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CardioPulm > Respiratory Failure > Flashcards

Respiratory Failure Flashcards

1
Q

Define hypoxemia:

A

failure of oxygenation

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2
Q

What is the Pa02 value associated with type I respiratory failure?

A

Pa02< 60 mmHg

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3
Q

Define type I respiratory failure:

A

processes impair oxygen transfer in the lung causing hypoxemia

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4
Q

What factors lead to hypoxemia?

A 
low pressure of inspired air
impaired diffusion
V/Q mismatch
shunt
hypoventilation
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5
Q

Impaired diffusion is primarily a result of:

A

increased thickness of alveolar membrane due to pulmonary fibrosis

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6
Q

How would exercise or increased CO effect diffusion?

A

Increased flow of blood through capillary beds means less time available for gas exchange to occur

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7
Q

What is normal V/Q ratio?

A

~0.8

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8
Q

What happens to blood flow with the presence of a shunt?

A

either the alveolar capillary membrane or the lungs are bypassed due to cardiac defect (patent foramen ovale).

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9
Q

Hypoventilation leads to depression in _____ and overall leads to hypercapnia.

A

central respiratory centers

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10
Q

Define type II respiratory failure:

A

inadequate ventilation leads to C02 retention with hypercarbia

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11
Q

What is the PaC02 value associated with type II respiratory failure?

A

PaC02 > 55mmHg

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12
Q

What factors lead to failure of ventilation?

A 
central hypoventilation
neuromuscular weakness
airway obstruction
chest wall deformities
marked abdominal interference with diaphragm descent
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13
Q

How should your body respond if you are hypercapnic?

A

ventilation increases as PC02 rises (eliminate excess C02)

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14
Q

What are the indications or mechanical ventilation?

A

elevated cost of breathing
inadequate oxygenation or ventilation
retention of pulmonary secretions
airway protection

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15
Q

Can a V/Q mismatch lead to a shunt?

A

yes.

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16
Q

Respiratory _____ is associated with hypercapnia.

A

acidemia

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17
Q

Which type(s) of respiratory failure are associated with gas exchange impairment?

A

Type I

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18
Q

Which type(s) of respiratory failure are associated with ventilatory pump impairment?

A

Type II

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19
Q

Which type(s) of respiratory failure are associated with airway clearance impairment?

A

Type I and II

20
Q

What NIF, negative inspiratory force, is needed for MV?

A

< -20 to -25 cm H2O

21
Q

What Pa02 is needed for MV?

A

PaO2 < 50 mmHg

22
Q

What PaC02 is needed for MV?

A

PaCO2 > 60 mmHg

23
Q

What is A-a gradient?

A

Alveolar-arterial oxygen tension difference

difference between PAO2 and PaO2 in pulmonary arteries

24
Q

High A-a gradient tells us:

A

there is diffusion problem or V/Q shunt

25
Q

What VC is needed for MV?

A

< 10-20 ml/kg (~ 30% predicted FVC)

26
Q

If A-a is normal then hypoxemia is explained by:

A

either hypoventilation to increase PaCo2

or altitude

27
Q

Is MV controlled by volume or pressure?

A

Varies depending on patient population, MD preference, Pathology

28
Q

When MV is controlled by volume, what is set?

A

Tidal volume is set so inspiration terminated when reach pre-set volume
(Pressure varies with resistance and elasticity of respiratory system)

29
Q

When MV is controlled by pressure, what is set?

A

Pressure levels are set so inspiration terminated when reach pre set pressure level
(Tidal volume varies with elasticity or compliance, airway resistance and tubing)

30
Q

What is PEEP?

A

positive end-expiratory pressure

31
Q

What is PEEP usually set at?

A

5cm H2O to prevent atelectasis

32
Q

What does PEEP setting influence?

A

Keeps alveoli from collapsing by increasing end-expired lung volume

33
Q

Risks of too much Fi02?

A

Absorption atelectasis
Increased hypercapnia
Airway or parenchymal injury

34
Q

What is an endotracheal tube?

A
  • Tube inserted into trachea through patient’s mouth when patient in respiratory failure
  • Allows air to easily pass in and out of lungs
  • Short-term use
35
Q

What is a tracheostomy tube?

A
  • Surgical procedure where incision made in tracheal rings and tube inserted
  • Placed in acute & chronic conditions for more permanent airway
36
Q

What does CPAP stand for?

A

Continuous Positive Airway Pressure

37
Q

What does BiPAP stand for?

A

Bilevel Positive Airway Pressure

38
Q

What does CPAP do?

A

Maintains constant airway pressure; Analogous to PEEP

39
Q

What does BiPAP do?

A

Delivers preset inspiratory positive airway pressure (IPAP) and preset expiratory positive airway pressure (EPAP) such that IPAP > EPAP

40
Q

What are the names of non-invasive ventilation?

A

CPAP and BiPAP

41
Q

Goals of PT management:

A
  • Maximize V/Q matching
  • Maximize airway clearance
  • Improve strength/endurance of ventilatory muscles to enhance airway protection and assist with weaning
  • Prevent deconditioning
  • Maintain functional mobility
42
Q

Which type of respiratory failure is most common?

A

type I

43
Q

How should your body respond if you are hypoxemic?

A

vasoconstriction
use of accessory respiratory muscles
elevate HR
inc. AV02 diff

44
Q

What does respiratory academia lead to?

A 
dec cardiac contractility
dec resp. muscle endurance
arterial vasodilation
inc cerebral blood flow
induces loss of consciousness
raises seizure threshold
45
Q

What are the Pa02 and Sp02 goals for MV?

A

Pa02 > 60 mmHg

Sp02 > 90%

CardioPulm (13 decks)

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