pait respiratory failure

7/21/2019 Pait Respiratory Failure

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Respiratory Failure (RF)


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Respiratory system includes:

CNS (medulla)Peripheral nervous system (phrenic

nerve) Respiratory musclesChest wallLungUpper airway

Bronchial treeAlveoliPulmonary

vasculature


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Potential causes o Respiratory !ailure


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Arterial Blood Gases (ABG)Normal values at sea level

pH 7.357.!5

"a#$ %7& mmH'

"a#$ 35!5 mmH'

H#3 $$$ mmol*l

+pH Acidosis

,pH Al-alosis

+ "a#$ Hypoemia

,"a#$ Hypercapnia +pH/ ,"a#$ R. acidosis

,H#3

,pH/+"a#$ R.Al-alosis

+H#3


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Respiratory Failure (RF)

0e1initions

linical conditions in

2ic "a#$ 4 & mmH'

2ile 6reatin' room air

or a "a#$ % 5& mmH'

Failure o1 oy'enation

and car6on dioide

elimination

Acute and cronic

ype 8 or $


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lassi1ication o1 RF

ype 8 Hypoemic RF

"a#$ 4 & mmH' 2it

normal or + "a#$ Associated 2it acute

diseases o1 te lun'

"ulmonary edema

(ardio'enic9noncardio'enic (AR0)9

pneumonia9 pulmonary

emorra'e

ype $ Hypercapnic RF

"a#$ % 5& mmH'

Hypoemia is present

0ru' overdose9

neuromuscular disease9

cest 2all de1ormity9

#"09 and Broncialastma


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0istinction 6et2een Acute and ronic RF

Acute RF

0evelops over minutes to

ours

+ pH ;uic-ly to 47.$


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"atopysiolo'ic causes o1 RF

"Hypoventilation

>?*" mismatc

>unt

>0i11usion

a6normality


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Assesment

#istory As$ i there is a

%& respiratory symptoms related to any underlyingdiseases ( S'B cough (productivenonproductive)pleuritic chest pain ever PN* orthopnea etc

+& symptoms o CNS involvement (muscle wea$nesshead in,ury headache) and Cardiovasvular ( chestpain palpitation)

-& .edical history/& *rug history 0 1eta 1loc$ers (asthma) CNS

depression drug

2& Social history


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"ysical eamination

3eneral inspection

Posture s$in colour (peripheral or central

cyanosis) clu11ing inger pitting oedema

temperature pulse Chest 0 chest shape chest movement

(symmetrically or unilaterally) 4wor$ o

1reathing5 (any use o accessory muscle)

respiration rate type o 1reathing pattern(6ussmaul Cheyne7sto$es)


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Palpation 0 chest e8pansion any tendernessany mass or lung cancer

Percussion 0 hyper resonant stony dull dull

related to underlying diseasesAuscultation 0 chec$ or any additional sounds

related to underlying diseases

CNS e8amination i there is CNS involvement in

the underlying disease


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linical (symptoms9 si'ns)

Hypoxemia

0yspnea9 yanosis

on1usion9 somnolence9 1its

acycardia9 arrytmia acypnea ('ood si'n)

@se o1 accessory ms

Nasal 1larin'

Recession o1 intercostal ms "olycytemia

"ulmonary Hypertension9orpulmonale9

Hypercapnia

,ere6ral 6lood 1lo29 andF "ressure

Headace

Asteriis

"apilloedema

arm etremities9collapsin' pulse

Acidosis (respiratory9 andmeta6olic)

+pH9 , lactic acid


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auses 8 N

0epression o1 te neural

Brain stem tumors or vascular

a6normality

#verdose o1 a narcotic9 sedative

Cyedema9 cronic meta6olic

al-alosis

Acute or cronic ypoventilation and ypercapnia


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$ 0isorders o1 periperal

nervous system9 Respiratory

muscle9 and est 2all

Dna6ility to maintain a levelo1 minute ventilation

appropriate 1or te rate o1

#$ production

GuillianBarre syndrome9

muscular dystropy9

Hypoemia and ypercapnia


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3 A6normities o1 te

air2ays

@pper air2ays

Acute epi'lotitis raceal tumors

Eo2er air2ay

#"09 Astma9 cystic

1i6rosis Acute and cronic

ypercapnia


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! A6normities o1 te

alveoli

0i11use alveolar 1illin'

ypoemic RF ardio'enic and

noncardio'enic

pulmonary edema

Aspiration pneumonia "ulmonary emorra'e

Associate 2it

Dntrapulmonary sunt and

increase 2or- o1 6reatin'


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Dnvesti'ations

ABG

B9 H6

Anemia tissue ypoemia

"olycytemia cronic RF

@rea9 reatinine

EF clues to RF orits complications


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est ray "ulmonary edema AR0


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Cana'ement o1 RF

D@ admition

8 Air2ay mana'ement


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$ orrection o1 ypoemia

#$ administration vianasal pron's9 1ace mas-9intu6ation and Cecanical

ventilation Goal: Ade;uate #$

delivery to tissues

"a#$ I % & mmH'

Arterial #$ saturation%J&K


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3 orrection o1 ypercapnia

ontrol te underlyin' cause

ontrolled #$ supply

8 3 lit*min9 titrate accordin'#$ saturation

#$ supply to -eep te #$

saturation %J&K


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! Cecanical ventilation Dncrease "a#$

Eo2er "a#$

Rest respiratory ms(respiratory ms 1ati'ue)

?entilator Assists or controls tepatient 6reatin'

e lo2est FD#$ tatproduces a#$ %J&K and"#$ %& mmH' sould 6e'iven to avoid #$ toicity


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Noninvasive?entilatory support

Cild to moderate RF

"atient sould ave Dntact air2ay9

Alert9 normal air2ayprotective re1lees

Nasal or 1ull 1ace mas-

Dmprove oy'enation9 Reduce 2or- o1

6reatin'

Dncrease cardiac output

#"09 astma9 HF


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7 reatment o1 teunderlyin' causes

A1ter correction o1 ypoemia9emodynamic sta6ility

Anti6iotics "neumonia

Dn1ection

Broncodilators (#"09 BA)

al6utamol reduce 6roncospasm air2ay resistance


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7 reatment o1 te

underlyin' causes

Anticoliner'ics(#"09BA)

D6ratropium 6romide ini6it va'al tone

rela smoot ms

eopylline (#"09 BA)

improve diapra'matic

contraction

rela smoot ms

0iuretics (pulmonary edema)

Frusemide9 CetalLone


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7 reatment o1 teunderlyin' causes

Cetyl prednisone(#"09BA) Reverse 6roncospasm9

in1lammation

Fluids and electrolytes Caintain 1luid 6alance and

avoid 1luid overload D? nutritional support

o restore stren't9 loss o1ms mass

Fat9 car6oydrate9 protein


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7 reatment o1 te

underlyin' causes

"ysioterapy

est percussion toloosen secretion

uction o1 air2ays

Help to drain secretion

Caintain alveolarin1lation

"revent atelectasis9 elp

lun' epansion


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eanin' 1rom mecanical ventilation ta6le underlyin' respiratory status

Ade;uate oy'enation Dntact respiratory drive

ta6le cardiovascular status

"atient is a 2a-e9 as 'ood nutrition9 a6le to cou' and

6reat deeply


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pait respiratory failure

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