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Year 3 > Respiratory failure (RESP) > Flashcards

Respiratory failure (RESP) Flashcards

1
Q

Define respiratory failure.

A

Acute or chronic inability of the respiratory system to maintain gas exchange causing hypoxia +/- hypercapnia - can lead to:

  • failure to oxygenate the body
  • failure to eliminate CO2
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2
Q

What is acute respiratory failure?

A
  • characterised by an acute lack of oxygen transfer to the blood by the respiratory system or acute failure of the respiratory system to remove CO2 from the blood
  • can be due to trauma, surgery or shock
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3
Q

What is chronic respiratory failure?

A
  • long-term lack of oxygen delivery to the blood by the respiratory system
  • causes progressively worsening respiratory acidosis with increased renal compensation and red cell count
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4
Q

List pulmonary causes of respiratory failure. (6)

A
  • acute exacerbation of asthma
  • PE
  • ARDS
  • pneumonia
  • pulmonary trauma
  • airway obstruction
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5
Q

List extrapulmonary causes of respiratory failure. (6)

A
  • CNS depression (narcotic OD or brain trauma)
  • respiratory muscle weakness (myasthenia gravis, MND)
  • decreased chest wall compliance
  • increased oxygen consumption or CO2 production (sepsis, cardiogenic shock)
  • hypovolaemia
  • shock
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6
Q

What are the types of respiratory failure? (4)

A
  • type 1 respiratory failure: hypoxia only
  • type 2 respiratory failure: hypoxia and hypercapnia
  • type 3 respiratory failure: peri-operative
  • type 4 respiratory failure: shock
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7
Q

Define type 1 respiratory failure.

A

Hypoxic (low oxygen PaO2<8kPa or <60mmHg) with normal CO2

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8
Q

Define type 2 respiratory failure.

A

Hypoxia AND hypercapnia (PaCO2>6kPa or >45mmHg)

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9
Q

List examples of type 2 respiratory failure. (2)

A
  • respiratory muscle weakness due to neurological conditions
  • COPD exacerbation
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10
Q

What are some causes of type 1 respiratory failure? (6)

A
  • fluid filling - pulmonary oedema
  • collapse of alveolar spaces - pneumothorax, pleural effusion
  • redistribution of blood flow
  • loss of blood flow - embolism, hypovolaemia, shock, anaemia
  • loss of tissue - emphysema, trauma, fibrosis
  • thickening/fluid buildup - pneumonia
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11
Q

What are some causes of type 2 respiratory failure? (4)

A
  • poor ventilatory muscle function (GBS, drug OD)
  • chest wall abnormalities (traumatic flail chest, kyphoscoliosis)
  • obstruction of airways (asthma, COPD, PO)
  • secretions (COPD, CF)
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12
Q

Describe type 3 respiratory failure. (5)

A
  • peri-operative respiratory failure
  • increased atelectasis due to low functional residual capacity
  • abnormal abdominal wall mechanics
  • results in hypoxemia and normal CO2/hypocapnia/hypercapnia
  • prevented by anaesthetic or operative technique, positioning, analgesia
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13
Q

Describe type 4 respiratory failure. (3)

A
  • patients that are intubated or ventilated during shock
  • optimise ventilation to improve gas exchange
  • unload respiratory muscles
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14
Q

What are the general clinical features of respiratory failure? (5)

A
  • direct trauma to thorax/neck
  • dyspnoea
  • confusion
  • tachypnoea
  • inability to speak
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15
Q

What might you find on examination of respiratory failure? (5)

A
  • accessory breathing muscle use
  • stridor
  • retraction of intercostal spaces
  • cyanosis
  • loss of airway/gag reflex
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16
Q

What are the clinical features of type 1 (hypoxemic) respiratory failure? (4)

A
  • tachypnoea
  • dyspnoea
  • cyanosis
  • pleuritic chest pain
17
Q

What are the clinical features of type 2 (hypercapnic) respiratory failure? (5)

A
  • hypoventilation
  • headache
  • anxiety
  • papilloedema
  • asterixis
18
Q

What is a feature of the hypoxemia in type 1 respiratory failure?

A

Hypoxemia refractory to supplemental oxygen

19
Q

What are some risk factors for respiratory failure? (7)

A
  • cigarette smoking
  • young/older age
  • respiratory system illness - pulmonary infection, chronic lung disease, airway obstruction, alveolar/perfusion abnormalities, pneumothorax
  • injury
  • infection
  • cardiac failure
  • hypercoagulable states
20
Q

What are the first-line investigations for respiratory failure? (2)

A
  • pulse oximetry (<80%)
  • ABG
21
Q

What might ABG show in respiratory failure? (3)

A
  • pH<7.38
  • pO2<60mmHg (<8kPa)
  • PaCO2>50mmHg (>6kPa)
22
Q

What might pulmonary function tests show in respiratory failure? (5)

A
  • PEFR <35-50% predicted
  • FEV <35-50% predicted
  • FVC <50-70% predicted
  • FEV1 <50% predicted
  • NIF above -25cm H2O
23
Q

What are some differential diagnoses for respiratory failure? (4)

A
  • hyperventilation secondary to metabolic acidosis - DKA, aspirin toxicity, Kussmaul breathing - ABG
  • hyperventilation secondary to anxiety
  • sleep apnoea
  • obesity
24
Q

What management approach do we take in respiratory failure?

A

ABCDE approach

25
Q

What is the first step in management of respiratory failure?

A

Check for airway obstruction –> airway clearance (head tilt, chin lift, jaw thrust)

26
Q

How do we manage respiratory failure with airway obstruction? (3+7)

A
  • airway clearance (head tilt, chin lift, jaw thrust)
  • supplementary oxygen
  • treatment of underlying causes:
    • infection –> Abx
    • anaphylaxis –> adrenaline
    • chronic lung disease –> bronchodilation/corticosteroids
    • pneumothorax –> decompression/chest tube insertion
    • hypovolaemia –> fluid resus
    • PE –> thrombolysis/embolectomy
    • malignancy –> chemotherapy
27
Q

How do we manage respiratory failure with no obstruction AND stable? (2+4)

A
  • supplemental oxygen
  • non-invasive ventilation - if PaCO2 rising:
    • CPAP or BiPAP - if oxygen delivered by nasal cannula/mask was unsuccessful
    • BiPAP/CPAP favoured for respiratory failure secondary to acute congestive HF
    • BiPAP very useful for management of hypercapnic respiratory failure
    • CPAP more used in type 1 respiratory failure
28
Q

How do we manage respiratory failure with no obstruction AND unconscious/unstable patient? (3)

A
  • endotracheal intubation
  • mechanical ventilation
  • rapid sequence induction
29
Q

How do we correct hypoxemia in respiratory failure via non-mechanical ventilation/oxygen support? (2)

A
  • nasal cannula
  • face mask
30
Q

What are the two types of mechanical ventilation in respiratory failure?

A
  • invasive (endotracheal intubation) - if patient unconscious and supplemental O2 not working
  • non-invasive (CPAP or BiPAP) - patient with type 2 respiratory failure secondary to chest wall deformity, neuromuscular disease or OSA
31
Q

Give an example of a group of patients we might offer CPAP/BiPAP to?

A

Acute exacerbation of COPD who are in respiratory acidosis (pH 7.25-7.35)

32
Q

What state should patients be in for CPAP/BiPAP (non-invasive ventilation)?

A

Awake and conscious

33
Q

What type of ventilation is used in type 1 respiratory failure?

A

CPAP - particularly useful in pulmonary oedema due to HF

34
Q

What type of ventilation is used in type 2 respiratory failure?

A

BiPAP

35
Q

What are some complications of respiratory failure? (7)

A
  • pneumothorax
  • endotracheal tube misplacement
  • nosocomial infection
  • nasal mucosa damage
  • dental injury
  • tracheal inflammation and stenosis
  • skin necrosis
36
Q

Describe the prognosis of respiratory failure.

A

Mortality is often related to patient’s overall health and potential development of systemic organ dysfunction that can occur with acute illness

Year 3 (203 decks)

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