Resp Failure Flashcards
Acute
Infection
Trauma
Chronic
COPD
Lung fibrosis
Acute on chronic
Infection exacerbated by COPD
Type I
Hypoxemic - PaO2 less than 60
Fail of O2 exchange
Increased shunt fraction
Alveolar flooding
Acute pulmonary oedema or acute lung injury
Type II
Hypercapnic PaCO2 more than 45 Fail to exchange or remove CO2 Decreased alveolar minute ventilation Dead space ventilation
Airway obstruction or neuromuscular disorder
Type III
Perioperative resp fail
Increased atelectasis due to low functional residual capacity
Collapse of airway
Anaesthetic technique prevention
Post operatively
Collapsed or reduced inflation of lungs
Hypoxia or hypercapnoea
Type IV
Shock
Intubated and ventilated during shock
Poor perfusion
Optimise ventilation, improve gas exchange to treat
Downstream of sepsis, cardiogenic or neurological shock
Acute lung injury
Injury to alveolar capillary membrane comprised of type I/II alveolar pneumocytes
Alveolar air space flooded with proteinaceous oedema fluid and inflammatory cells
Fibrin deposition occurs - hyaline membrane
Injury to type II pneumocytes and alveolar flood contribute to surfactant dysfunction
In vivo evidence
TNF signalling implicated
Leukocyte activation and migration
Cell death
Release of IL6, IL8
Treatment
Bronchodilator
Steroids
Physio
Nebuliser
Consequences
Poor gas exchange
Hypercapnoea
Poor perfusion
Sepsis
ARDS specific intervention
Respiratory support
Ventilation
Pitfalls of ventilation
Breath stacking
COPD and asthma may get trapped air in lungs
Escalation of treatment
Murray score 0 - normal 1-2.5 - mild more than 2.5 - severe more than 3 - ECMO
ECMO inclusion
Severe resp failure
Non cardiac
Positive pressure ventilation not appropriate
