Pait Respiratory Failure
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Transcript of 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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