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Clinical pathology > Respiratory failure > Flashcards

Respiratory failure Flashcards

1
Q

Respiratory insufficiency

A

The inability of the respiratory system to provide adequate gas exchange and keep the levels of CO2 and/or O2 within a normal range. ALTERED V/Q RATE

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2
Q

Limits of respiratory sufficiency in arterial blood

A

PO2 larger or equal to 60 mmHg
&
PCO2 smaller or equal to 50 mmHg

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3
Q

Limits of respiratory insufficiency in arterial blood

A

PO2 smaller than 60 mmHg and PCO2 larger than 50 mmHg

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4
Q

ventilation

A

breathing (getting air in)

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5
Q

diffusion

A

gases get diffused passively from higher to lower partial pressure areas in between capillaries and alveoli (ALVEOLO-CAPILLARY BARRIER)

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6
Q

perfusion

A

the amount of blood that reaches the alveoli

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7
Q

Minute ventilation

A

the total volume of gas entering the lungs per minute. VE=tidal volume*respiratory rate

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8
Q

Alveolar ventilation

A

the volume of gas entering the alveoli per unit of time. VA=(tidal volume-dead space)*respiratory rate

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9
Q

Dead space ventilation

A

the volume of gas per unit of time that comes in to the respiratory system but does not reach the alveoli. VD=dead space*respiratory rate

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10
Q

VENTILATION/PERFUSION RATIO

A

the amount of air that reaches the alveoli divided by the amount of blood reaching the alveoli in a unit of time V/Q

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11
Q

adequate V/Q

A

0,8

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12
Q

Increased V/Q rate

A

Proper ventilation, hypoperfusion

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13
Q

Decreased V/Q rate

A

Alveolar hypoventilation, correct perfusion

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14
Q

Inadequate transfer of O2 can be a problem in

A

ventilation (environment-> alveoli) or perfusion (alveoli -> pulmonary circulation)

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15
Q

Factors affecting diffusion

A 
Thickness
Surface area (atelectasis)
Contact time
Gas solubility (CO2 has higher solubility than O2)
Pressure difference
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16
Q

Consequences of respiratory insufficiency

A

Hypoxemia and/or hypercapnia

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17
Q

Hypoxemia and hypercapnia

A

Total respiratory insufficiency

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18
Q

Hypoxemia without hypercapnia

A

Partial respiratory insufficiency

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19
Q

Types of respiratory failure

A
  1. ventilation failure
  2. 1 obstructive
  3. 2 restrictive
  4. diffusion failure
  5. V/Q mismatch failure
20
Q

Obstructive lung disease aetiology

A

Bronchitis
tracheal collapse
foreign body

21
Q

Obstruction can lead to

A

alveolar rupture (emphysema)

22
Q

restrictive lung disease

A

deacreased lung volume due to decreased ability of the lungs to expand

23
Q

Restrictive lung disease aetiology

A
  1. insufficient contraction of the respiratory muscles due to
  2. 1 neuromuscular disease
  3. 2 pain
  4. Increased resistance to lung expansion
  5. 1 pleural disease
  6. 2 anatomical abnormalities
  7. 3 thoracic or mediastinal mass
  8. pulmonary disease that alters lung elasticity
24
Q

Intrapulmonary causes of restrictive respiratory insufficiency

A
  • oedema
  • interstitial pneumonia
  • alveolar fibrosis
25
Q

Intrapulmonary causes of restrictive respiratory insufficiency lead to

A

reduced elasticity and thus decreased volume of inspired or expired air in each breath (tidal volume)

Hypoxemia and hypercapnia
Exhaustion of respiratory muscles

26
Q

Extrapulmonary causes of restrictive respiratory insufficiency

A

Pulmonary compression
Pleural effussion
Pneumothorax
Tumors/masses

27
Q

Extrapulmonary causes of restrictive respiratory insufficiency lead to

A

Reduced ventilation (though with Normal Perfusion), and thus decreased volume of inspired or expired air in each breath (tidal volume)

Hypoxemia and hypercapnia
Exhaustion of respiratory muscles

28
Q

Clinical signs of restrictive lung disease

A

Tachypnoea, shallow respiration

Mixed dyspnoea

29
Q

RESPIRATORY INSUFFICIENCY DUE TO DIFFUSION ALTERATIONS can be caused because of

A

Increased thickness of alveolo-capillary barrier (fibrosis or oedema) or decreased contact surface (emphysema or obstructed blood vessel)

30
Q

Why mild diffusion defect leads to hypoxia only?

A

CO2 has 20x higher diffusion rate

31
Q

Hypercapnia is a sign of

A

Severe diffusion defect

32
Q

Diffusion takes how much time in normal resting conditions?

A

0,3s

33
Q

What is the contact time of diffusion in rest and why?

A

0,75 s, because then during exercise when blood is moving faster there is possibility to get adequate gas exchange

34
Q

What happens in moderate diffusion alteration?

A

Hypoxia during excersise not in rest, may lead to hypocapnia because of the impaired O2/CO2 balance and the much faster diffusion rate of CO2

35
Q

What happens in severe diffusion alteration?

A

Hypoxia and hypercapnia also during rest. Eventually metabolic acidosis

36
Q

Does hyperventilation work for hypoxia/hypercapnia?

A

More effective for hypercapnia -> can lead to hypocapnia

37
Q

HIGH V/Q mismatch failure

A

Some area is poorly perfused, due to thromoembolism

38
Q

Consequences of high V/Q mismatch failure?

A

Increases in dead space: Useless ventilatory effort

39
Q

LOW V/Q mismatch failure

A

Poorly ventilated area

40
Q

Compensatory mechanism of high V/Q failure

A

bronchoconstriction

41
Q

Consequences of low V/Q mismatch

A

Heart gets poorly oxygenated blood -> increased cardiac effort

42
Q

Compensatory mechanism of low V/Q mismatch failure

A

Hypoxic vasoconstriction and pulmonary artery hypertension

43
Q

Hypoxia can be

A

hypoxic
anaemic
circulatory
histotoxic

44
Q

Hypoxic hypoxia aetiology

A

High altitude
Respiratory failure
Blend of arterial and venous blood

45
Q

Hypoxia compensatory mechanism

A

• HYPERVENTILATION: due to stimulation of the peripheral chemoreceptor
located on the carotid body
• POLYCITAEMIA: due to increased production of EPO
• SHIFTED BLOOD FLOW: cutaneous and visceral vasoconstriction and cerebral and coronary vasodilation
• PRODUCTION OF 2,3 DPG. It is an enzyme produced in RBC’s in response to hypoxia. It decreases HB affinity for O2, easing its releases to tissues.
• CIRCULATORY (increased Cardiac output):
Tachycardia
increased stroke volume

46
Q

HYPERCAPNIA consequences

A

Hyperventilation (Respiratory centre stimulation)
– Central vasoconstriction and peripheral and cerebral vasodilation
• Increased intracranial pressure
• CNS excitation  depression if prolonged
– Renal:
•  Elimination of H+ and bicarbonate retention  bladder stones
– Increase bone resorption (carbonate as a pH buffer): osteoporosis
– Potassium: hyperpotassemia. Reduced kidney excretion due to H+
excretion

Clinical pathology (8 decks)

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