respiratory failure

Ronald Chrisbianto Gani405090223

Faculty of MedicineTarumanagara University

EMERGENCY MEDICINE BLOCK

RESPIRATORY FAILURE

RESPIRATORY FAILURE

RESPIRATORY FAILURE

• Inadequate blood oxygenation or cabon dioxide removal

• Classified as– Hypercapnic Respiratory Failure– Hypoxemic Respiratory Failure

Fishman’s Pulmonary Diseases & Disorders 4th Ed

ETIOLOGY• Central nervous system

– Sedative/narcotic overdose– Meningoencephalitis– Tumirs or vascular

abnormalities of medulla– Strokes– Severe myxedema– Hepatic failure– Advanced Uremia– Obesity-hypoventilation

syndrome

• Perpipheral Nervous system or Chest Wall– GBS– Mysathenia Gravis– Polymiositis– Muscular dystrophies– Acute Poliomyelitis– Traumatic Spinal Cord

Injury– Severe kyphoscoliosis– Flail chest, morbid obesity


ETIOLOGY

• Airways– Epiglotitis– Foreign body aspiration– Tracheal tumor– COPD– Asthma– Advanced cystic fibrosis

• Alveoli– Pulmonary edema– Diffuse pneumonia– Pulmonary hemmorhage– Aspiration of stomach

contents– Near-drowning


CLASSIFICATION


PATHOPHYSIOLOGY


MANAGEMENT

• Blood gas analysis for confirmation• Triage, based on– Acuity of the respiratory failure– Degree of hypoxemia, hypercapnia, acidemia– Presence of co-morbidities (cardiac/renal disease)

• Airway Management– Emergency intubation or ventilator depends on

clinical condition and arterial blood gas test


MANAGEMENT

• Correction of Hypoxemia and Hypercapnia– Hypoxemia correction to PaO2 60mmHg, higher

in patients with coronary or CVD – May use face mask or Venturi Mask (high flow O2)– May require intubation or ventilator

• Search for underlying cause


MANAGEMENT

• Monitoring– Acute : RR, tidal volume, use of accessory muscles,

paradoxical breathing movement– Mechanical ventilation related complications– Status asthmaticus hypotension due to intrinsic

PEEP alter ventilator, implement sedation or paralytic agents


COMPLICATIONS


PROGNOSIS

• Acute hypoxemic respiratory failure– Survival rate 60%– Worse outcomes in old patients and patients with

pre-existing lung disease– 2/3 survivors impaired pulmonary function


PROGNOSIS

• Acute hypercapnic respiratory failure– Mortality depends on• Patient physiological reserve (cardiac, renal, hepatic

status, patient’s age)• Underlying causes• Severity of respiratory failure (pH and PCO2)• Complications after onset (sepsis, pneumonia, GI bleed)• Cachexia and hime confinement poor outcome


REFERENCES

• Fishman AP, Elias JA, Fishman JA, Grippi MA, editors. Fishman’s Pulmonary Diseases and Disorders. 4th Ed. New York : McGraw-Hill, 2008

• Marx JA, Hockberger RS, Walls RM, Adams JG, editors. Rosen’s Emergency Medicine Concepts and Clinical Practice. 7th Ed. Philadelpia : Mosby Elsevier, 2010

respiratory failure

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