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Heart, Lungs and Blood > Respiratory Faliure > Flashcards

Respiratory Faliure Flashcards

1
Q

what does hypoventilation mean

A

under breathing

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2
Q

what can hypoventilation cause

A

type 1 and 2 RF

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3
Q

what is hypoventilation caused by

A

inadequate alveolar ventilation resulting in low alveolar pO2 (and high pCO2)

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4
Q

when does hypoventilation occur

A

when the respiratory drive is impared

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5
Q

what does low FIO2 result in

A

low alveolar PO2

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6
Q

how do you manage low FIO2

A

supplemental o2

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7
Q

what does disease or damage to the basement membrane

A

a reduction in the amount of oxygen that diffuses across the interstitium and this results in Hypoxaemia

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8
Q

what are the oxygen values like for diffusion impairment

A

Normal PAO2 but reduced PaO2

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9
Q

what does TLCO measure

A

difusion capacity

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10
Q

how do you calculate TLCO

A

small amount of CO

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11
Q

what is the alveolar- arterial gradient used for

A

if theres a problem in diffusion capacity

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12
Q

what factors affect diffusion of gasses

A

surface area
thickness
diffusion coefficient
partial pressure

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13
Q

how do you manage diffusion impairment

A
  • Treatment of underlying condition if possible
    Supplemental oxygen
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14
Q

what are the types of shunt

A

physiological
anatomical
cardiac
pulmonary

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15
Q

what is an anatomical shunt

A

blood that goes from the right side to the left side of the heart without traversing pulmonary capillaries

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16
Q

What is the main difference between anatomical and physiological shunts

A

Anatomic shunts cause a ventilation-perfusion ratio of zero, and physiologic shunts cause a low ventilation-perfusion ratio, contributing to the lowering of partial pressure of oxygen (PaO2)

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17
Q

what does anatomical shunts result in

A

mixing of venous and arterial blood

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18
Q

how does anatomical shunts result in the mixing of venous and arterial blood

A
  • Deoxygenated blood from bronchial circulation → pulmonary veins
  • Deoxygenated blood from coronary circulation → Thebesian vein → left ventricle
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19
Q

what is a cardiac shunt

A

A cardiac shunt is a pattern of blood flow in the heart that deviates from the normal circuit of the circulatory system. It may be described as right-left, left-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemi

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20
Q

how can cardiac shunts arise

A

either congenital or acquired

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21
Q

what is a pulmonary shunt

A

passage of deoxygenated blood from the right side of the heart to the left side without participating in gas exchange in the pulmonary capillaries

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22
Q

what is a physiological shunt

A

when nonventilated alveoli remain perfused, thus functioning as a shunt even though there is not an anatomic anomaly

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23
Q

what are reasons for physiological shunts forming

A

consolidation e.g. pneumonia
atriovenous malformation
hypoxaemia

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24
Q

what is ventilation (v)

A

flow of oxygen into the alveoli

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25
Q

what is perfusion (Q)

A

the flow of blood of alveolar capillaries

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26
Q

what is a normal V/Q value

A

0.8 ratio

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27
Q

how do you calculate ventilation

A

alevolar ventilation rate x resp rate

28
Q

how do you calculate alveolar ventilation rate

A

tidal volume- alveolar dead space

29
Q

what is perfusion equal to

A

cardiac output

30
Q

where is ventilation lowest in the lung

A

apex

31
Q

why is ventilation lowest at the apex of the lung

A

Because more negative pleural pressure means higher transpulmonary pressure- more distending pressure on the alveoli
alveoli at functional residual capacity have lower compliance at this higher volume
less airflow during inspiration

32
Q

what happens to ventilation as you move down the lung

A

increases

33
Q

where is ventilation highest

A

lung base

34
Q

when is ventilation higher than perfusion

A

lung apex

35
Q

when is ventilation equal to perfusion

A

middle of the lung

36
Q

when is ventilation lower than perfusion

A

lung base

37
Q

what area is relativley over ventilated

A

lung apices

38
Q

what area is relativley over perfused

A

lung bases

39
Q

In healthy lungs, how is VQ mismatch minimised

A

Hypoxic Vasoconstriction which directs blood away from poorly ventilated areas

40
Q

what is anatomical dead space

A

the upper respiratory tract up to the terminal bronchioles
do not take part in gas exchange

41
Q

what is the function of anatomical dead space

A

warming, filtering and humidifcation of inspired air

42
Q

what is alveolar dead space

A

alveoli that have lost blood supply do not participate in gas exchange

43
Q

what is physiological dead space

A

Anatomical dead space + Alveolar dead space

44
Q

in healthy lungs what is the ratio of physiological dead space to anatomical dead space

A

they are equal

45
Q

what is hypoxic pulmonary vasoconstrictuon

A

constriction of pulmonary arteries in the presence of alveolar hypoxia to re-direct blood flow from areas that are poorly ventilated to areas that are well ventilated and more oxygen rich

46
Q

where are ABG’s taken from

A

A sample of blood is taken from an artery, usually the radial artery as that is the most accessible artery (or brachial artery or femoral artery)

47
Q

what is the difference between type 1 and type 2 resp faliure

A

type 1 has normal co2 levels

48
Q

what is acute resp faliure

A

sudden deterioration

49
Q

what is chronic resp faliure

A

gradual and usually permanent change

50
Q

what is acute on chronic resp faliure

A

worsening of existing abnormalities

51
Q

what is mechanism of resp faliure

A

Lung Failure → Gas Exchange Failure → Hypoxaemia Pump Failure → Ventilatory Failure → Hypercapnoea

52
Q

why does type 1 resp failure (hypoxaemic) occur

A

Due to disease of the lungs which prevents adequate oxygenation of the blood

53
Q

are the lungs able to excrete CO2 during type 1 resp failure

A

yes

54
Q

what are the oxygen and carbon levels like in type 1 respiratory failure

A

This results in ↓ O2 but normal or ↓ CO2 levels

55
Q

what are the 5 mechanisms of type 1 RF

A

Hypoventilation
Low inspired oxygen (FIO2)
Diffusion impairment
Shunt
Ventilation/perfusion (VQ) mismatch

56
Q

why does type 2 RF occur

A

Occurs due to failure of ventilation, resulting in alveolar hypoventilation

57
Q

what are the o2 levels and co2 levels like in type 2 rf

A

Hypoxaemia (pO2 < 8.0 KPa) and Hypercapnoea (pCO2 > 6.5 kPa)

58
Q

what is acute tyoe 2 Rf like

A

can develop within minutes to hours, renal buffering does not have time to act, so HCO3- remains normal and pH ↓↓ (= Acidosis)

59
Q

what is chronic type 2 RF like

A

can develop over several days to weeks, to months. The kidneys excrete H2CO3, reabsorb HCO3-, increasing its levels and slightly ↓ pH (Compensation)

60
Q

what are the causes of type II respiratory failure

A

chronic lung disease
chest wall deformity
Neuromuscular and peripheral nerve disorders
Neuro-muscular lung disorders
disorders of the respiratory centre

61
Q

how do you manage type 1 RF: hypoxaemia

A
  • Treatment of underlying condition
  • Correct hypoxaemia by giving oxygen and maintaining O2 saturation between 94- 98%
  • Intubation and ventilation
62
Q

what is the management of Type II RF: hypoxaemia and hypercapnoea

A
  • Treatment of underlying condition if possible eg COPD
  • Administering controlled O2 aiming to keep saturation between 88-92%
  • Non-invasive ventilation (NIV)
  • Intubation and ventilation
63
Q

what is cytotoxic or histotoxic hypoxia

A

(Cyanide poisoning impairs mitochondrial cytochrome oxidase): Reduced ability to utilise O2

64
Q

what is circulatory or stagnant hypoxia

A

(heart failure): Reduced ability to deliver O2

65
Q

what is anaemic hypoxia

A

(CO poisoning): Reduced ability to deliver O2

66
Q

what is Hypoxaemic or hypoxic hypoxia

A

(PaO2): Reduced ability to deliver O2

Heart, Lungs and Blood (51 decks)

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