Acute respiratory failure
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Acute respiratory failure

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Acute respiratory failure

Acute respiratory failure

  • Type I:„acute hypoxaemic” PaO2 < 60 mmHg, PaCO2 normal or low due to diseases that damage lung tissue (right-to-left shunts or V/Q mismatch): pulmonary oedema, pneumonia, ARDS, pulmonary fibrosing alveolitis (chronic)

  • Type II:„ventilatory failure”

    PaO2 < 60 mmHg, PaCO2 > 55 mmHg due to insufficient alveolar ventilation (diminished carbon dioxide excretion): chronic bronchitis and emphysema (COPD), chest-wall deformities, respiratory muscle weakness (e.g. Guillain-Barre syndrome), depression of the respiratory centre.


Clinical assessment of respiratory distress

Clinical assessment of respiratory distress

  • The use of accessory muscles of respiration

  • Tachypnoe

  • Tachycardia

  • Sweating

  • Pulsus paradoxus

  • Inability to speak

  • Signs of CO2 retention (peripheral vasodilation, a bounding pulse, a coarse flapping tremor, confusion, progressive drowsiness, coma, papilloedema)

  • Asonchronous respiration

  • Paradoxical respiration


Gas blood analysis

Gas blood analysis

pH 7.35-7.45

PaO2 75-100 mmHg

PaCO235-45 mmHg

HCO3- 21-28 mmHg

HCO3-

pCO2

Saturation vs. oxygenation

SaO2 PaO2

pulse oximetry


Management of respiratory failure i c u

Management of respiratory failure – I.C.U.

  • Oxygen therapy

  • Respiratory support (e.g. IPPV, CPAP, IMV, HFJV).

  • Control of secretions

  • Treatment of pulmonary infection

  • Control of airways obstruction

  • Limitation of pulmonary oedema


Ards adult respiratory distress syndrome

ARDS = adult respiratory distress syndrome

Syndrome of severe dyspnoea, tachypnoea, cyanosis refractory to oxygen therapy, a reduction in lung compliance (stiff lungs), diffuse alveolar infiltrates on the chest X-ray

Causes: sepsis, shock, fat embolism, trauma, burns, acute pancreatitis, inhalation of smoke and toxic gases, amniotic fluid aspiration... usu. a part of MOF

Mortality: > 50% overall


Chronic respiratory failure

Chronic respiratory failure

  • COPD = chronic obstructive pulmonary disease, a condition of chronic obstruction to airflow due to:

  • Chronic bronchitis(cough with expectoration for at least 3 months of the year for more than 2 consecutive years).

  • Emphysema(permanent, abnormal distension of the air spaces distal to the terminal brochiole with destruction of alveolar septa).

  • Clinical picture:

  • „blue bloater” vs. „pink puffer”


Acute respiratory failure

Pleural disease

  • Dry pleurisy

  • Pleural effusion

  • Chylothorax

  • Empyema – complication of pneumonia

  • Pneumothorax

  • Malignancy


Acute respiratory failure

Exsudate vs. transsudate - causes


Acute respiratory failure

Exsudate vs. transsudate – laboratory features

  • Light’s criteria: exsudate when 1 criterion is present:

  • fluid protein/serum protein > 0.5

  • fluid LDH/serum LDH > 0.6

  • fluid LDH > 2/3 of upper normal value in serum


Pleural fluid examination

Pleural fluid examination

  • appearance

  • protein and LDH content

  • cellular content (lymphocytosis  malignancy, TBC)

  • pH (if  7.2 drainage of infected fluid is necessary)

  • glucose (< 3.3 mmol/l: RA, empyema)

  • amylase

  • cytology

  • bacterial culture

  • TBC


Pneumothorax

Pneumothorax

  • Trauma

  • Chronic bronchitis, emphysema

  • Spontaneous: tall and thin young males, M:F = 6:1, both lungs are effected with equal frequency

  • Lung carcinoma

  • Bronchial asthma


Pneumothorax management

Pneumothorax - management

  • Chest X-ray on expiration

  • Small pneumothorax: < 20% of radiographic volume: observe, avoidance of strenous exercise

  • Medium (20-50%): aspiration, intercostal drainage with underwater seal

  • Large (> 50%, shift of trachea and mediastinum): as above

  • Tension pneumothorax

  • Recurrent pneumothorax (more than twice): surgery (pleurectomy), talc pleurodesis.


Physical signs pleural effusion pneumothorax

Physical signs: pleural effusion, pneumothorax


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