Respiratory Failure

Question 1

What is respiratory failure

Answer 1

Failure of the lungs to maintain adequate gas exchange.

Question 2

What can cause respiratory failure?

Answer 2

Alveolar hypoventilation
Diffusion impairment
Intrapulmonary shunting
VQ mismatch

EEG, pneumonia may cause diffusion impairment and VQ mismatch

Question 3

What does respiratory failure cause?

Answer 3

Hypoxaemia and tissue hypoxia
Hypercarbia –> CO2 narcosis
Exhausion and respiratory arrest

Question 4

What are signs of moderate respiratory distress in infancy?

Answer 4

Tachycardia
Respiratory rate > 50
Nasal flaring
Use of accessory muscles
Intercostal and subcostal recession
Head retraction
Unable to feed
Tracheal tug

Question 5

What are signs of severe respiratory distress in infants?

Answer 5

Cyanosis
Getting tired
Reduced conscious level
SaO2<92% despite oxygen
Rising pCO2

Question 6

What is the management for respiratory failure?

Answer 6

Supportive therapy:
Oxygen - aim for > 92%

Noninvasive ventilation - cPAP via face or nasal mask
High flow nasal cannula therapy - high flow humidified gas whilst providing some CPAP with a known O2 concentration

Invasive ventilation
Endotracheal intubation and mechanical ventilation

Question 7

What are indications of intubation and mechanical ventilation?

Answer 7

Severe respiratory distress
Tiring de to excessive work of breathing
Progressive hypoxaemia
Reduced conscious level
Progressive neuromuscular weakness