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Respiratory Sytem > Respiratory Failure > Flashcards

Respiratory Failure Flashcards

1
Q

Compare Type 1 and Type 2 respiratory failure

Type 1 and 2 can co-exist, Type 1 can lead to Type 2

A

Type 1;

  • Low pO2
  • Normal or low pCO2
  • Failure of gas exchange

Type 2;

  • Low pO2
  • High pCO2
  • Failure of pump/ ventilation
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2
Q

List 4 effects of Hypoxaemia/ Hypoxia

A
  • Impaired CNS function
  • Cardiac arrhythmia
  • Hypoxic pulmonary vasoconstriction
  • Central cyanosis
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3
Q

List 4 effects of Hypercapnia

(If Chronic, Choroid Plexus imports HCO3 into CSF to restore brain ECF pH, so central chemoreceptors ‘reset’ to raised CO2)

A
  • Respiratory acidosis (Renally compensated)
  • Impaired CNS function
  • Peripheral vasodilation (‘Pink puffers’)
  • Cerebral vasodilation
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4
Q

Suggest 6 broad types of causes of Hypoxaemia

A
  • Low inspired pO2 (Type 1)
  • Hypoventilation (Type 2)
  • V/Q Mismatch (Type 1, Type 2 if severe)
  • Diffusion impairment (Type 1, may progress to Type 2)
  • Intrapulmonary shunts (ARDS, Type 1 may progress to Type 2)
  • Right to left shunts (Not a respiratory problem)
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5
Q

Suggest 3 adaptations in people who live at high altitudes

A
  • Polycythaemia (Increased EPO secretion)
  • Increased 2,3 DPG
  • Increased capillary density in tissues
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6
Q

Why do people at high altitudes have low pO2 and pCO2?

A
  • Peripheral chemoreceptors stimulated by low pO2

- Causes hyperventilation-> Increased CO2 removal

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7
Q

What are 2 consequences of chronic Hypoxaemia

A

Pulmonary hypertension-> Cor Pulmonale (RH Failure)

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8
Q

In Hypoventilation, insufficient air is moved in and out so low pO2 and high CO2 present.

What are 4 causes of Hypoventilation?

(Hypoventilation ALWAYS causes Type 2 failure)

A
  • Respiratory centre depression (injury, drug OD)
  • Respiratory muscle weakness
  • Chest wall problems
  • Severe lung fibrosis/ airway obstruction
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9
Q

How do you treat Type 2 Respiratory failure?

A

Controlled O2 Therapy;

  • Give 24% or 28% O2
  • To reach 88-92% saturation
  • Monitor CO2 to prevent dangerous hypercapnia
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10
Q

How can a PE affecting the Left Upper Lobe cause V/Q mismatch in the Left Lower Lobe and Right Lung?

A
  • Blood redirected away from L/ UL to L/ LL and Right Lobes (Increased Q here)
  • These areas need increased V to maintain ratio, so hyperventilation must occur
  • If hyperventilation is not sufficient, V/Q <1 in these areas of increased perfusion

(Hyperventilation causes normal or low pCO2)

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11
Q

Why can’t hyperventilation correct low pO2, leading to Type 1 respiratory failure (Low O2, low CO2)

A

Hb is fully saturated already, so V/Q >1 will only affect amount of dissolved O2 in blood, which is insufficient to correct Hypoxaemia

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12
Q

What are 3 changes that can impair diffusion?

Causes Type 1 as CO2 is less likely to be affected

A
  • Thickened barrier (fibrosis)
  • Lengthened pathway (Oedema where extra layer of fluid lengthens diffusion distance)
  • Reduced total SA for diffusion (Emphysema)
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13
Q

What do we meany Intra-pulmonary Shunt?

A

Perfusion of an alveoli with ZERO ventilation

V/Q=0

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14
Q

Suggest a condition that causes intrapulmonary shunting

A

Acute Respiratory Distress Syndrome (ARDS)

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15
Q

In what ways does ARDS causes intrapulmonary shunting?

ARDS is due to acute alveolar injury E.g sepsis, pneumonia, toxins

A
  • Increased vascular permeability
  • Oedema
  • Fibrin exudation
  • Loss of surfactant-> Stiff lungs
  • Decreased lung volumes
  • Alveolar collapse
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16
Q

A single disease may causes Hypoxaemia va multiple mechanisms.

Give some examples

A
  • Neonatal Respiratory Distress Syndrome;
    1. Lung stiffness-> Hypoventilation
    2. Alveoli collapse-> V/Q Mismatch
  • Type 1 respiratory failure can lead to Type 2 respiratory failure (E.g Asthma)
  • In chronic Type 2 failure, body adapts to raised CO2
17
Q

There are 2 mechanisms that explain why O2 therapy leads to rising CO2 in patients with Chronic CO2 retention (E.g COPD)

One of which, is the Peripheral Chemoreceptors no longer being stimulated.

How big of a role does this mechanism play?

A

Small part

18
Q

Other than that of the Peripheral Chemoreceptor, describe the mechanism that explains why O2 therapy can lead to a further rise in CO2 in some patients?

(This mechanism has 2 parts)

A
  1. O2 therapy leads to worsening V/Q Mismatch
    - Increased blood O2-> Less Hypoxic Pulmonary Vasoconstriction, so increased perfusion to poorly ventilated alveoli so less CO2 removal
  2. O2 therapy increases the Haldane Effect
  • Increased Hb O2 saturation, so Hb can’t carry as much CO2
  • Rise in dissolved CO2 levels

Respiratory Sytem (21 decks)

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