Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Respiratory failure

No description
by

benny goodman

on 24 November 2010

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Respiratory failure

Respiratory Failure Respiratory failure occurs when the respiratory system fails in oxygenation and/or carbon dioxide elimination. Hypoxaemic Hypercapnic Type 1:

PaO2 is less than 60 mmHg (8kPa) with a normal or low PaCO2. This is caused by ventilation-perfusion mismatch with either/both:

•Under-ventilated alveoli (e.g. pulmonary oedema, pneumonia or acute asthma).

•Venous blood bypasses ventilated alveoli (e.g. right to left cardiac shunts).

Hyperventilation increases CO2 removal but does not increase oxygenation as blood leaving unaffected alveoli is almost fully saturated. Type 2:
PaCO2 is more than 50 mmHg (6.5kPa) and indicates inadequate alveolar ventilation.
Any ventilation-perfusion mismatch will affect PaO2 and therefore hypoxaemia is also common. Common causes of type 1 * Chronic obstructive pulmonary disease
* Pneumonia
* Pulmonary oedema
* Pulmonary fibrosis
* Asthma
* Pneumothorax
* Pulmonary embolism
* Pulmonary arterial hypertension
* Cyanotic congenital heart disease
* Bronchiectasis
* Adult respiratory distress syndrome
* Kyphoscoliosis
* Obesity
Common causes of type 2 * Chronic obstructive pulmonary disease
* Severe asthma
* Drug overdose, poisoning
* Myasthenia gravis
* Polyneuropathy
* Poliomyelitis
* Muscle disorders
* Head and neck injuries
* Obesity
* Pulmonary oedema
* Adult respiratory distress syndrome
* Myxedoema
symptoms confusion
reduced LoC
breathless Signs
restlessness, anxiety, confusion, seizures, coma

Tachycardia and cardiac arrhythmias may result from hypoxaemia and acidosis.

Cyanosis.

Polycythaemia is a complication of long-standing hypoxaemia.

Cor pulmonale: pulmonary hypertension is frequently present and may induce right ventricular failure, leading to hepatomegaly and peripheral oedema.
investigations * Arterial blood gas analysis: confirmation of the diagnosis.
* Chest x-ray.
* Full blood count: anaemia can contribute to tissue hypoxia; polycythaemia may indicate chronic hypoxaemic respiratory failure.
* Renal and hepatic function: may provide clues to the aetiology or identify complications associated with respiratory failure. Abnormalities in electrolytes such as potassium, magnesium, and phosphate may aggravate respiratory failure and other organ function.
* Serum creatine kinase and troponin I: to help exclude recent myocardial infarction. An elevated creatine kinase may also indicate myositis.
* Thyroid function tests.
* Echocardiography: if a cardiac cause of acute respiratory failure is suspected.
* Pulmonary function tests are useful in the evaluation of chronic respiratory failure.
* ECG: to evaluate a cardiovascular cause and may also detect dysrhythmias resulting from severe hypoxaemia or acidosis.
* Right heart catheterization: should be considered if uncertainty about cardiac function, adequacy of volume resuscitation, and systemic oxygen delivery.
* Pulmonary capillary wedge pressure may be helpful in distinguishing cardiogenic from non-cardiogenic oedema.
* Arterial blood gas analysis: confirmation of the diagnosis.
* Chest x-ray.
* Full blood count: anaemia can contribute to tissue hypoxia; polycythaemia may indicate chronic hypoxaemic respiratory failure.
* Renal and hepatic function: may provide clues to the aetiology or identify complications associated with respiratory failure. Abnormalities in electrolytes such as potassium, magnesium, and phosphate may aggravate respiratory failure and other organ function.
* Serum creatine kinase and troponin I: to help exclude recent myocardial infarction. An elevated creatine kinase may also indicate myositis.
* Thyroid function tests.
* Echocardiography: if a cardiac cause of acute respiratory failure is suspected.
* Pulmonary function tests are useful in the evaluation of chronic respiratory failure.
* ECG: to evaluate a cardiovascular cause and may also detect dysrhythmias resulting from severe hypoxaemia or acidosis.
* Right heart catheterization: should be considered if uncertainty about cardiac function, adequacy of volume resuscitation, and systemic oxygen delivery.
* Pulmonary capillary wedge pressure may be helpful in distinguishing cardiogenic from non-cardiogenic oedema.
Management

* A patient with acute respiratory failure generally needs prompt admission to hospital. Most patients with chronic respiratory failure can be treated at home with oxygen as well as therapy for their underlying disease.
* Airway: ensure an adequate airway.
* Correction of hypoxaemia: ensure adequate oxygen delivery to tissues, generally achieved with a PaO2 of 60 mmHg or an arterial oxygen saturation (SaO2) of greater than 90%.
* Beware the prolonged use of high concentration oxygen in chronic sufferers who have become reliant on their hypoxic drive to maintain an adequate ventilation rate. Elevating the PaO2 too much may reduce the respiratory rate so that the PaCO2 may rise to dangerously high levels.
* Hypercapnia and respiratory acidosis: correct the underlying cause and/or provide assisted ventilation.
* Mechanical ventilation is used to increase PaO2 and to lower PaCO2. Mechanical ventilation also rests the respiratory muscles and is an appropriate therapy for respiratory muscle fatigue. Weaning patients with chronic respiratory failure off of mechanical ventilation may be very difficult.
* Appropriate management of the underlying disease.


complications * Pulmonary: e.g. pulmonary embolism, pulmonary fibrosis, and complications secondary to the use of mechanical ventilation.
* Cardiovascular: e.g. cor pulmonale, hypotension, reduced cardiac output, arrhythmias, pericarditis, and acute myocardial infarction.
* Gastrointestinal: e.g. haemorrhage, gastric distention, ileus, diarrhoea, and pneumoperitoneum. Stress ulceration is common in patients with acute respiratory failure.
* Polycythaemia.
* Hospital acquired infection: e.g. pneumonia, urinary tract infections, and catheter-related sepsis, are frequent complications of acute respiratory failure.
* Renal: acute renal failure and abnormalities of electrolytes and acid-base homeostasis are common in critically ill patients with respiratory failure.
* Nutritional: including malnutrition and complications related to administration of enteral or parenteral nutrition. Complications associated with naso-gastric tubes, e.g. abdominal distention and diarrhoea.
Prognosis

* The mortality rate associated with respiratory failure varies according to the underlying aetiology.
* The mortality rate for adult respiratory distress syndrome is approximately 40%.
* In patients with COPD and acute respiratory failure, the overall mortality rate is approximately 10%.
Document references

1. Roussos C, Koutsoukou A; Respiratory failure. Eur Respir J Suppl. 2003 Nov;47:3s-14s. [abstract]

Internet and further reading

* MBTS Guideline : Non-invasive ventilation in acute respiratory failure, British Thoracic Society (2002)
* Sharma S; Respiratory Failure. Emedicine; June 2006.
Full transcript