Type 2 respiratory failure

Question 1

What is type 2 respiratory failure?

Answer 1

hypoxaemia and hypercapnia

Question 2

What are the signs of type 2 respiratory failure?

Answer 2

CO2 flap - hand tremor
Pursed lips
hypoxia
tachypnoea (or low resp rate if drug sedated or brain injury)

Question 3

What are the possible prior events?

Answer 3

reduced breathing effort in fatigued patient

decrease in area of lung available for gas exchange (COPD with emphysema)

Question 4

What is a signal that long term oxygen therapy is needed?

Answer 4

Low oxygen saturation
Ankle swelling

Patients with COPD with PaO2 <7.3kPa when stable
Patients with PaO2 between 7.3 and 8 kPa + secondary polycythaemia (increase haem conc), nocturnal hyperaemia, peripheral oedema, pulmonary hypertension

Question 5

What is a pink puffer?

Answer 5

Will maintain relatively normal blood gases at the expense of breathlessness - causes skeletal muscle wasting

Question 6

What is a blue bloater?

Answer 6

Less breathlessness but will have abnormal blood gas tensions and right heart failure

Question 7

What is the danger with giving high flow oxygen to someone in type 2 respiratory failure?

Answer 7

Causes hypoxic drive; if you give O2 their respiration will decrease, so increase blood CO2 and reduces consciousness

Question 8

Abnormal test results

Answer 8

PaO2 < 10
PaCO2 > 6
pH decreased (respiratory acidosis)

Question 9

Why can a chest infection in someone with emphysema/COPD lead to type 2 respiratory failure?

Answer 9

low oxygen reserves

Question 10

What is CO2 flap?

Answer 10

Asterixis = tremor of hands and arms (flapping tremor when holding hands out like a stop sign)

caused by abnormal function of motor systems in the brain

Question 11

What is ambulatory oxygen therapy?

Answer 11

Portable oxygen used outside the home

Question 12

What is short burst oxygen therapy?

Answer 12

intermittent use of oxygen, from a static cylinder.

Question 13

In those with chronically elevated CO2 levels, why does a high PCO2 not cause an increase in respiration? When will inspiratory muscles be stimulated to try and remove some CO2?

Answer 13

Chronic elevation of PCO2 means medullary chemoreceptors become insensitive to high PCO2

When PO2 gets very low and stimulated peripheral chemoreceptors

Question 14

What would be the treatment for someone in type 2 respiratory failure caused by an exacerbation of COPD/emphysema due to a bacterial infection?

Answer 14

B agonist to relax airway
Anticholinergic agents
Inhaled/oral steroids
Antibiotics
Flu vaccination 
Phsyio
Surgery

Question 15

How can surgery be used in COPD?

Answer 15

Remove bollous in bullous disease

Question 16

How does bronchoscope lung volume reduction and intrabronchial valves help to treat COPD?

Answer 16

Valves are inserted into the lungs to obstruct some airflow into particular lung parts - redirects the ventilation away from diseased lung tissue