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”
slide7
Pleural disease
  • Dry pleurisy
  • Pleural effusion
  • Chylothorax
  • Empyema – complication of pneumonia
  • Pneumothorax
  • Malignancy
slide9
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.
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