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Y4 Respiratory > Respiratory failure & oxygen > Flashcards

Respiratory failure & oxygen Flashcards

1
Q

Go over this:

  • Bellows = diaphragm & muscles
  • Pumps = lungs
A
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2
Q

Go over this:

  • Causes of decreased capacity of ventilation
A
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3
Q

Appreciate this:

  • Simply shows factors which influence the capacity of the lungs need to be balanced against the factors which increase the load (work required by the diaphragm and muscles) to ensure adequate ventilation
  • If anything increases the load this may tip someone into respiratory failure
A
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4
Q

Go over this:

  • Causes of increased work of breathing/ventilation
A
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5
Q

Appreciate the control of the ventilation drive and some of the causes of depression of this signalling driving ventilation:

Causes of ventilation drive depression:

  • Opiods
  • Alcohol
  • Benzos
A
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6
Q

Define what respiratory failure is

A
  • This is where the respiratory system fails in one or both of its gas exchange functions; oxygenation and CO2 elimination
  • PaO2 < 8kPa
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7
Q

What are the 2 different types of respiratory failure?

A
  • Type I resp failure = hypoxia (PaO2 < 8kPa) with a normal or low PaCO2.
  • Type II resp failure = hypoxia (PaO2 < 8kPa) with hypercapnia (PaCO2 > 6kPa) (note - if chronic HCO3- will typically be high to try compensate, if acute this wont have had time to happen)
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8
Q

What are the 3 different ways in which onset of respiratory failure can occur ?

A
  • Acute = develops within minutes or hours in patients with no or minor evidence of pre-existing respiratory disease
  • Acute on chronic = an acute deterioration in an individual with pre-existing respiratory failure
  • Chronic = develops over several days or longer in patients with existing respiratory disease.
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9
Q

List some of the causes of type I respiratory failure

A

It is caused primarily by ventilation/perfusion (V/Q) mismatch e.g:

  • Pneumonia
  • Pulmnoary oedema
  • PE
  • Asthma
  • Emphysema
  • Pulmonary fibrosis
  • ARDS
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10
Q

List some of the causes of type II respiratory failure

A

This is caused by alveolar hypoventilation, with or without V/Q mismatch. Causes include:

  • Pulmonary disease - asthma, COPD, pneumonia, end-stage pulmonary fibrosis, obesity hypoventilation/obstructive sleep apnoea
  • Redcued respiratory drive - sedative drugs, CNS tumours or trauma
  • Neuromuscular disease - cervical cord lesion, diaphragmatic paralysis, poliomyelitis, myasthenia gravis, guillian barre syndrome
  • Chest wall deformity
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11
Q

What are the clinical features of respiratory failure ?

A

Hypoxia features:

  • Dysponea
  • Restlessness
  • Agitation
  • Confusion
  • Central cyanosis
  • If long-standing hypoxia - polcythaemia, pulmonary HTN, cor pulmonale

Hypercapnia features:

  • Headache
  • Peripheral vasodilatation
  • Tachycardia
  • Bounding pulse
  • Tremor/flap
  • Papilloedema
  • Confusion
  • Drowsiness
  • Coma
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12
Q

What investigations should be done in someone with respiratory failure to help determine the underlying cause ?

A
  • Blood tests - FBC, Us & Es, CRP, ABG’s
  • Radiology - CXR
  • Microbiology if febrile - sputum and blood cultures
  • Spirometry
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13
Q

In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given?

A

Via a reservoir mask at 15 l/min. Hypoxia kills.

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14
Q

What is the management of type I respiratory failure and what are the target O2 sats?

A
  • Treat the underlying cause
  • Give O2 (35-60%) via simple facemask to correct hypoxia
  • Assisted ventilation if PaO2 despite 60% O2
  • Target O2 sats are 94-98%

Note assisted ventilation options include - HFNC, CPAP, mechanical ventilation & ECMO

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15
Q

What is the management of type II respiratory failure ?

A
  1. Treat underlying cause
  2. Give controlled O2 therapy starting with 24 or 28% O2 using a venturi mask
  3. Obtain ABG’s

If pH ≥ 7.35 & pCO2 > 6kPa (hypercapnia) then treat with the lowest dose venturi mask that will keep O2 level within target of 88-92%

If pH < 7.35 and pCO2 > 6kPa (patient has resp acidosis or is tiring) Seek immediate senior review and consider NIV or ventilation

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16
Q

What is the primary indication for using NIV ?

A
17
Q

Describe the difference in the situations NIV vs CPAP

A
18
Q

List some of the situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia

A
  • Myocardial infarction and acute coronary syndromes
  • Stroke
  • Obstetric emergencies
  • Anxiety-related hyperventilation
19
Q

Go over the pressure curve for NIV

A

Go over the terminology of NIV

20
Q

What is the function of IPAP and EPAP used in NIV?

A
21
Q

In general what are the indications for and against NIV ?

A

Note it is often used as a trial before invasive ventilation

Additional contraindications:

  • Asthma
  • Pneumonia with T2RF
  • Extreme/profound hypoxia
22
Q

Re-cap of indications and contraindications for NIV

A

Y4 Respiratory (27 decks)

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