CVR resp failure Flashcards

(62 cards)

1
Q

systems/structures that fail in respiratory failure (3)

A
  1. nervous system
  2. respiratory muscle
  3. pulmonary
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2
Q

what is respiratory failure?

A

syndrome of inadequate gas exchange due to dysfunction of one/more components of the respiratory system

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3
Q

where can lesions occur in the nervous system to cause resp failure? (3)

A
  1. CNS/brainstem
  2. PNS
  3. neuro-muscular junction
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4
Q

issues with which resp muscles could lead to resp failure? (2)

A
  1. diaphragm/thoracic muscle

2. extra-thoracic muscle

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5
Q

pulmonary issues that could lead to resp failure? (3)

A
  1. airway disease
  2. alveolar-capillary
  3. circulation
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6
Q

what ranking are respiratory diseases for causing mortality?

A

3rd worldwide

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7
Q

cause of higher incidence of resp-related mortality in russia?

A

solid fuels in the home

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8
Q

what’s the biggest risk factor for males getting chronic resp disease?

A

smoking

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9
Q

what’s the biggest risk factor for females getting chronic resp disease?

A

household air pollution from solid fuels

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10
Q

what is an acute respiratory disease?

A

acute respiratory distress syndrome

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11
Q

what is seen on imaging in acute respiratory distress syndrome?

A

bilateral opacities

-> not fully explained by effusions, lobar, nodules

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12
Q

What is the criteria in regards to the origin of oedema in acute respiratory distress syndrome?

A
  • Can not be explained by cardiac failure or fluid overload

- Needs objective assessment e.g. echocardiography to exclude hydrostatic oedema if no risk factor present

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13
Q

What is the boundary for mild oxygenation in ARDS?

A

P/F ratio 200-300 mmhg

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14
Q

What is the boundry for moderate oxygenation in ARDS?

A

P/F RATIO 100-200 mmHg

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15
Q

What is the boundary for severe oxygenation in ARDS?

A

100mmHg>= PaO2/FIO2

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16
Q

what does severity of ARDS and increased age lead to?

A

increased mortality

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17
Q

classification of ARDS (3)

A
  1. acute
  2. chronic
  3. acute on chronic
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18
Q

causes of acute ARDS (3)

A
  1. pulmonary (infection, aspiration, primary graft dysfunction (Lung Tx)
  2. extra-pulmonary: trauma, pancreatitis, sepsis
  3. neuro-muscular: myasthenia/GBS
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19
Q

causes of chronic ARDS (2)

A
  1. pulmonary/airways: COPD, lung fibrosis, CF, lobectomy

2. musculoskeletal: muscular dystrophy

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20
Q

causes of acute on chronic ARDS (3)

A
  1. infection exacerbation: COPD, CF
  2. myasthenic crises
  3. post operative
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21
Q

classification groups for ARDS using physiological classification

A
  1. type I (hypoxemic)
  2. type II (hypercapnic)
  3. type III (perioperative resp failure)
  4. type IV (shock)
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22
Q

Features of type I ARDS (using physiologic classification) (3)

A

Failure of oxygen exchange

  1. increased shunt fraction
  2. due to alveolar flooding
  3. refractory hypoxemia to supplemental oxygen
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23
Q

Features of type II ARDS (using physiologic classification)

A

Failure to exchange or remove CO2

  1. decreased alveolar minute ventilation
  2. dead space ventilation
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24
Q

reasons for type I ARDS (using physiologic classification) (6)

A
  1. collapse
  2. aspiration
  3. pulmonary oedema
  4. fibrosis
  5. pulmonary embolism
  6. pulmonary hypertension
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25
reasons for type II ARDS (using physiologic classification) (5)
1. nervous system 2. neuromuscular 3. muscle failure 4. airway obstruction 5. chest wall deformity
26
reasons for type III ARDS (using physiologic classification)
1. increased atelectasis due to low functional residual capacity with abnormal abdominal wall mechanics 2. hypoxemia or hypercapnoea
27
prevention of type III ARDS (using physiologic classification)
``` Prevention: anaesthetic operative technique posture incentive spirometry analgesia attempt to lower intra-abdominal pressure ```
28
how to optimise typre IV ARDS (using physiologic classification)
optimise ventilation to improve gas exchange and to unload the resp muscles, lowering their O2 consumption. Ventilatory effects on right and left heart -> cause reduced afterload (good for LV), increased preload (bad for RV)
29
risk factors for chronic respiratory failure (6)
1. COPD 2. pollution 3. recurrent pneumonia 4. cystic fibrosis 5. pulmonary fibrosis 6. neuro-muscular disease
30
risk factors for acute respiratory failure (5)
1. infection (viral, bacterial) 2. aspiration 3. trauma 4. pancreatitis 5. transfusion
31
what is type I ARDS
failure of oxygen exchange
32
what is type II ARDS
failure to exchange or remove CO2
33
what is type III ARDS?
perioperative resp failure
34
what is type IV ARDS?
resp failure due to shock
35
what is used to classify ARDS? (4)
1. timing- needs to be acute 2. chest imaging- bilateral opacities 3. origin of oedema 4. PF ratio
36
PaO2 in type I ARDS?
<60 at sea level
37
Pa CO2 in type II ARDS>
>45 at sea level
38
what can cause pulmonary burns?
inhalation of ash
39
what do pulmonary causes of ARDS affect?
the alveolus
40
what do extra-pulmonary causes of ARDS affect?
systemic disease, causing inflammation response
41
what TNFR is implicated in lung damage in ARDS?
TNFR-1 (in vitro in animal studies)
42
where does macrophage activation occur in ARDS?
the alveoli
43
where do neutrophils migrate to in ARDS?
the lung
44
apoptotic mediators in ARDS? (3)
FAS, FAS-L, BCI-2
45
is proning beneficial to patients with ARDS?
yes
46
what can determine hyper and hypo inflammatory endotypes?
TNFR1, IL-6, IL-8, TNF-alpha
47
what PAMP is associated with alveolar damage?
RAGE
48
what PAMP is associated with vascular damage?
Ang-2
49
3 mechanisms of acute lung injury
1. inflammation 2. infection 3. immune response
50
therapeutic intervention in ARDS
1. treat underlying disease 2. respiratory support 3. multiple organ support
51
what are inotropes?
drugs that alter contractility of the <3
52
examples of respiratory support (5)
1. proning 2. non-rebreather face mask 3. non-invasive ventilation 4. intubation 5. ECMO cannulation
53
consequences from ARDS
1. poor gas exchange (poor perfusion, hypercapnoea) 2. infection (sepsis) 3. inflammation
54
how to minimise ventilator-induced lung injury
driving pressure management
55
types of imaging for the lungs
CT and lung USS
56
what score is used to grade the severity of lung injury in ards?
the Murray score (0->4) Its an average score of all 4 parameters: P/F ratio CXR PEEP Compliance (learn boundaries)
57
what is given if you have a poor Murray score?
ECMO
58
inclusion criteria for ECMO
1. severe resp failure | 2. +ve pressure ventilation isn't appropriate e.g. bad tracheal injury
59
exclusion criteria for ECMO
1. contraindication to continuation of active treatment 2. significant comorbidity -> dependency on ECMO support 3. significant life-limiting comobidity
60
issues with ECMO
time to access referral system consideration of referral
61
adv ECMO
improve oxygen delivery, improve carbon dioxide removal, rest lung and prevent ventilator associated lung injury, resolve respiratory acidosis, reduce multiple organ dysfunction arising from hypoxaemia and hypercarbia
62
disadv ECMO
``` Case selection, not universally available/inequity of provision of care, bleeding: intra-cerebral, venepuncture sites, epistaxis, haemoptysis, Haemolysis, infections from central dwelling canulae, cost. ```