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respiratory failure Flashcards

1
Q

what is the key sign/symptom of resp failure

A

shortness of breath - due to inadequate gas exchange

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2
Q

what is resp failure

A

syndrome of inadequate gas exchange due to dysfunction of one/more components of resp system

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3
Q

what components is the respiratory system broken down into

A

nervous system
respiratory muscle
pulmonary

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4
Q

what parts of the nervous system are involved in resp failure

A

cns,brainstem - resp centre found in ventrolateral medulla

neuromuscular junctions

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5
Q

what muscles are involved in resp failure

A

diaphragm and thoracic muscles

extra - thoracic muscles

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6
Q

pulmonary components of resp failure

A

alveolar - capillary
circulation
any airway disease e.g copd,fibrosis

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7
Q

what is the 3rd leading cause of death globally (2017)

A

chronic respiratory disease

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8
Q

what is the biggest risk factor for chronic respiratory disease in men

A

smoking

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9
Q

what is the biggest risk factor for chronic respiratory disease in women

A

household air pollution from solid fuels

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10
Q

what is the criteria used to classify ards

A 
berlin definition:
timing
imaging
origin of oedema
oxygenation
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11
Q

what stats tell us its mild disease

A

200 mmHg 5cm h2O

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12
Q

what stats tell us its moderate disease

A

100mmHg 5cm H2O

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13
Q

what stats tell us severe disease

A

PaO2/FiO2 <100 mmHg with PEEP >5cm H2O

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14
Q

how can we classify acute respiratory failure/disease

A

pulmonary - infection,aspiration, primary graft dysfunction
extrapulmonary - trauma, pancreatitis,sepsis
neuro muscular - myasthenia/gbs

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15
Q

how can we classify chronic resp disease

A

pulmonary/airways:
copd, lung fibrosis,cf,lobectomy
musculoskeletal: muscular dystrophy

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16
Q

how can we classify acute on chronic resp disease

A

infective exacerbation of: copd/fibrosis
myasthenic crises
post operative

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17
Q

what is type 1 resp failure

A

hypoxemic - failure of oxygen exchange

pao2<60

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18
Q

what are some causes of type 1 failure

A 
collapse
aspiration
pulmonary oedema
fibrosis
pulmonary embolism
pulmonary hypertension
= causes alveolar flooding
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19
Q

what is the response to supplemental oxygen in type 1 failure

A

refractory (stubborn/unmanageable)

20
Q

what is type 2 resp failure

A

hypercapnic - failure to exchange/remove co2

paco2 >45

21
Q

what causes hypercapnea

A 
decreased alveolar minute ventilation
dead space ventilation due to
nervous system
neuromuscular
muscle failure
airway obstruction
chest wall deformity
22
Q

what is type 3 respiratory failure

A

perioperative respiratory failure
increased atelactasis (collapse of airway) due to low functional residual capacity with abnormal wall mechanics
hypoxemia/hypercapnoea

23
Q

how can we prevent type 3 resp failure

A 
anaesthetics, operative technique
posture
incentive spirometry 
analgesia
attempts to lower intra abdominal pressure
24
Q

what is type 4 resp failure

A

patients who are intubated and ventilated during shock (septic,cardiogenic,neurologic)

25
Q

what are some risk factors for chronic resp failure

A 
copd
pollution
recurrent oneumonia
cystic fibrosis
pulmonary fibrosis
neuromuscular disease
26
Q

what are some risk factors for acute resp failure

A 
infection - viral,bacterial
aspiration
trauma
pancreatitis
transfusion
27
Q

whats the first thing to look at in patients with acute resp failure

A

origin of shortness of breath

28
Q

causes of acute resp failure

A 
lower resp infection
aspiration
trauma
pulmonary vascular disease
extra pulmonary - pancreatitis, new meds
29
Q

what causes acute lung injury

A

damage to interstitum causes:
alveolar macrophages release cytokines: il6,il8, tnf alpha and type1 and 2 cells
in response to inflammation- = alveolar fluid build up, protein rich oedema
leads to degradation of surfactant
migration of leukocytes e.g neutrophils into interstitium
causes more oedema
therefore greater distance between alveolar and blood supply

30
Q

what damps are released during lung injury

A

hmgb1

rage

31
Q

therapies that have been tried for resp failure

A 
steroids
salbutamol
surfactant
n acetylcysteine
neutrophil esterase inhibitor
gm-csf
statins
32
Q

what is proning

A

rolling patient onto tummy

33
Q

useful indicators to look at for ards

A

platelet count
bilirubin
creatinine
crp

34
Q

how can we treat underlying disease in resp failure

A

inhaled therapies - bronchodilators, pulmonary vasodilators
steroids
antibiotics
antivirals
drugs - pyridostigmine, plasma exchange, iViG, Rituximab

35
Q

what type of respiratory support can be provided

A 
physiotherapy
oxygen
nebulisers
high flow oxygen
non invasive ventilation
mechanical ventilation
extra corporeal support
36
Q

what are some multi organ support that can be given

A

cardiovascular support - fluids, vasopressors,ionotropes,pulmonary vasodilators
renal support - haemofiltration
haemodialysis
immune therapies - plasma exchange ,convalescence

37
Q

what takes place during ards

A 
poor gas exchange - 
inadequate oxygenation
poor perfusion
hypercapnoea
infection - sepsis
inflammation
systemic effects
38
Q

ards specific intervention

A

resp support
intubation and ventilation
procedures to support ventilation

39
Q

what are the types of ventilation

A

volume controlled
pressure controlled
assisted breathing modes
advanced ventilatory modes

40
Q

what are some imaging techniques we can use for management of ards

A

lung us - to evaluate how well expanded lung is/ any fluid

lung ct

41
Q

which guidelines used for escalation of therapy

A 
use murray score
pao2/flO2 on 100% oxygen
cxr
peep
compliance
42
Q

what does murray scores mean

A

0 = normal
1-2.5 - mild
2.5 - severe
3 - ecmo

43
Q

inclusion criteria for ecmo treatment

A

severe resp failure
non cardia cause
pos pressure ventilation is not appropriate

44
Q

exclusion criteria for ecmo

A

contraindication to continuation if treatment
significant co morbidity
significant life limiting co morbidity

45
Q

what is ecmo

A

very invasive
large cannula passed through femoral vein into ivc
removal of co2 and input of oxygenated blood

46
Q

issues with ecmo

A 
time to access
referral system - geographical inequity
invasive
costly
clotting/bleeding

brs2 (65 decks)

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