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Y2 CARDIORESP > 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

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2
Q

What are the three components of the respiratory system?

A

Nervous system, respiratory muscle, pulmonary

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3
Q

How does the nervous system contribute to the respiratory system?

A

CNS/ brainstem (ventro-lateral medulla) contains respiratory centres.
PNS and neuromuscular junction

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4
Q

What happens in terms of ventilation when the pressure in the pleura is more negative?

A

There is a greater transmural pressure gradient therefore the alveoli become larger and less compliant resulting in less ventilation

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5
Q

What happens in terms of ventilation when the pressure in the pleura is less negative?

A

Smaller transmural pressure gradient therefore the alveoli become smaller and more compliant so more ventilation

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6
Q

What happens in terms of lung perfusion when there is a lower intravascular pressure?

A

Less recruitment, greater resistance, lower flow rate

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7
Q

What happens in terms of lung perfusion when there is a higher intravascular pressure?

A

More recruitment, less resistance and higher flow rate

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8
Q

What are the three classifications of respiratory failure?

A

Acute, chronic, acute on chronic

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9
Q

What are some examples of acute respiratory failure?

A

Pulmonary: infection, aspiration, primary graft dysfunction. Extra-pulmonary: trauma, pancreatitis, sepsis. Neuromuscular: myasthenia/GBS

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10
Q

What are some examples of chronic respiratory failure?

A

Pulmonary: COPD, lung fibrosis, CF, lobectomy. Muscoskeletal: muscular dystrophy

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11
Q

What are some examples of acute on chronic respiratory failure?

A

Infective exacerbation of COPD or CF, myasthenic crises, post operative

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12
Q

What is the biggest risk factor in males for respiratory failure and what is the biggest risk factors in females?

A

Males = smoking. Females = household air pollution

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13
Q

What are the four different physiological classifications of respiratory failure?

A

Type 1 (hypoxemic). Type 2 (hypercapnic). Type 3. Type 4

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14
Q

What is meant by the term hypoxemic?

A

below-normal level of oxygen in your blood, specifically in the arteries

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15
Q

What is meant by the term hypercapnic

A

an elevation in the arterial carbon dioxide tension

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16
Q

What is type 1 respiratory failure?

A

Failure of oxygen exchange, pO2<60. Leads to increased shunt fraction due to alveolar flooding. Hypoxemia despite adequate levels of inspiration. Causes collapse, pulmonary oedema, fibrosis or embolism and hypertension

17
Q

What is type 2 respiratory failure?

A

Failure to exchange or remove CO2, pCO2>45. Decreased alveolar minute ventilation, dead space ventilation. Seen in NM disease or COPD, obstructive airway disease

18
Q

What is type 3 respiratory failure?

A

Perioperative respiratory failure. Increased atelactasis due to low functional residual capacity with abnormal abdominal wall mechanics. Results in hypoxemia or hypercapnia, can be prevented with good postural positioning

19
Q

What is type 4 respiratory failure?

A

Shock. Poor perfusion of the lung, intubated and ventilated during shock. Ventilator effects on LV reducing afterload but has negative effect on RV as increases preload

20
Q

Define minute ventilation?

A

Gas entering and leaving the lungs per minute

21
Q

Define alveolar ventilation

A

Gas entering and leaving the alveoli per minute

22
Q

How do we calculate minute ventilation?

A

Tidal volume (L) x breathing frequency

23
Q

How do we calculate alveolar ventilation?

A

(Tidal volume (L) - dead space (L)) x breathing frequency

24
Q

What are the risk factors associated with chronic respiratory failure?

A

COPD
Pollution
Recurrent pneumonia
CF
Pulmonary fibrosis
Neuro-muscular diseases

25
Q

What are the risk factors associated with acute respiratory failure?

A

Infection – viral, bacterial
Aspiration
Trauma
Pancreatitis
Transfusion

26
Q

What is commonly seen alongside acute respiratory failure?

A

Lower respiratory tract infections, aspiration of gastric contents, trauma, pulmonary vascular disease, pancreatitis

27
Q

Why is aspiration of gastric contents often seen alongside acute respiratory failure?

A

Acid results in response in the lungs

28
Q

Outline how vascular supply injury can lead to acute lung injury

A

Leads to damage of lung interstitium which is necessary for structural support

29
Q

Outline how activation of alveolar macrophages leads to acute lung injury

A

When alveolar macrophages are activated by infection or inflammation release further cytokines.
IL-6 and TNF-alpha, (also TNFR1) well established in response to ARDs
In response to inflammatory setup, get alveolar fluid build-up/protein-rich oedema forming within lung.
Degradation of surfactant so lung less efficient at expanding
Migration of leukocytes out of blood vessels into interstitium where they can cause damage before getting to site of interest, due to chemokines
Secrete proteases + other inflammatory mediators causing damage and fluid build up.
Larger gap between alveoli and capillary so gas exchange less effective

30
Q

What are the pulmonary causes of ARDS?

A

Aspiration, trauma, burns, surgery, drug toxicity, infection

31
Q

What are the extra-pulmonary causes of ARDS?

A

Trauma, pancreatitis, burns, transfusion, surgery, BM transplant, drug toxicity, infection

32
Q

What pharmacological therapies have been tried to treat ARDS?

A

Steroids like dexamethasone, salbutamol, surfactant, N-acetylcysteine, neutrophil esterase inhibitor, GM-CSF, statins

33
Q

What pharmacological treatments are currently being trialled for ARDS?

A

Mysenchymal stem cells, keratinocyte growth factor, mircovesicles, extra corporeal removal of CO2 using ECMO light circuit

34
Q

What are the underlying distinct biological processes in ARDS?

A

Pulmonary vascular, endothelial inflammatory response
Thrombosis -> micro emboli – vast areas of lung with poor perfusion
Angiogenesis -> radiological evidence of new blood vessel formation

35
Q

What therapeutic interventions are offered to treat underlying disease of ARDS?

A

Inhaled therapies -> bronchodilators, pulmonary vasodilators (esp. if proven RH failure)
Steroids
Antibiotics
Anti-virals
Drugs -> pyridostigmine, plasma exchange, IViG, rituximab

36
Q

What therapeutic intervention is offered to give respiratory support to those with ARDS?

A

Physiotherapy
Oxygen (COPD + type 2 chronic resp. failure need diff. oxygen management to normal)
Nebulisers  salbutamol, ipratropium bromide, saline, NAC to reduce mucus.
High flow oxygen – nasal cannula, face masks
Non invasive ventilation – stent to open alveoli
Mechanical ventilation
Extra-corporeal support – membrane lung

37
Q

What therapeutic intervention is given for multiple organ support to those with ARDS?

A

Cardiovascular support  fluids, vasopressors, inotropes, pulmonary vasodilators
Renal support  haemofiltration, haemodialysis
Immune therapies  plasma exchange, convalescent plasma

38
Q

What are the sequelae of ARDS?

A

Poor gas exchange, infection, inflammation, systemic effects

Y2 CARDIORESP (15 decks)

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