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CardioRespiratory 2 > Respiratory failure > Flashcards

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
Q

What pulmonary causes of ARDS are there?

A 
Aspiration 
Trauma
Burns through inhalation
Surgery
Drug toxicity

Infection!

26
Q

What extra pulmonary causes are there of ARDS?

A 
Trauma
Pancreatitis
Transfusions
Burns
Surgery
BM transplant
Drug toxicity
27
Q

What physiological changes drives Acute lung injury?

A

Leucocytes
Inflammation (TNF-a, IL-8)
Infection
Immune response (neutrophils, migrate and can release proteases)

all in the lungs

28
Q

What do Leukocytes do?

A

Active macrophages in alveolus

and neutrophil migration into alveoli

29
Q

What DAMPs are released in acute lung injury?

A

HMGB-1

RAGE

30
Q

Which cytokines are released in acute lung disease?

A

IL-6
IL-8
IL-1B
IFN-y

31
Q

What can be seen on lung biopsy of acute lung injury?

A

Necrosis in lung showing cell death

32
Q

Which Apoptotic mediators are seen in acute lung injury cell death?

A

FAS
FAS-I
BCL-2

33
Q

Which pharmacological therapies have been tried for acute lung injury?

A
  • steroids
  • salbutamol
  • surfactant
  • N-Acetylcysteine
  • Neutrophil esterase inhibitor
  • GM-CSF
  • Statins
34
Q

What pharmacological interventions are being trialled for acute lung injury?

A

mesenchymal stem cells - have an ex vivo benefit

keratinocyte growth factor for repair

microvesicles

high dose Vt c, thiamine, steroids

ECCO2R

35
Q

How is pro-inflammatory ARDS cetergorised?

A

Hyper

Hypo

Depending on biological markers

36
Q

What markers are high in hyper pro-inflammatory ARDS? (and not in hypo)

A 
sTNFr1
Creatinine
Interleukin 6
Bilirubin 
Age
37
Q

What markers are high in hypo pro inflammatory ARDS (and not in hyper)

A

Tidal volume
PaO2 to FiO2 ratio
Platelets

  • only plateau pressure is the same in both
38
Q

Which has a higher level of IL-6, hypo or hyper pro-inflammatory ARDS?

A

Hyper

39
Q

Which has a higher level of IL-8, hypo or hyper pro-inflammatory ARDS?

A

Hyper

40
Q

Which has a higher level of TNF-a, hypo or hyper pro-inflammatory ARDS?

A

Hypo (slightly)

41
Q

Which has a higher level of TNFR-1, hypo or hyper pro-inflammatory ARDS?

A

Hyper

42
Q

Which has a greater level of DAMP sRAGE upregulation, hypo or hyper pro-inflammatory ARDS?

A

Hyper, significantly

43
Q

Which has a greater level of DAMP Ang-2 upregulation, hypo or hyper pro-inflammatory ARDS?

A

Hyper

44
Q

Which has a greater level of DAMP VEGF-D upregulation, hypo or hyper pro-inflammatory ARDS?

A

Hyper, very slightly

45
Q

What would you use to treat the underlying cause?

A

Inhaled therapies : bronchodilator / pulmonary vasodilators

steroids
antibiotics
antivirals

Drugs:

  • pyridostigimine
  • plasma exchange
  • IViG
  • Rituximab
46
Q

What would you use to provide respiratory support?

A 
physiotherapy
Oxygen
Nebulisers
High flow Oxygen
Non invasive ventilation
mechanical ventilation
extra corporeal support
47
Q

How to provide cardiovascular support during ARDS?

A

fluids
vasopressors
inotropes
pulmonary vasodilators

48
Q

How to provide renal support during ARDS?

A

Haemofiltration

Haemodialysis

49
Q

How to provide immune therapies during ARDS?

A

Plasma exchange

convalescent plasma

50
Q

What types of ventilation are provided for ARDS?

A

Volume controlled
pressure controlled
assisted breathing models
advanced ventilatory modes

51
Q

How may the pressure volume loop of someone with ARDS look in comparison to a normal lung?

A

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
Q

What are the issues presented by ventilation?

A

V/Q mismatch, ventilation without gas exchange vice versa

Ventilator induced lung injury

53
Q

What is the Murray scoring system?

A

0 - normal
1-2.5 - mild
2.5+ severe
3+ ECMO

measures PaO2 on 100% O2
CXR
PEEP
compliance

54
Q

How do you know who to treat, what is the inclusion criteria?

A

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
Q

How do you know who to treat, what is the exclusion critera?

A
  • 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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