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Y3 Conditions > Respiratory Failure > Flashcards

Respiratory Failure Flashcards

1
Q

Resp Failure

What is the biggest risk factor for chronic respiratory disease for men? for women?

A

Males: Smoking
Women: Household air pollution

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2
Q

Resp failure

Describe the ventilation in the lung.

A

more ventilation at top of lung

at top of lung, less gravity, so less fluid and blood, so these cavities will be more open

when we breathe the diaphragm pulls down and air is pulled into lungs

alveoli are smaller at the bottom of the lungs, so they are more open to change, so there is more ventilation

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3
Q

Resp failure

Does gas exchange of O2 or CO2 happen faster?

A

CO2 because going down diffusion gradient
more rapid offset

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4
Q

Resp failure

describe this:

A

there is relatively more perfusion at the bottom of the lung that there is gas for exchange at the bottom of the lung and vice versa for the top of the lung

at the middle of the lung it is roughly in equilibrium

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5
Q

Resp failure

What is the difference between a lung volume and a lung capacity?

A

Volumes are discrete sections of the graph and don’t overlap

Capacities are the sum of two or more volumes

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6
Q

Resp failure

Name these

A
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7
Q

Resp failure

What is the equation for minute ventilation and give the units.

A
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8
Q

Resp failure

What is the equation for alveolar ventilation and give the units.

A
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9
Q

Resp failure

What is compliance and give the equation.

A
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10
Q

Resp failure

What is elastance and give the equation.

A
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11
Q

Resp failure

Give some causes of an acute respiratory failure.

  • pulmonary
  • extra-pulmonary
  • neuromuscular
A

pulmonary
- infection
- aspiration

extra-pulmonary
- trauma
- pancreatitis
- sepsis

neuromuscular
- myasthenia
- GBS

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12
Q

Resp failure

Give some causes of chronic respiratory failure.

  • pulmonary/airways
  • musculoskeletal
A

pulmonary/airwarys
- COPD
- lung fibrosis
- CF
- lobectomy

musculoskeletal
- muscular dystrophy

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13
Q

Resp failure

Give some examples of an acute on chronic respiratory failure.

3

A

infective exacerbation
- COPD
- CF

myasthenic crisis

post operative

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14
Q

Resp failure

How do we differentiate between type 1 and type 2 resp failure?

A
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15
Q

Resp failure

What conditions may cause a type 1 resp failure?

A
  • COPD
  • Pneumonia (infection)
  • Pulmonary oedema
  • Pulmonary fibrosis
  • Asthma
  • Pneumothorax
  • Pulmonary embolism
  • Pulmonary hypertension
  • Bronchiectasis
  • ARDS
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16
Q

Resp failure

What conditions may cause a type 2 resp failure?

A
  • COPD
  • Severe asthma
  • Drug overdose, poisoning
  • Myasthenia gravis
  • Muscle disorders
  • Head injuries and neck injuries
  • Obesity
  • Pulmonary oedema
  • ARDS
  • Hypothyroidism
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17
Q

Resp failure

Name some differentials

A
  • Acute severe asthma or COPD exacerbation
  • Pneumonia or other severe respiratory infections
  • Stroke or other severe neurological disorders
  • Cardiac arrhythmias
  • Drug overdose or poisoning
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18
Q

Resp failure

What is type 3 resp failure?

A

down to the lungs collapsing when you are having surgery (related to abdo surgery)

leads to increased intraabdominal pressure, which means that ventilatory volumes start to drop

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19
Q

Resp failure

What is type 4 resp failure?

A

related to pt who are in septic, cardiogenic or neurologic shock

need high metabolic requirements

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20
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity. Investigations may include:

A
  • ABG
  • CXR
  • FBC
  • Renal function tests and LFTs
  • Serum creatine kinase and troponin I
  • TFTs
  • Spirometry
  • Echocardiography
  • Pulmonary function tests
  • ECG
  • Right heart catheterisation
  • Pulmonary capillary wedge pressure
  • Microbiological studies
  • Histopathology of lung aspirate
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21
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an ABG?

A

confirmation of the diagnosis

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22
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an CXR?

A

often identifies the cause of respiratory failure

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23
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an FBC?

A

anaemia can contribute to tissue hypoxia

polycythaemia may indicate chronic hypoxaemic respiratory failure

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24
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an Renal function tests and liver function tests?

A

may provide clues to the aetiology or identify complications associated with respiratory failure

Abnormalities in electrolytes such as potassium, magnesium and phosphate may aggravate respiratory failure and other organ dysfunction.

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25
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an Serum creatine kinase and troponin I?

A

to help exclude recent myocardial infarction. Elevated creatine kinase may also indicate myositis.

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26
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an TFTs?

A

hypothyroidism may cause chronic hypercapnic respiratory failure

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27
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an spirometry and pulmonary function tests?

A

useful in the evaluation of chronic respiratory failure.

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28
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an echo?

A

if a cardiac cause of acute respiratory failure is suspected.

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29
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do an ECG?

A

to evaluate a cardiovascular cause; it may also detect dysrhythmias resulting from severe hypoxaemia or acidosis.

30
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we do right heart catheterisation?

A

should be considered if there is uncertainty about cardiac function, adequacy of volume replacement and systemic oxygen delivery

31
Q

Resp failure

Investigations will depend on the individual cause and severity of respiratory failure and comorbidity.

Why might we test Pulmonary capillary wedge pressure?

A

may be helpful in distinguishing cardiogenic from non-cardiogenic oedema.

32
Q

Resp failure

How to manage acute resp failure.

A
  • immediate hosp admission
  • abcde resuscitation
  • treat underlying cause
33
Q

Resp failure

Ensure adequate oxygen delivery to tissues, generally achieved with a PaO2 of ____ mm Hg or an arterial oxygen saturation (SaO2) of greater than ____%.

A

60mmHg
90%

34
Q

Resp failure

Why should you be careful with the use of high-flow O2 in some pts?

A

some pt may have become reliant on their hypoxic drive to maintain an adequate ventilation rate

Elevating the PaO2 too much may reduce the respiratory rate so that the PaCO2 may rise to dangerously high levels.

35
Q

Resp failure

Mechanical ventilation:

  • The goal of mechanical ventilation in acute hypoxaemic respiratory failure is to ____.
  • It is used to increase ____ and to lower ____.
  • It also rests the respiratory muscles and is an appropriate therapy for ____.
A
  • The goal of mechanical ventilation in acute hypoxaemic respiratory failure is to support adequate gas exchange without harming the lungs.
  • It is used to increase** PaO2** and to lower PaCO2.
  • It also rests the respiratory muscles and is an appropriate therapy for respiratory muscle fatigue.
36
Q

Resp failure

Name 3 different modalities of assisted ventilation.

A
  • mechanical ventilation
  • non-invasive ventilation
  • ECMO

Extracorporeal membrane oxygenation

37
Q

What is one of the most important aspects of resp failure to consider when assessing for it?

A

think about the ORIGIN

38
Q

What are some causes for pulmonary ARDS?

A
39
Q

What are some causes for extra-pulmonary ARDS?

A
40
Q

What is ARDS?

A

Acute respiratory distress syndrome

very severe form of resp failure

very hetreogenous

41
Q

What is the Berlin definition of ARDS?

A
  1. timing
  2. chest imaging
  3. origin of edema
  4. oxygenation
42
Q

What is CPAP?

A

continuous positive airway pressure

43
Q

What is the underlying mechanisms of ARDS? What are the drivers…?

A

unknown…

drivers:
- lung
- leucocytes
- inflammation
- infection
- immune response

44
Q

What type of signalling is very highly indicated in lung injury?

A

TNF signalling

45
Q

How do WBC impact lung injury?

A

stimulation + secondary response in lung
* Macrophage activation: alveolar
* Neutrophil lung migration

46
Q

Which proteins are highly inflammatory in lung injury and can indicate the site of injury (in research, not clinical)?

A

HMGB-1
and
RAGE

47
Q

What role do cytokines play in lung injury (and which ones?)

A

tells us bout inflammatory and signalling pathways

IL-6 (infection) /IL-8 (TNF signalling)
IL-1B, IFN-y

48
Q

What role does cell death play in ARDS?

A

necrosis forms part of the histiological diagnosis

increased levels of apoptosis in blood and alveolar fluid

49
Q

How do we treat ARDS pts? Tried and trialling…

A

not that useful however

(statins have an anti-inflammatory effect)
(steroids back in fahion…)
What is ECCO2R: try and extract CO2 from blood

50
Q

What significantly reduced mortality in ARDS the PROSEVA study?

A

proning, if the pts has a breathing tube and the pt lies facedown on a ventilator

redistribute blood flow

51
Q

What did the HARP-2 ARDS study identify?

A

identified hyper and hypo inflammatory endotypes

hyperinflammatory groups had worse outcomes

52
Q

Why do we not flood an ARDS pt with fluid?

A

The FACCT study showed that although there was no difference in mortality, they were ventilated for fewer days

53
Q

What was seen in the pulmonary vascular endothelium and vasculature in COVID?

A

significant inflammation of endothelium
extensive clot formation, microthrombi -> poor perfusion
angiogenesis

54
Q

What are the different ways we can treat underlying disease when it comes to ARDS?

A
55
Q

How can we provide resp support when it comes to ARDS?

A
56
Q

How can we provide multi-organ support when it comes to ARDS?

A
57
Q

What type of resp support is this?

A

nasal oxygen

58
Q

What type of resp support is this?

A

CPAP

59
Q

What type of resp support is this?

A

intubation ventilation

60
Q

What type of resp support is this?

A

proned patient

61
Q

What type of resp support is this?

A

ECMO - Extracorporeal Membrane Oxygenation

62
Q

How do we escalate care through different stages of ARDS?

A
63
Q

What is PEEP?

A

Positive end-expiratory pressure

alveolar pressure during CPAP

64
Q

What are the different types of ventilation?

A

volume controlled
pressure controlled
assisted breathing modes (when pt getting better, pt triggers breathe themselves)
advanced ventilatory modes

65
Q

Describe how the pressure-volume loop look like in an ARDS pt?

A

lung is ‘small’ in ARDS, so much less to work with

more pressure required to open it up

66
Q

What are some issues with ventilation?

A

gas trapping can occur if not enough time is given for air to be expired

ventilator induced injury

67
Q

What scoring system can we use for escalation of treatment for ARDS?

A

Murray Score (0-4)
average score of all 4 parameters

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

68
Q

What is the National ARDS approach?

A
69
Q

Who do we treat with ECMO?

A
70
Q

Who do we NOT treat with ECMO?

A
71
Q

What is this a picture of?

A

ECMO

72
Q

Describe the perfusion in the lung.

A

top: less blood
bottom: more blood

differences in matching between the blood flow and the gas in the lung because there is more blood at the bottom of the lung, but relatively, more gas for exchange at the top of the lung

Y3 Conditions (55 decks)

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