Acute Respiratory Failure & ARDS Flashcards Preview

CVPR: Pulmonary > Acute Respiratory Failure & ARDS > Flashcards

Flashcards in Acute Respiratory Failure & ARDS Deck (8)
Loading flashcards...
1

Types of respiratory failure

  • hypoxemic
  • hypercapneic

2

Characteristics of hypoxemic respiratory

  • respiratory failure due to inadequate oxygenation
  • cause: any process that impairs oxygen transport across alveolar/capillary barrier

3

Examples of hypoxemic respiratory failure


  • alveolar filling processes:

    • LHF w/pulmonary edema


    • pneumonia 




    • alveolar hemorrhage 






    • ARDS 






  • extra-alveolar proccesses:
    • ​pulmonary vascular disease
    • shunt

 

 

4

Characteristics of hypercapneic respiratory failure

  • due to inadequate ventilation/inadequate CO2 removal
  • caused by any process that impairs ventilation
  • e.g. obstructive lung disease, restrictive lung disease, central hypoventilation

5

Four parameters for managing patients on the ventilator

  1. FIO2 - the fraction of inspired oxygen between 21% (room air) and 100% (pure oxygen.
  2. PEEP - Positive end-expiratory pressure.
  3. Respiratory rate 
  4. Tidal volume
  5. Ventilation (minute) = RR x TV
    1. increase these to increase ventilation
  6. Oxygenation determinants = FIO2 & PEEP
    1. increase these to increase oxygenation 

6

Dx criteria for ALI/ARDS

  • "Acute Lung Injury"/"Acute Respiratory Distress Syndrome"
  1. Diffuse bilateral radiographic infiltrates
  2. PaO2:FIO2 ratio < 300(ALI) or <200(ARDS)
  3. No evidence of a cardiogenic etiology (e.g. LHF)

7

Characteristics of ARDS + common causes

  • intense alveolar inflammation w/increased pulmonary capillary permeability ==>
  • neutrophil influx, epithelial cell damage/death, alveolar flooding, hyaline membrane deposition, hemmorhage
  • predisposition: inflammation
  • common causes: 
    • sepsis
    • pancreatitis
    • trauma
    • aspiration
    • transfusion

8

Strategies for management of ARDS to improve survival

  • ARMA trial ==> low tidal volumes = only successful tx to increase survival
    • 6 cc/kg = better volume (vs. 12 cc/kg)
  • continue low volumes even if pt develops hypercapnea and respiratory acidosis = "permissive hypercapnea"