RESPIRATORY FAILURE

Question 1

A 65-year-old patient with sepsis develops severe hypoxemia and a PaO2/FiO2 ratio of 150. A chest X-ray reveals diffuse infiltrates. What type of respiratory failure does this patient most likely have?

A) Type I: Acute hypoxemic respiratory failure
B) Type II: Hypercapnic respiratory failure
C) Type III: Lung atelectasis
D) Type IV: Respiratory failure due to shock

Answer 1

Type I: Acute hypoxemic respiratory failure

• Type I respiratory failure occurs in clinical settings such as sepsis, gastric aspiration, pneumonia, COVID-19, near-drowning, multiple blood transfusions, and pancreatitis

Question 2

A 55-year-old male with chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory failure. He is unable to eliminate carbon dioxide, and his PaCO2 level rises significantly. Which type of respiratory failure does this patient most likely have?

A) Type I: Acute hypoxemic respiratory failure
B) Type II: Hypercapnic respiratory failure
C) Type III: Lung atelectasis
D) Type IV: Respiratory failure due to shock

Answer 2

Type II: Hypercapnic respiratory failure

Question 3

During a spontaneous breathing trial (SBT), a patient begins to exhibit a respiratory rate >35/min for over 5 minutes. What should be done next?

A) Continue the SBT for another 30 minutes
B) Increase the pressure support to facilitate breathing
C) Stop the SBT and reassess the patient’s readiness for extubation
D) Administer sedatives to decrease respiratory rate

Answer 3

Stop the SBT and reassess the patient’s readiness for extubation

• Spontaneous breathing trial is declared a failure and stopped if any of the following occur:
  
  • 1) respiratory rate >35/min for >5 min
  • (2) O2 saturation <90%
  • (3) heart rate >140/min or a 20% increase or decrease from baseline
  • (4) systolic blood pressure <90 mmHg or >180 mmHg,
  • (5) increased anxiety or diaphoresis

Question 4

A 45-year-old male in shock develops respiratory failure due to hypoperfusion of respiratory muscles. What is the primary factor contributing to his respiratory distress?

A) Increased cardiac output leading to pulmonary edema
B) Hypoperfusion of the respiratory muscles
C) Acute lung injury from mechanical ventilation
D) Severe anemia

Answer 4

Hypoperfusion of the respiratory muscles

• Normally, respiratory muscles consume <5% of total cardiac output and oxygen delivery
• Patients in shock often experience respiratory distress due to pulmonary edema (e.g., in cardiogenic shock), lactic acidosis, and anemia.
  
  • up to 40% of cardiac output may be distributed to the respiratory muscles.