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Respiratory failure Flashcards

1
Q

What is respiratory failure defined as?

A

Syndrome of inadequate gas exchange due to dysfunction of one or more components of the respiratory system

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2
Q

What is the predominant feature of resp failure?

A

Shortness of breath

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3
Q

How is the Resp system broken down? e.g. what can lead to resp failure

A

Nervous system –> CNS/PNS/NMJ

Resp muscles –> Diaphragm
Extra thoracic muscles

Pulmonary –> airways disease, alveolar capillary, circulation

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4
Q

What is the biggest cause globally of chronic resp disease in men?

A

Smoking

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5
Q

What is the biggest cause globally of chronic resp disease in women?

A

Household air pollution from solid fuels

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6
Q

What makes acute resp distress syndrome worse?

A

Severity and getting it at an advance age –> increase mortality

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7
Q

Give examples of acute resp failure?

A

pulmonary:

  • infection
  • aspiration
  • primary graft dysfunction

Extra pulmonary:

  • trauma
  • pancreatitis
  • sepsis

Neuro muscular:
- myasthenia/GBS

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8
Q

What is Myasthenia?

A

Nuro M disease leading to muscle weakness

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9
Q

How is ARDS defined?

(time
imaging
origin
oxygenation

A

Check slide 6

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10
Q

What are some examples of chronic resp failure?

A

Pulmonary/airways:

  • COPD
  • Lung fibrosis
  • CF
  • Lobectomy

Musculoskeletal:
- Muscular dystrophy

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11
Q

What are some examples of Acute on Chronic respiratory failure?

A

Infective exacerbation:

  • COPD
  • CF

Myasthenic crises

Post operative

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12
Q

What is type 1 respiratory failure also known as?

A

Hypoxemic

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13
Q

What is Type 1 Respiratory failure?

A

PaO2 <60

Failure of O2 exchange

  • Increased shunt fraction
  • Due to alveolar flooding
  • Hypoxemia refractory to supplemental O2§
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14
Q

What can cause acute hypoexmic resp failure? (Type 1) 6

A 
Lobe collape
Aspiration
pulmonary oedema
fibrosis
pulmonray pulmonary embolism
hypertension
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15
Q

What is type 2 resp falure also known as?

A

Hypercapnic

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16
Q

What is type 2 respiratory failure?

A

(PaCO2 >45):

Failure to
exchange or remove carbon dioxide
n

  • Decreased alveolar minute ventilation (V A )
  • n Dead space ventilation
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17
Q

What is Type III resp failure?

A

Perioperative resp failure
Due to collapse of airways

Increased atelectasis due to low functional residual capacity
(FRC) with abnormal abdominal wall mechanics
n

Hypoxaemia or hypercapnoea
n

Prevention: anesthetic or operative technique, posture,
incentive spirometry, analgesia, attempts to lower intra- abdominal pressure

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18
Q

What is Type IV resp failure?

A

Shock

poor perfusion

describes patients who are intubated and ventilated
During shock (Septic/cardiogenic/neurologic)
n Optimise ventilation improve gas exchange and to unload the
respiratory muscles, lowering their oxygen consumption
Ventilatory effects on right and left heart
Reduced afterload (good for LV) Increased pre-load (bad for RV)

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19
Q

What are the risk factors of chronic resp failure?

A 
COPD
Pollution
Recurrent pneumonia
Cystic fibrosis
Pulmonary fibrosis
Neuro-muscular diseases
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20
Q

What are the risk factor for acute resp failure?

A 
Infection
Viral
Bacterial
Aspiration
Trauma
Pancreatitis
Transfusion
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21
Q

What can cause shortness of breath?

A
  • Lower respiratory tract infection
  • Aspiration
  • Trauma
  • Pulmonary vascular disease
  • Extrapulmonary e.g. pancreatitis, new meds
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22
Q

What can cause trauma?

A

Transfusion

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23
Q

What can cause Pulmonary vasucular disease?

A

Pulmonary embolism

haemoptysis

24
Q

What is Haemoptysis?

A

Coughing up of blood

25
What pulmonary causes of ARDS are there?
``` Aspiration Trauma Burns through inhalation Surgery Drug toxicity ``` Infection!
26
What extra pulmonary causes are there of ARDS?
``` Trauma Pancreatitis Transfusions Burns Surgery BM transplant Drug toxicity ```
27
What physiological changes drives Acute lung injury?
Leucocytes Inflammation (TNF-a, IL-8) Infection Immune response (neutrophils, migrate and can release proteases) all in the lungs
28
What do Leukocytes do?
Active macrophages in alveolus | and neutrophil migration into alveoli
29
What DAMPs are released in acute lung injury?
HMGB-1 | RAGE
30
Which cytokines are released in acute lung disease?
IL-6 IL-8 IL-1B IFN-y
31
What can be seen on lung biopsy of acute lung injury?
Necrosis in lung showing cell death
32
Which Apoptotic mediators are seen in acute lung injury cell death?
FAS FAS-I BCL-2
33
Which pharmacological therapies have been tried for acute lung injury?
- steroids - salbutamol - surfactant - N-Acetylcysteine - Neutrophil esterase inhibitor - GM-CSF - Statins
34
What pharmacological interventions are being trialled for acute lung injury?
mesenchymal stem cells - have an ex vivo benefit keratinocyte growth factor for repair microvesicles high dose Vt c, thiamine, steroids ECCO2R
35
How is pro-inflammatory ARDS cetergorised?
Hyper Hypo Depending on biological markers
36
What markers are high in hyper pro-inflammatory ARDS? (and not in hypo)
``` sTNFr1 Creatinine Interleukin 6 Bilirubin Age ```
37
What markers are high in hypo pro inflammatory ARDS (and not in hyper)
Tidal volume PaO2 to FiO2 ratio Platelets * only plateau pressure is the same in both
38
Which has a higher level of IL-6, hypo or hyper pro-inflammatory ARDS?
Hyper
39
Which has a higher level of IL-8, hypo or hyper pro-inflammatory ARDS?
Hyper
40
Which has a higher level of TNF-a, hypo or hyper pro-inflammatory ARDS?
Hypo (slightly)
41
Which has a higher level of TNFR-1, hypo or hyper pro-inflammatory ARDS?
Hyper
42
Which has a greater level of DAMP sRAGE upregulation, hypo or hyper pro-inflammatory ARDS?
Hyper, significantly
43
Which has a greater level of DAMP Ang-2 upregulation, hypo or hyper pro-inflammatory ARDS?
Hyper
44
Which has a greater level of DAMP VEGF-D upregulation, hypo or hyper pro-inflammatory ARDS?
Hyper, very slightly
45
What would you use to treat the underlying cause?
Inhaled therapies : bronchodilator / pulmonary vasodilators steroids antibiotics antivirals Drugs: - pyridostigimine - plasma exchange - IViG - Rituximab
46
What would you use to provide respiratory support?
``` physiotherapy Oxygen Nebulisers High flow Oxygen Non invasive ventilation mechanical ventilation extra corporeal support ```
47
How to provide cardiovascular support during ARDS?
fluids vasopressors inotropes pulmonary vasodilators
48
How to provide renal support during ARDS?
Haemofiltration | Haemodialysis
49
How to provide immune therapies during ARDS?
Plasma exchange | convalescent plasma
50
What types of ventilation are provided for ARDS?
Volume controlled pressure controlled assisted breathing models advanced ventilatory modes
51
How may the pressure volume loop of someone with ARDS look in comparison to a normal lung?
Compliance: is reduced to the lung injury Upper inflection point: above this pressure more alveolar recruitment causes disproportional increases in applied airway pressure Lower inflection point: minimum baseline pressure needed for optimal alveolar recruitment
52
What are the issues presented by ventilation?
V/Q mismatch, ventilation without gas exchange vice versa Ventilator induced lung injury
53
What is the Murray scoring system?
0 - normal 1-2.5 - mild 2.5+ severe 3+ ECMO measures PaO2 on 100% O2 CXR PEEP compliance
54
How do you know who to treat, what is the inclusion criteria?
Severe resp failure - non cardiac cause, murray score 3+ if positive pressure ventilation no appropriaye e.g. significant tracheal injury * these ppl should be treated in a special expert location
55
How do you know who to treat, what is the exclusion critera?
- Contraindication to continuation of active treatment; - Significant co-morbidity -> dependency to ECMO support - Significant life limiting co-morbidity

CardioRespiratory 2 (12 decks)

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