Respiratory Failure
byBy
Dr. Adel HamadaLecturer of Chest Diseases
Faculty of Medicine Zagazig University
It is a condition in which the lung cannot
fulfill its primary function of maintaining
adequate gas exchange leading to PaO2 less
than 60mmHg and/or PaCO2 more than 50
mmHg .
Definition
- Hypxemia without hypercapnia.
-Level of PaO2 is less than 60mmHg at rest. While breathing
room air at see level-As severe pneumonia and ARDS.
-Hypoxemia with hypercapnia.-As 1. Depression of Respiratory centre-2. Disease of the respiratory bellows-3. COPD
Type I R.F (Hypoxaemic R.F):
Type II R.F (Hypercapnic R.F) :as
Gases Values
PaO2 80-100mmHg.
PaCO2 35- 45mmHg.
PH 7.35 - 7.45
HCO-3 22 -27 ml equivalent
SaO2 97-99%.
Normal values of arterial blood gases
Where P = partial pressure, a = arterial, O2= oxygen, CO2 = carbon dioxide, HCO-
3 = serum bicarbonate level, SaO2 = oxygen saturation of arterial blood
Pathogenesis
Type I1- ventilation
perfusion mis-match
2- Shunt effect
Type IIAlveolar
Hypoventilation
Causes of alveolar hypoventilation
generator Pump Effector organ
Presentation of respiratory failure
hypoxemia
hypercapneaBoth
Manifestation of precipitating cause
Plus
Dyspnea
Impaired mental status
headache
Tachycardia
Papiledema
Cyanosis
Lung examination
Symptoms
signs
Tremors
Treatment of respiratory failure
A B C D EMaintain adequate
oxygen delivery
Mechanical ventilation if indicated
Treatment of cause
Life threatening conditions
Acute severe asthma
COPD exacerbation
Severe pneumonia
Acute Respiratory Distress Syndrome
Acute massive pulmonary embolism
Acute severe asthma
An exacerbation of COPD is:
“an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.”
Manage Exacerbations: Key Points
The most common causes of COPD exacerbations are viral upper respiratory tract infections and infection of the tracheobronchial tree.
Diagnosis relies exclusively on the clinical presentation of the patient complaining of an acute change of symptoms that is beyond normal day-to-day variation.
The goal of treatment is to minimize the impact of the current exacerbation and to prevent the development of subsequent exacerbations.
Short-acting inhaled beta2-agonists with or without short-acting anticholinergics are usually the preferred bronchodilators for treatment of an exacerbation.
Systemic corticosteroids and antibiotics can shorten recovery time, improve lung function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk of early relapse, treatment failure, and length of hospital stay.
COPD exacerbations can often be prevented.
Manage Exacerbations: Key Points
Impact on symptoms
and lungfunction
Negativeimpact on
quality of life
Increasedeconomic
costs
Acceleratedlung function
decline
IncreasedMortality
EXACERBATIONS
Consequences Of COPD Exacerbations
Manage Exacerbations: Assessments
Arterial blood gas measurements (in hospital): PaO2 < 8.0 kPa with or without PaCO2 > 6.7 kPa when breathing room air indicates respiratory failure.Chest radiographs: useful to exclude alternative diagnoses. ECG: may aid in the diagnosis of coexisting cardiac problems. Whole blood count: identify polycythemia, anemia or bleeding. Purulent sputum during an exacerbation: indication to begin empirical antibiotic treatment.Biochemical tests: detect electrolyte disturbances, diabetes, and poor nutrition.Spirometric tests: not recommended during an exacerbation.
Manage Exacerbations: Treatment Options
Oxygen: titrate to improve the patient’s hypoxemia with a target saturation of 88-92%. Bronchodilators: Short-acting inhaled beta2-agonists with or without short-acting anticholinergics are preferred. Systemic Corticosteroids: Shorten recovery time, improve lung function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk of early relapse, treatment failure, and length of hospital stay. A dose of 30-40 mg prednisolone per day for 10-14 days is recommended.
Antibiotics should be given to patients with:
Three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence.
Who require mechanical ventilation.
Manage Exacerbations: Treatment Options
Noninvasive ventilation (NIV):
Improves respiratory acidosis, reduces respiratory rate, severity of dyspnea, complications and length of hospital stay.
decreases mortality and needs for intubation.
Manage Exacerbations: Treatment Options
Manage Exacerbations: Indications for Hospital Admission
Marked increase in intensity of symptoms Severe underlying COPD Onset of new physical signs Failure of an exacerbation to respond to
initial medical management Presence of serious comorbidities Frequent exacerbations Older age Insufficient home support
Severe pneumonia
ATS/IDSA Recommendations for Empirical Antibiotic Treatment of Community-Acquired Pneumonia
Definition:Form of acute lung injury characterized by non cardiogenic pulmonary
edema and refractory hypoxemia that is produced by neutrophil-
mediated cytotoxicity to lung cells (alveolar epithelium and capillary
endothelium) as a result of a wide variety of insults to the lung, either
directly or indirectly
Acute Respiratory Distress Syndrome
The Berlin Definition of Acute Respiratory Distress Syndrome
ETIOLOGY OF ARDS
Clinical Disorders Associated with Development of (ARDS)
RESCUE STRATEGIES FOR REFRACTORY
HYPOXEMIA
MANAGEMENT OF ARDS
VENTILATORY MANAGEMENT
SUPPORTIVE TREATMENT
Acute massive pulmonary embolism
Risk factors of pulmonary embolism
Treatment
Anticoagulant
Thrombolytic Therapy if haemodynamically unstable
THANK
YOU
Top Related