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Respiratory Failure Flashcards

1
Q

Define respiratory failure.

A

syndrome of inadequate gas exchange due to dysfunction of one or more components of the respiratory system

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2
Q

List the components of the nervous system involved in respiratory function.

A

CNS/brainstem
PNS
NMJ

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3
Q

List respiratory muscles.

A

diaphragm
thoracic muscles
extra-thoracic muscles

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4
Q

What is the biggest risk factor for males developing chronic respiratory disease?

A

smoking

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5
Q

What is the biggest risk factor for females developing chronic respiratory disease?

A

household air pollution from solid fuels

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6
Q

What does ARDS stand for?

A

acute respiratory distress syndrome

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7
Q

What two factors increase mortality from acute respiratory disease?

A

severity

advanced age

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8
Q

Give examples of acute pulmonary respiratory disorders.

A

infection
aspiration
primary graft dysfunction

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9
Q

Give examples of acute extra-pulmonary respiratory disorders.

A

trauma
pancreatitis
sepsis

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10
Q

Give examples of acute neuro-muscular respiratory disorders.

A

myasthenia gravis

guillan barre syndrome

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11
Q

Give examples of chronic pulmonary respiratory disorders.

A

COPD
lung fibrosis
cystic fibrosis

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12
Q

Give examples of chronic musculoskeletal respiratory disorders.

A

muscular dystrophy

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13
Q

What is type I respiratory failure?

A

hypoxemic, failure of O2 exchange

[Increased shunt fraction due to alveolar flooding, hypoxemia refractory to supplemental oxygen]

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14
Q

What is type II respiratory failure?

A

hypercapnic, failure to exchange/remove CO2

[decreased alveolar minute ventilation, dead space ventilation]

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15
Q

What conditions fall under type I respiratory failure?

A 
collapse
aspiration
pulmonary oedema
fibrosis
pulmonary embolism
pulmonary hypertension
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16
Q

What conditions fall under type II respiratory failure?

A

muscle failure
airway obstruction
chest wall deformity

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17
Q

What is type III respiratory failure?

A

perioperative respiratory failure, hypoxaemia or hypercapnoea
[increased atelectasis due to low FRC w/ abnormal abdominal wall mechanics]

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18
Q

Prevention of type III respiratory failure?

A

anaesthetic or operative technique, posture, incentive spirometry, analgesia, attempts to lower intra abdominal pressure

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19
Q

What is type IV respiratory failure?

A

describes patients who are intubated and ventilated during shock (septic/ cardiogenic/ neurologic)

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20
Q

List risk factors for chronic respiratory failure.

A 
COPD
pollution
recurrent pneumonia
CF
pulmonary fibrosis
neuromuscular diseases
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21
Q

List risk factors for acute respiratory failure.

A 
infection
aspiration
trauma
pancreatitis
transfusion
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22
Q

List which criteria are used to classify ARDS.

A

acute onset, ratio PaO2/FiO2 of >200, regardless of positive end-expiratory pressure, bilateral infiltrates seen on frontal chest radiograph, pulmonary artery wedge pressure >18 mm Hg when measured, or no clinical evidence of LA hypertension.

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23
Q

List pulmonary causes of ARDS.

A 
aspiration
trauma
burns: inhalation
surgery
drug toxicity
infection
24
Q

List extra-pulmonary causes of ARDS.

A 
trauma
pancreatitis
burns
transfusion
surgery
bone marrow transplant
drug toxicity
infection
25
Response to acute lung injury
damage to interstitium > macrophages release cytokines > IL-6 +TNF alpha > activates TNFR-1 pathway > protein rich oedema > less efficient expanding migration of neutrophils increases diffusion distance, increases oedema
26
In vivo evidence of acute lung injury blocking mechanism
reduced injury in TNFR1 animal KO, blocking macrophage activation/ neutrophil migration, DAMP release e.g. HMGB1, cytokines IL6 IL8 IL1B
27
Therapies tried as pharmacological intervention for ARDS
``` steroids salbutamol surfactant N-Acetylcysteine neutrophil esterase inhibitor GM-CSF statins ```
28
Therapies being trialled for ARDS
``` mesenchymal stem cells keratinocyte growth factor microvesicles high dose vit C, thiamine, steroids ECCO2R ```
29
Underlying distinct biological processes in ARDS
pulmonary vascular endothelialitis thrombosis angiogenesis poor perfusion
30
List therapeutic interventions to treat underlying disease of respiratory failure.
inhaled e.g bronchodilators, pulm. vasodilators, steriods, antibiotics, antivirals, drugs e.g. pyridostigmine, plasma exchange, IViG, rituximab
31
List respiratory support therapeutic interventions of respiratory failure.
physiotherapy, oxygen, nebulisers, high flow, oxygen, non-invasive ventilation, mechanical ventilation, extra corporeal support
32
List cardiovascular support therapeutic interventions of respiratory failure.
fluids vasopressors inotropes pulmonary vasodilators
33
List renal support therapeutic interventions of respiratory failure.
haemofiltration | haemodialysis
34
List interventional immune therapies for multiple organ support of respiratory failure.
plasma exchange | convalescent plasma
35
ARDS and its sequelae include?
poor gas exchange: inadequate oxygenation, poor perfusion, hypercapnoea infection: sepsis inflammation, systemic effects
36
Types of ventilation?
Volume controlled Pressure controlled Assisted breathing modes Advanced ventilatory modes
37
How is compliance affected in respiratory failure?
reduced
38
How do you see change in compliance on a pressure-volume loop?
gradient of inspiratory curve is less steep in ARDS lung
39
What is upper inflection point?
above this pressure, additional alveolar recruitment requires disproportionate increases in applied airway pressure
40
What is lower inflection point?
can be thought of as minimum baseline pressure needed for optimal alveolar recruitment
41
pitfalls of ventilation
``` minute ventilation (PaCO2 control) alveolar recruitment (PEEP) V/Q mismatch (ventilation without gas exchange) ```
42
what is breath stacking?
when patients take a breath in, but are unable to get that air out, so it builds up and up in their lungs
43
breath stacking often occurs in what populations?
severe bronchospasm | COPD
44
what is driving pressure?
difference between peak and plateau (static) pressure
45
how to minimise ventilator induced lung injury?
keep driving pressure appropriate
46
what imaging modalities used to guide diagnosis and treatment in the management of the ARDS?
lung CT | lung ultrasound
47
how is escalation of therapy guided?
Murray Lung Injury score
48
what parameters make up the Murray score?
PaO2/FlO2 (on 100% oxygen) CXR PEEP Compliance (ml/cmH20)
49
a 0 Murray score indicates?
normal
50
a 1-2.5 Murray score indicates?
mild
51
a >2.5 Murray score indicates?
severe
52
a >3 Murray score indicates?
ECMO
53
inclusion criteria for ECMO?
severe resp. failure (non cardiac cause) Murray score > or = 3 positive pressure ventilation is not appropriate
54
when might positive pressure ventilation not be appropriate?
significant tracheal injury
55
exclusion criteria for ECMO?
contraindication to continuation of active treatment significant co-morbidity > dependency to ECMO support significant life limiting co-morbidity
56
what does ECMO stand for?
extracorporeal membrane oxygenation
57
what is ECMO?
technique of providing respiratory support; blood is circulated through an artificial lung consisting of two compartments separated by a gas-permeable membrane, blood on one side and ventilating gas on other

Cardiorespiratory (20 decks)

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