Physiology of Respiratory Failure Flashcards

1
Q

What is type 1 respiratory failure?

A

Hypoxic respiratory failure

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2
Q

What is type 2 respiratory failure?

A

Hypercapnic respiratory failure

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3
Q

What does lung failure lead to?

A

Type 1 respiratory failure

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4
Q

What does pump (heart?) failure lead to?

A

Type 2 respiratory failure

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5
Q

What is the problem in type 1 respiratory failure?

A

Gas exchange

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6
Q

What is the problem in type 2 respiratory failure?

A

Ventilation

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7
Q

What is the definition of hypoxaemia?

A

PaO2 < 8kPa

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8
Q

What are the 5 causes of hypoxaemia?

A

1) VQ mismatch (main reasons)
2) Alveolar hypoventilation e.g. GBS (neuromuscular diseases)
3) Impaired diffusion e.g. pulmonary fibrosis (can’t get gas across BM)
4) Low partial pressure of inspired oxygen (low PiO2) e.g. flying
5) Anatomical R-L shunt e.g. PAVM lobar pneumonia

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9
Q

What is the most common cause of arterial hypoxaemia?

A

VQ mismatch

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10
Q

Describe V/Q matching

A
  • Ventilation and perfusion must be exactly matched
  • Va = Q
  • Va/Q is the critical factor governing gas exchange
  • Regions of high ventilation should have high blood flows i.e. base of lung
  • Regions of low ventilation should have low blood flows i.e. apex of lung
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11
Q

What does inadequate gas exchange occur?

A

When regional Va &laquo_space;1 or Va/Q&raquo_space; 1

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12
Q

What happens in shunt?

A
  • Va/Q = 0
  • Q&raquo_space; Va
  • There is wasted perfusion so the blood is perfusing an underventilated lung
  • So low PAO2 (40) and high PACO2 (46)
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13
Q

What happens in dead space?

A
  • Va/Q = infinity
  • Q &laquo_space;Va
  • There is wasted ventilation as we are ventilating and underperfused lung
  • So PAO2 = 150 (v high) and PACO2 = 0
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14
Q

What happens in an ideal VA/Q match?

A
  • Va/Q = 1
  • Q = Va
  • PAO2 = 100 and PACO2 = 40
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15
Q

What happens to blood flow in a healthy lung?

A

There are important reflex mechanisms that increase blood flow to well ventilated alveoli and reduce blood flow to poorly ventilated alveoli

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16
Q

What happens in lung disease?

A

There is an imbalance between Va and Q resulting in hypoxaemia and hypercapnia

17
Q

What is the definition of hypercapnia?

A

PaCO2 > 6 kPa

18
Q

What is the equation for overall minute ventilation (VE)?

A

Tidal volume (VT) x RR

19
Q

What is PaCO2 inversely proportional to?

A

Alveolar ventilation

20
Q

What is essential to maintain CO2 homeostasis?

A

Adequate alveolar ventilation

21
Q

What determines alveolar ventilation?

A

RR and VT

22
Q

What are the two possible responses to oxygen therapy?

A

1) Patient’s PaCO2 and clinical state may improve or not change
2) Patient’s PaCO2 rises and they become drowsy or unconscious

23
Q

What 3 characters need to be balanced to avoid (?) hypercapnia?

A

1) Drive
2) Load
3) Capacity (ability to transmit information through nervous system)

24
Q

What causes hypercapnia?

A
Reduced drive, causing low capacity 
High load (resistive)
25
Q

What two areas are involved in drive to breathe?

A

Cortex and brain stem

26
Q

What are causes of drive failure?

A

1) Cortical and brainstem lesions → trauma, encephalitis, ischaemia, haemorrhage, Cheyne-Stokes Respiration (linked to CHF)
2) Drugs → sedatives, opioids
3) Metabolic alkalosis → loop diuretics, blunts respiratory drive (hypercapnia?)

27
Q

What are causes of low capacity?

A

Problems with spinal cord, peripheral nerves, NMJ and muscles

28
Q

What can lead to problems with nerves and the NMJ (transmission failure from nerves) leading to problems with capacity?

A

1) Spinal cord lesion
2) Polio
3) MND
4) Phrenic nerve injury
5) GBS
6) CINMA
7) NMB agents
8) Aminoglycosides esp. gentamicin
9) Myasthenia gravis

29
Q

What can lead to action failure (problems with muscles and the diaphragm) leading to problems with capacity?

A

1) Muscular dystrophies (Duchenne = most common)
2) Inflammatory myopathies
3) Malnutrition myopathy
4) Acid maltase deficiency
5) Thyroid myopathy
6) Biochemical anomalies → hypokalaemia, hypophosphataemia

30
Q

What are causes of high load (impedance)

A

1) Elastic load → pulmonary infarction, alveolar oedema, atelectasis, pleural effusion, obesity, abdominal distension
2) Resistive load → bronchospasm, UAO, OSA, secretion retention in ET tube
3) Threshold → intrinsic PEEP, dynamic hyperinflation

31
Q

What does load outweigh?

A

What the muscles can do

32
Q

What do a ⅓ of patients with chronic respiratory disease have it secondary to?

A

Obesity

33
Q

What is hypercapnic respiratory failure?

A
  • Acute (on chronic) imbalance in load-capacity-drive relationship
  • Caused by a defect in each area or combination
34
Q

In summary, what are causes of hypoxic respiratory failure?

A
  • V/Q mismatch
  • R-L shunt
  • Impaired diffusion
  • Hypoventilation
  • Low FiO2 (low fraction of oxygen in the air, e.g. high altitudes)
35
Q

What is the cause of hypercapnic respiratory failure?

A

Imbalance in load, capacity or drive