

systems/structures that fail in respiratory failure (3)

A
  1. nervous system
  2. respiratory muscle
  3. pulmonary
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2
Q

what is respiratory failure?

A

syndrome of inadequate gas exchange due to dysfunction of one/more components of the respiratory system

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3
Q

where can lesions occur in the nervous system to cause resp failure? (3)

A
  1. CNS/brainstem
  2. PNS
  3. neuro-muscular junction
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4
Q

issues with which resp muscles could lead to resp failure? (2)

A
  1. diaphragm/thoracic muscle

2. extra-thoracic muscle

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5
Q

pulmonary issues that could lead to resp failure? (3)

A
  1. airway disease
  2. alveolar-capillary
  3. circulation
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6
Q

what ranking are respiratory diseases for causing mortality?

A

3rd worldwide

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7
Q

cause of higher incidence of resp-related mortality in russia?

A

solid fuels in the home

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8
Q

what’s the biggest risk factor for males getting chronic resp disease?

A

smoking

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9
Q

what’s the biggest risk factor for females getting chronic resp disease?

A

household air pollution from solid fuels

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10
Q

what is an acute respiratory disease?

A

acute respiratory distress syndrome

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11
Q

what is seen on imaging in acute respiratory distress syndrome?

A

bilateral opacities

-> not fully explained by effusions, lobar, nodules

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12
Q

What is the criteria in regards to the origin of oedema in acute respiratory distress syndrome?

A
  • Can not be explained by cardiac failure or fluid overload

- Needs objective assessment e.g. echocardiography to exclude hydrostatic oedema if no risk factor present

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13
Q

What is the boundary for mild oxygenation in ARDS?

A

P/F ratio 200-300 mmhg

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14
Q

What is the boundry for moderate oxygenation in ARDS?

A

P/F RATIO 100-200 mmHg

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15
Q

What is the boundary for severe oxygenation in ARDS?

A

100mmHg>= PaO2/FIO2

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16
Q

what does severity of ARDS and increased age lead to?

A

increased mortality

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17
Q

classification of ARDS (3)

A
  1. acute
  2. chronic
  3. acute on chronic
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18
Q

causes of acute ARDS (3)

A
  1. pulmonary (infection, aspiration, primary graft dysfunction (Lung Tx)
  2. extra-pulmonary: trauma, pancreatitis, sepsis
  3. neuro-muscular: myasthenia/GBS
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19
Q

causes of chronic ARDS (2)

A
  1. pulmonary/airways: COPD, lung fibrosis, CF, lobectomy

2. musculoskeletal: muscular dystrophy

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20
Q

causes of acute on chronic ARDS (3)

A
  1. infection exacerbation: COPD, CF
  2. myasthenic crises
  3. post operative
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21
Q

classification groups for ARDS using physiological classification

A
  1. type I (hypoxemic)
  2. type II (hypercapnic)
  3. type III (perioperative resp failure)
  4. type IV (shock)
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22
Q

Features of type I ARDS (using physiologic classification) (3)

A

Failure of oxygen exchange

  1. increased shunt fraction
  2. due to alveolar flooding
  3. refractory hypoxemia to supplemental oxygen
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23
Q

Features of type II ARDS (using physiologic classification)

A

Failure to exchange or remove CO2

  1. decreased alveolar minute ventilation
  2. dead space ventilation
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24
Q

reasons for type I ARDS (using physiologic classification) (6)

A
  1. collapse
  2. aspiration
  3. pulmonary oedema
  4. fibrosis
  5. pulmonary embolism
  6. pulmonary hypertension
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25
Q

reasons for type II ARDS (using physiologic classification) (5)

A
  1. nervous system
  2. neuromuscular
  3. muscle failure
  4. airway obstruction
  5. chest wall deformity
26
Q

reasons for type III ARDS (using physiologic classification)

A
  1. increased atelectasis due to low functional residual capacity with abnormal abdominal wall mechanics
  2. hypoxemia or hypercapnoea
27
Q

prevention of type III ARDS (using physiologic classification)

A 
Prevention: 
anaesthetic
operative technique
posture
incentive
spirometry
analgesia
attempt to lower intra-abdominal pressure
28
Q

how to optimise typre IV ARDS (using physiologic classification)

A

optimise ventilation to improve gas exchange and to unload the resp muscles, lowering their O2 consumption.

Ventilatory effects on right and left heart -> cause reduced afterload (good for LV), increased preload (bad for RV)

29
Q

risk factors for chronic respiratory failure (6)

A
  1. COPD
  2. pollution
  3. recurrent pneumonia
  4. cystic fibrosis
  5. pulmonary fibrosis
  6. neuro-muscular disease
30
Q

risk factors for acute respiratory failure (5)

A
  1. infection (viral, bacterial)
  2. aspiration
  3. trauma
  4. pancreatitis
  5. transfusion
31
Q

what is type I ARDS

A

failure of oxygen exchange

32
Q

what is type II ARDS

A

failure to exchange or remove CO2

33
Q

what is type III ARDS?

A

perioperative resp failure

34
Q

what is type IV ARDS?

A

resp failure due to shock

35
Q

what is used to classify ARDS? (4)

A
  1. timing- needs to be acute
  2. chest imaging- bilateral opacities
  3. origin of oedema
  4. PF ratio
36
Q

PaO2 in type I ARDS?

A

<60 at sea level

37
Q

Pa CO2 in type II ARDS>

A

> 45 at sea level

38
Q

what can cause pulmonary burns?

A

inhalation of ash

39
Q

what do pulmonary causes of ARDS affect?

A

the alveolus

40
Q

what do extra-pulmonary causes of ARDS affect?

A

systemic disease, causing inflammation response

41
Q

what TNFR is implicated in lung damage in ARDS?

A

TNFR-1 (in vitro in animal studies)

42
Q

where does macrophage activation occur in ARDS?

A

the alveoli

43
Q

where do neutrophils migrate to in ARDS?

A

the lung

44
Q

apoptotic mediators in ARDS? (3)

A

FAS, FAS-L, BCI-2

45
Q

is proning beneficial to patients with ARDS?

A

yes

46
Q

what can determine hyper and hypo inflammatory endotypes?

A

TNFR1, IL-6, IL-8, TNF-alpha

47
Q

what PAMP is associated with alveolar damage?

A

RAGE

48
Q

what PAMP is associated with vascular damage?

A

Ang-2

49
Q

3 mechanisms of acute lung injury

A
  1. inflammation
  2. infection
  3. immune response
50
Q

therapeutic intervention in ARDS

A
  1. treat underlying disease
  2. respiratory support
  3. multiple organ support
51
Q

what are inotropes?

A

drugs that alter contractility of the <3

52
Q

examples of respiratory support (5)

A
  1. proning
  2. non-rebreather face mask
  3. non-invasive ventilation
  4. intubation
  5. ECMO cannulation
53
Q

consequences from ARDS

A
  1. poor gas exchange (poor perfusion, hypercapnoea)
  2. infection (sepsis)
  3. inflammation
54
Q

how to minimise ventilator-induced lung injury

A

driving pressure management

55
Q

types of imaging for the lungs

A

CT and lung USS

56
Q

what score is used to grade the severity of lung injury in ards?

A

the Murray score (0->4)
Its an average score of all 4 parameters:

P/F ratio
CXR
PEEP
Compliance

(learn boundaries)

57
Q

what is given if you have a poor Murray score?

A

ECMO

58
Q

inclusion criteria for ECMO

A
  1. severe resp failure

2. +ve pressure ventilation isn’t appropriate e.g. bad tracheal injury

59
Q

exclusion criteria for ECMO

A
  1. contraindication to continuation of active treatment
  2. significant comorbidity -> dependency on ECMO support
  3. significant life-limiting comobidity
60
Q

issues with ECMO

A

time to access
referral system
consideration of referral

61
Q

adv ECMO

A

improve oxygen delivery,
improve carbon dioxide removal,
rest lung and prevent ventilator associated lung injury,
resolve respiratory acidosis,
reduce multiple organ dysfunction arising from hypoxaemia and hypercarbia

62
Q

disadv ECMO

A 
Case selection,
not universally available/inequity of provision of care,
bleeding: intra-cerebral, 
venepuncture sites,
epistaxis,
haemoptysis,
Haemolysis,
infections from central dwelling canulae,
cost.

BRS Year 2 (110 decks)

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