respiratory failure

Question 1

how is respiratory failure defined?

Answer 1

PaO2 <8kPa

Question 2

what is type 1 RF?

Answer 2

hypoxia with normal or low PaCO2. Caused by V/Q mismatch

Question 3

what are the causes of T1RF?

Answer 3

pneumonia 
pulmonary oedema 
PE 
Asthma 
Pulmonary fibrosis

Question 4

what is T2RF?

Answer 4

hypoxia with hypercapnia (PaCO2 > 6.0kPa). remember ‘type Co2.’ Typically caused by alveolar hypoventilation with or without V/Q mismatch

Question 5

what are the causes of T2RF?

Answer 5

pulmonary disease
- Asthma, COPD, pneumonia, fibrosis

Decreased respiratory drive
- sedatives, CNS tumour, trauma

Neuromuscular disease
- MG, GBS, diaphragm paralysis

Throacic wall disease
- flail chest, kyphoscoliosis

Question 6

what are the hypoxic symptoms seen in both types of respiratory failure?

Answer 6

dyspnoea 
restlessness 
agitation 
confusion 
central cyanosis

Question 7

what are the hypercapnic symptoms seen in T2RF?

Answer 7

headache 
bounding pulse 
tremor 
peripheral vasodilation 
tachycardia 
confusion 
papilloedema

Question 8

how is respiratory failure investigated?

Answer 8

blood tests

ABG

CXR

blood and sputum cultures

spirometry

Question 9

how is RF treated?

Answer 9

T1RF

• treat underlying cause
• Give 02 via face mask (35%-60%)
• if unresponsive to 60% then ventilate

T2RF

• treat cause
• controlled o2 therapy starting at 24%
• recheck ABG every 20 mins
• if PaCO2 unchanged or worse then increase to 28%
• ventilation if declining after that

Question 10

look at acid base notes

Answer 10

do it now