Respiratory Failure

Question 1

Define type 1 and type 2 respiratory failure?

Answer 1

Type 1 respiratory failure O2 less than 8.0kPa

In Type 2 = 2 things wrong
pO2 less than 8.0kPa
pCO2 greater than 6.5kPa

Question 2

What are the implications of high arterial pCO2?

Answer 2

Acute: Respiratory acidosis, CO2 forms carbonic acid. Can lead to unconsciousness and death.

Chronic: Chronically high levels will desensitize a persons hypercapnic drive to breath therefore they rely on their hypoxic drive

It is therefore dangerous to give high flow O2 in patients with COPD as it will cause the respirartory rate to drop and cause increased CO2 retention.

Question 3

Outline the effect of chest wall and spinal deformity on respiratory failure?

Answer 3

Deviation in the shape of the chest wall away from normal impacts respiratory function as it can limit chest expansion.

Kyphoscoliosis: Over curved and s shaped spine. Impedes proper chest expansion and therefore can cause type 1 respiratory failure.

Question 4

How is ventilatory failure managed?

Answer 4

A to E assessment

Type 1 give O2 therapy.

Treat underlying cause.

Type 2
-caution in giving oxygen start on low %

Consider providing assisted ventilation. Non invasive ventilation (CPAP or BIPAP) or endotracheal tube.

Question 5

What are the metabolic causes of an acidosis?

Answer 5

Ketoacidosis (DKA)
Ingestion (salicylate poisoning)
Lactate (sepsis)

Ureamia

KIL U mnemonic

Question 6

What are causes of type 1 resp failure?

Answer 6

Asthma
COPD
Pulmonary oedema
PE
Pneumonia

Question 7

What are the causes of type 2 resp failure?

Answer 7

Severe asthma
Neuromuscular disorders e.g. myasthenia gravis
Flail chest
Rib fracture 
Cord lesions