Resp. Failure

Question 1

What are the two types of resp. failure?

Answer 1

Type 1:
Hypoxia (PaO2 < 8kPa) without hypercapnia (PaCO2 < 6kPa)

Type 2:
Hypoxia with Hypercapnia (PaCO2>6kPa)

Question 2

What causes type 1?

Answer 2

A V/Q mismatch usually, caused by:

• Pneumonia
• Pulmonary Oedema
• Asthma
• ARDS
• PE
• Emphysema (COPD)
• Pulmonary Fibrosis

Question 3

What are the symptoms of hypoxia?

Answer 3

Confusion/Agitation
Central Cyanosis
Dyspnoea

Question 4

What are the symptoms of hypercapnia?

Answer 4

Headache
Peripheral Vasodilation
Drowsiness/confusion
Tachycardia
Flapping Tremor
Bounding Pulse

Question 5

How do we investigate Resp. Failure?

Answer 5

Most investigations are aimed at the cause:
FBC - U+E - CRP - ABG
CXR
Sputum/blood cultures if pyrexial
Spirometry

Question 6

How do we treat Resp. Failure?

Answer 6

Oxygen Mask -> NIPPV -> Intubation & Ventilation
Treat Cause

Be very careful with oxygen in the case of Type 2 as they may be on hypoxic drive

Question 7

What are the causes of Type 2 Resp Failure?

Answer 7

Anything that causes alveolar hypoventilation:

Pulmonary Disease: Asthma - COPD - OSA - Pneumonia - End Stage Pulmonary Fibrosis

Decreased Resp. Drive: Sedatives - CNS tumour - Trauma

Neuromuscular Disease: Guillain-Barre - Paralysed Diaphragm - Myasthenia Gravis

Thoracic Wall Disease: Kyphoscoliosis