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Respiratory > Acute and Chronic Respiratory Failure > Flashcards

Acute and Chronic Respiratory Failure Flashcards

1
Q

What is respiratory failure?

A

Lungs failing to adequately oxygenate arterial blood or prevents the retention of CO2

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2
Q

What is acute respiratory failure? (time, reversibility)

A

Abrupt onset of failure within hours to days

Can reverse or become chronic

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3
Q

What is chronic respiratory failure? (time, clinical course, reversibility)

A

Months to years
Can be insidious
Irreversible

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4
Q

What is the definition of acute on chronic respiratory failure?

A
  • Increased baseline oxygen requirements

- Increased CO2 above baseline to drop pH below 7.3

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5
Q

A pH drop below what level characterizes acute on chronic respiratory failure?

A

7.3

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6
Q

What is the usual cause of acute respiratory failure secondary to a ventilatory failure?

A

Drug overdose

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7
Q

What is the usual cause of acute respiratory failure secondary to a oxygenation failure?

A

Pneumonia

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8
Q

What is the usual cause of chronic respiratory failure secondary to a ventilatory failure?

A

Neuromuscular disease

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9
Q

What is the usual cause of acute respiratory failure secondary to a oxygenation failure?

A

Pulmonary fibrosis

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10
Q

What is the failure value of PaO2?

A

Less than 60 mmHg

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11
Q

What is the failure value of PaCO2?

A

More than 50 mmHg

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12
Q

True or false: PaO2 varies by age

A

True

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13
Q

What is normal PaCO2?

A

40 mmHg

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14
Q

What is the equation for PaO2 to adjust for age?

A

100.1 - 0.32(age)

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15
Q

What is the most common cause of respiratory failure? Second?

A

Malignant neoplasm

COPD and related

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16
Q

What percent of patients with AECOPD with admission PaCO2 greater than 50 mmHg will die in the hospital? In 6 months

A

11% in hospital

33% in 6 months

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17
Q

What are the four classifications of respiratory failure?

A
  1. Hypoxemic respiratory failure
  2. Hypercapnic respiratory failure
  3. Perioperative
  4. Shock
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18
Q

What is hypoxemic respiratory failure d/t?

A
  • R-L shunt
  • V/Q mismatch
  • Diffusion defect
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19
Q

What is the cause of hypercapnic respiratory failure?

A
  • Pump failure
  • Increased CO2 production
  • Deadspace
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20
Q

Blood flow to the respiratory muscles increase by how much in shock? What is the consequence of this?

A

10x

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21
Q

What are the four major host causes of hypoxemia?

A
  • Hypoventilation
  • Diffusion impairment
  • Shunt
  • V/Q mismatch
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22
Q

What is the major environmental causes of hypoxemia?

A

Low FiO2

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23
Q

If there is not an increase in PaO2 with oxygenation, what type of pathology should you suspect?

A

Shunting

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24
Q

What is the usual BP change with tissue hypoxia?

A

HTN

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25
Q

What are the CV changes late in the course of hypoxia?

A

Bradycardia

Hypotension

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26
Q

What is the best diagnostic tool to assess the cause of respiratory failure?

A

H&P

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27
Q

What is the normal A-aa gradient?

A

Less than 10 mmHg

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28
Q

What is the equation for the age adjusted A-a gradient?

A

age/4 +4

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29
Q

What is PaO2/FiO2? Why it it useful?

A

Determines the severity of respiratory failure

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30
Q

What are the mild, moderate, and severe levels of PaO2/FiO2?

A

Mild 300-200
Moderat 200-100
Severe less than 100

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31
Q

What do B lines on an US indicate?

A

Pulmonary edema

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32
Q

What are the three interventions that should be obtained with all patients in respiratory failure?

A
  • Oxygen
  • IV access
  • Vital sign monitoring
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33
Q

What are the four aspects of vital monitoring with patients in acute respiratory failure?

A
  • SpO2
  • HR
  • BP
  • EKG
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34
Q

What is the goal of advanced support for respiratory failure?

A

Provide adequate oxygen delivery to the tissues

35
Q

What is the role of vasodilators in CHF?

A

Reduce workload of the heart

36
Q

What is the goal Hb level for respiratory support?

A

More than 7 mg/dL, unless bleeding

37
Q

What is the goal MAP for respiratory failure?

A

more than 65 mmHg

38
Q

What is the amount of IVF that should be administered for advanced respiratory support?

A

30 ml/kg

39
Q

What is the goal lactic acid level for advanced respiratory support?

A

less than 4.0

40
Q

True or false: assessment and treatment occur simultaneously with respiratory distress?

A

True

41
Q

What is ventilatory failure?

A

Hypercapnic respiratory failure–alveolar ventilation becomes inadequate in relation to CO2 production

42
Q

Acute changes in PaCO2 developes rapidly enough to decreased pH to less than what level in hypercapnic respiratory failure?

A

7.3

43
Q

What are the two major causes of hypercapnic respiratory failure?

A
  • Ventilatory capability (pump failure)

- Ventilatory effort (drive failure)

44
Q

What is the equation for PaCO2?

A

K(VCO2/VA) | VA = alveolar ventilation, VE = minute ventilation
VCO2 = CO2 output

45
Q

What are the three major hypoventilation (drive) causes of hypercapnia?

A
  • Neuromuscular
  • Body habitus
  • Drugs
46
Q

What are the causes of increased CO2 production that can lead to hypercapnia?

A
  • sepsis
  • burns
  • seizures
47
Q

What are the three major components of the pump that can cause hypercapnia?

A
  • Airway obstruction
  • Respiratory muscle issue
  • V/Q mismatch
48
Q

An acute change in CO2 level of 10 decreases pH by how much?

A

0.08

49
Q

A chronic change in CO2 level of 10 decreases pH by how much? Why is this different from acute?

A

0.03

Kidney compensation by increased bicarb

50
Q

For every 10 rise of CO2 in acute respiratory acidosis, bicarb increases by how much?

A

1

51
Q

For every 10 rise of CO2 in chronic respiratory acidosis, bicarb increases by how much?

A

3

52
Q

For every 10 decrease of CO2 in acute respiratory acidosis, bicarb increases by how much?

A

2

53
Q

For every 10 decrease of CO2 in chronic respiratory acidosis, bicarb decreases by how much?

A

5

54
Q

What causes the CNX issues with hypercapnia?

A

Increased cerebral blood flow

55
Q

What are the three major clinical manifestations of ventilatory pump failure?

A
  • Dyspnea
  • Respiratory distress
  • CNX activation
56
Q

What are the two major clinical manifestations of ventilatory drive failure?

A

Bradypnea

Apnea

57
Q

GSC***

A
58
Q

What is the lab that is needed for a diagnosis of respiratory distress?

A

ABG

59
Q

True or false: intubation and mechanical ventilation aids in airway protection and secretion clearance

A

True

60
Q

What are the causes of hypercapnia from oxygen administration? (3)

A
  • Increased V/Q mismatch
  • attenuated hypoxic ventilatory drive
  • Haldane effect
61
Q

What is the Haldane effect?

A

Oxygen released bound CO2 increases PaCO2.

62
Q

Normal pH with elevated PaCO2 is suspicious for what?

A

Chronic respiratory failure

63
Q

What is the treatment for chronic respiratory failure?

A
  • Vaccination
  • Oxygen therapy
  • Mechanical ventilation
64
Q

What are the three major vaccines that should be administered to patients with chronic respiratory failure?

A
  • TDaP
  • Flu
  • Pneumococcal
65
Q

What percent of middle aged smokers have a sustained cessation effort after 5 year f/u?

A

22%

66
Q

What does oxygen administration not improve?

A

-lung function

67
Q

Oxygen administration for chronic respiratory failure does not improve survival in what patients?

A
  • Moderate hypoxemia (56-65 mmHg)

- Nocturnal hypoxemia

68
Q

What qualifies someone for home oxygenation?

A

PaO2 less than 55 mmHg or SaO2 less than 88%

69
Q

Patients with a PaO2 or 56-59 with what other factors qualify for home oxygen?

A
  • P pulmonale
  • pedal edema
  • Secondary erythrocytosis
70
Q

Is there a survival benefit with pulmonary rehab?

A

No

71
Q

What does pulmonary rehab improve?

A
  • Strength
  • Weaning outcomes
  • Functional status
72
Q

What is the 5 year survival rate for a lung transplant?

A

50%

73
Q

What are the two rate limiting steps for lung transplantation?

A
  • Chronic rejection

- infection

74
Q

What age do you need to be under to receive a lung transplant?

A

65

75
Q

What are the chronic infections that are absolute contraindications for a lung transplant?

A
  • HIV
  • Hep C
  • Hep B
76
Q

What type of musculoskeletal disease is an absolute contraindication for a lung transplant?

A

Kyphoscoliosis

77
Q

True or false: patients with major organ dysfunctions cannot receive lung transplants

A

true

78
Q

True or false: osteoporosis is an absolute contraindication for a lung transplant

A

False– relative

79
Q

True or false: BMI greater than 30 is an absolute contraindication for a lung transplant

A

False– relative

80
Q

True or false: steroid use is a relative contraindication for a lung transplant

A

True

81
Q

What are the PaO2 and PaCO2 findings with: hypoventilation?

A

Increased PaCO2

Decreased PaO2

82
Q

What are the PaO2 and PaCO2 findings with: ILDs?

A

Pure decrease in PaO2 with no change in PaCO2

83
Q

What are the PaO2 and PaCO2 findings with: ARDS?

A

Decrease in both PaO2 and PaCO2

84
Q

What are the PaO2 and PaCO2 findings with: COPD

A

Increased PaCO2
Decreased PaO2

Similar to hypoventilation, but less severe

Respiratory (34 decks)

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