Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS Phase 1b > Respiratory failure > Flashcards

Respiratory failure Flashcards

1
Q

Define respiratory failure:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 3 main areas can be affected by respiratory failure?

A

Nervous system;

CNS/Brainstem
Peripheral nervous system
Neuro-muscular junction

Respiratory Muscle;
Diaphragm & thoracic muscles
Extra-thoracic muscles

Pulmonary:
Airway disease
Alveolar-capillary
Circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiology of Chronic respiratory disease?

A

Chronic respiratory disease 3rd leading cause of death* (2017) 39.8% rise from 1990

Males: Smoking biggest risk factor
Women: Household air pollution from solid fuels

Costs: EU 380m Euro’s annually (2019) care for chronic respiratory disorders
Accounts for: Inpatient care, lost productivity
Despite extensive costs: limited granular data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the epidemiology of Acute respiratory failure?

A

Limited data:
Heterogenous disease presentation
Acute respiratory distress syndrome

Prevalence: 6-7 per 100,000 = 6-700 people/yr in UK

30 to 40% Mortality (ALIEN/Esteban)
35, 40 and 46% (Severity dependent. Bellani)

Severity and advance age
 increase mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes for Acute respiratory failure?

A

Pulmonary: Infection, aspiration, Primary graft dysfunction (Lung Tx)
Extra-pulmonary: Trauma, pancreatitis, sepsis,
Neuro-muscular: Myasthenia/GBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes for Chronic respiratory failure?

A

Pulmonary/Airways: COPD, Lung fibrosis, CF, lobectomy

Musculoskeletal: Muscular dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes for Acute on Chronic respiratory failure?

A

Infective exacerbation
COPD, CF
Myasthenic crises
Post operative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the reasons for & criteria for Type 1 Respiratory failure?

A 
Reasons;
Collapse
Aspiration
pulmonary oedema
Fibrosis
Pulmonary embolism
Pulmonary hypertension
Criteria;
(PaO2 <60 at sea level): 
Failure of oxygen exchange
n Increased shunt fraction (Q S /QT )
n Due to alveolar flooding
n Hypoxemia refractory to supplemental oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the reasons for & criteria for Type 2 Respiratory failure?

A 
Nervous system
Neuromuscular
Muscle failure
Airway obstruction
Chest wall deformity

(PaCO2 >45): Failure to
exchange or remove carbon dioxide
n Decreased alveolar minute ventilation (V A )
n Dead space ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of Type 3 Respiratory failure?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of Type 4 Respiratory failure?

A

Type IV 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors for Chronic Respiratory failure?

A 
COPD
Pollution
Recurrent pneumonia
Cystic fibrosis
Pulmonary fibrosis
Neuro-muscular diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors for Acute Respiratory failure?

A 
Infection
	Viral
	Bacterial
Aspiration
Trauma
Pancreatitis
Transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the first thing to look for in Acute Respiratory failure?

A

Origin of shortness of breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the Pulmonary causes of ARDS?

A 
Aspiration
Trauma
Burns: Inhalation
Surgery
Drug Toxicity 
Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the extra-pulmonary causes of ARDS?

A 
Trauma
Pancreatitis
Burns
Transfusion
Surgery
BM transplant
Drug Toxicity
Infection
17
Q

What is the alveolar macrophage response in ARDS?

A

Release cytokines; IL-6,8, TNF-alpha.
Alveolar fluid build up, inactivation of surfactant, alveolar expansion defficiency.

Increased Oedema causes greater distance between the alveolus & capillary. Greater distance for gas exchange response, less efficient.

18
Q

What are the mechanisms that lead to inefficient gas exchange in the lung in ARDS?

A

Leucocytes
Inflammation
Infection
Immune response

19
Q

What happens in Neutrophil lung migration?

A

Inflammation causes migration of neutrophils out of the blood vessels into the interstitium where they cause damage through secretion of cytokines and proteases.

Increased Oedema causes greater distance between the alveolus & capillary. Greater distance for gas exchange response, less efficient.

20
Q

What are some possible explanations as to why certain patients have a more severe response to viral infections?

A

TNF signalling implicated in vivo and in vitro
Leucocyte migration and activation
DAMP release; HMGB-1, RAGE.
Cytokine release IL-6,8,1B,IFN-y
Cell death - necrosis in lung biopsies
- Apoptotic mediators; FAS, FAS-I, BCI-2.

21
Q

What are some Pharmacological interventions available for ARDS?

A 
Steroids
Salbutamol
Surfactant
N-Acetylcysteine
Neutrophil esterase inhibtitor
GM-CSF
Statins
22
Q

How do you treat the underlying disease in Respiratory failure?

A 
Inhaled therapies
	Bronchodilators
	Pulmonary vasodilators
Steroids
Antibiotics
Anti-virals
Drugs
	Pyridostigmine
	Plasma exchange
	IViG
	Rituximab
23
Q

What respiratory support would you provide in respiratory failure?

A 
Physiotherapy
Oxygen
Nebulisers
High flow oxygen
Non invasive ventilation
Mechanical ventilation
Extra-corporeal support
24
Q

What organ support would you provide in respiratory failure?

A 
Cardiovascular support
	Fluids
	Vasopressors
	Inotropes
	Pulmonary vasodilators
Renal support
	Haemofiltration
	Haemodialysis
Immune therapies
	Plasma exchange
	Convalescent plasma
25
Q

What happens sequentially in ARDS?

A

Poor gas exchange
Inadequate oxygenation
Poor perfusion
Hypercapnoea

Infection
Sepsis

Inflammation
Inflammatory response

Systemic effects

26
Q

What are the specific interventions for ARDS?

A 
Respiratory support
Intubation and ventilation
ARDS necessitates mechanical intervention
Types of ventilation
	Volume controlled
	Pressure controlled
	Assisted breathing modes
	Advanced ventilatory modes
Procedures to support ventilation
27
Q

What is Compliance

A

amount of lung that opens for the amount of pressure that you use.

28
Q

What is the upper inflection point?

A

Above this pressure additional alveolar recruitment requires disproportionate increases in applied airway pressure.

29
Q

What is the lower inflection point?

A

Can be thought of as the minimum baseline pressure needed for optimal alveolar recruitment.

30
Q

What are some of the Pitfalls of ventilation?

A

In complications with asthma and COPD you can get trapping of air in the lung which leads to breath stacking, so the chest becomes fuller and fuller, making CO2 management harder.

31
Q

What scoring system is used to escalate therapy?

A 
Murray score
0 = normal
1-2.5 Mild
2.5 Severe
3  ECMO
32
Q

What is the Inclusion criteria for ECMO treatment?

A

severe respiratory failure
non-cardiac cause (i.e. Murray Lung Injury score 3.0 or above)
• Positive pressure ventilation is not appropriate (e.g. significant tracheal injury).

33
Q

What is the Exclusion criteria for ECMO treatment?

A
  • Contraindication to continuation of active treatment;
  • Significant co-morbidity  dependency to ECMO support
  • Significant life limiting co-morbidity
34
Q

What is the process for ECMO?

A

Cannula through femoral vein, pumps blood from IVC out where it comes across an artificial membrane that oxygenates the blood, and returns it to the patient also through a femoral vein.

35
Q

What are some issues with ECMO?

A 
Time to access
Referral system - geographical inequality
Obtaining access;
Internal jugular
subclavian
femoral
Circuit
Haemodynamics
Clotting/Bleeding
Cost
36
Q

Name 2 imaging modalities that can be used to guide diagnosis and treatment in the management of the acute respiratory distress syndrome?

A

CT scan

Lung ultrasound

BRS Phase 1b (80 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions