Respiratory failure

Question 1

What is Type I respiratory failure?

Answer 1

'Acute hypoxaemic' respiratory failure 
PaO2 low (<8kPa), PaCO2 low

Question 2

What is Type II respiratory failure?

Answer 2

'Alveolar hypoventilation' respiratory failure 
PaO2 low (<8kPa), PaCO2 high (>6kPa)

Question 3

What can cause Type I respiratory failure?

Answer 3

Damage to lung tissues causing V/Q mismatch eg
R-L shunt
Pulmonary oedema
Pneumonia
Acute lung injury 
Chronic fibrosis 
PE

Question 4

What can cause Type II respiratory failure?

Answer 4

Inadequate alveolar ventilation causing CO2 buildup eg 
Pulmonary disease
Reduced respiratory drive
Neuromuscular disease
Thoracic wall disease

Question 5

What are the symptoms of respiratory failure?

Answer 5

Tachycardia 
Tachypnoea
Inspiratory muscle use 
Intercostal recession
Paradoxical respiration 
Unwillingness to lie flat 
Pulsus paradoxus

Question 6

What is respiratory failure?

Answer 6

When gas exchange is inadequate, resulting in hypoxia - PaO2 < 8kPa

Question 7

What is the treatment for Type I respiratory failure?

Answer 7

High flow O2 - 35-60%
Bloods for FBC, U&E, CRP
ABG
If hypoxia not corrected on hi flow, consider assisted ventilation

Question 8

What is the treatment for Type II respiratory failure?

Answer 8

High flow O2 - start at 24%
Bloods for FBC, U&E, CRP
ABG
If after 20 min ABG shows PaCO2 same or lower, increase O2 to 28%, if PaCO2 rises by <1.5kPa, consider assisted vent, if on assisted vent no change, consider intubate+ventilate

Question 9

What is the general management for respiratory failure?

Answer 9

Elicit underlying cause with Ix bloods for FBC, U&E, CRP, treat underlying cause, correct hypoxia with high flow O2, if not corrected consider assisted vent eg CPAP, if not corrected then consider intubate+ventilate