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Respiratory Failure Flashcards

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1
Q

Respiratory failure: physiologic definition is what?

A

Inability of the lungs to meet the metabolic demands of the body.
A failure of tissue oxygenation and/or CO2 homeostasis

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2
Q

A failure of tissue oxygenation and/or CO2 homeostasis simply put is what?

A

cant take in enough O2 or eliminate CO2 fast enough

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3
Q

Components of O2 delivery
O2 Deliver (DO2) =?

A

CO x CaO2

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4
Q

CaO2= ?

A

(1.34 x Hgb x HgbSat%) + (PaO2 x 0.003)

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5
Q

Oxygen Consumption
VO2 =

A

Q x (CaO2 x CvO2)

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6
Q

O2 Extraction Ratio
O2ER =

A

VO2/DO2(normal approx. 25%)

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7
Q

Normal at Sea Level
PIO2 =?
PAO2 =?
PACO2 =?
PAH2O =?
PaVO2 =?
PaO2 =?

A

.21 x (760-47) = 150mmHg
100
40
47
40
95

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8
Q

Types of Respiratory Failure
Hypercapnic RF:

A

PaCO2 > the patients normal value (> 45mmHg in a healthy person)
Pump Failure

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9
Q

Types of Respiratory Failure
Hypoxemic RF:

A

PaO2 < 60 mmHg
Lung Failure

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10
Q

Classes of Respiratory Failure
Type 1 Hypoxemic:
Mechanism =?
Etiology =?
Clinical Setting =?

A

Shunt
Airspace Flooding
Water, Blood or Pus filling the alveoli

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11
Q

Classes of Respiratory Failure
Type 2 Ventilatory:
Mechanism =?
Etiology =?
Clinical Setting =?

A

Decreased Va
Increased Respiratory Load, Decreased ventilatory drive
CNS depression, Bronchospasm, Stiff respiratory system, respiratory muscle failure

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12
Q

Classes of Respiratory Failure
Type 3 Post-op:
Mechanism =?
Etiology =?
Clinical Setting =?

A

Atelectasis
Decreased FRC and increased closing volume
Abdominal surgery, poor inspiratory effort, obesity

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13
Q

Classes of Respiratory Failure
Type 4 Shock:
Mechanism =?
Etiology =?
Clinical Setting =?

A

Decreased CO
Decreased FRC and increased Closing Volume
Sepsis, MI, acute hemorrhage

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14
Q

Important Equations
VE =?

A

VT x RR
VE is min ventilation

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15
Q

VE = alveolar respiration + deadspace

A

VA + VD

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16
Q

PaCO2 =?

A

K x VCO2/VA

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17
Q

PaCO2 ~ ?

A

VCO2/ (1 - VD/VT) x VE

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18
Q

Causes of Hypercapnic Respiratory Failure
CNS

A

Drugs
Disease of the medulla
Idiopathic (Odine’s curse)
Hypothyroidism
Central Sleep Apnea
Metabolic Alkalosis

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19
Q

Causes of Hypercapnic Respiratory Failure
Chest Bellows

A

ALS
Polio
Cord Injury
GBS
MG
Eaton Lambert myasthenic syndrome
phrenic nerve paralysis
NM d/o
tense ascites
post-op states
porphyria
fish toxins
critical illness polyneuropathy
Myopathy
Chest wall abnormalities

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20
Q

Causes Of Hypercapnic Respiratory Failure
Airway Disorders

A

Acute Asthma
COPD

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21
Q

Acute Hypercapnic Respiratory Failure
A decrease in CNS drive leads to?

A

Decrease in RR and VT

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22
Q

Acute Hypercapnic Respiratory Failure
A decrease in RR and VT leads to?

A

Decrease in VE and VA

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23
Q

Acute Hypercapnic Respiratory Failure
A decrease in VE and VA leads to?

A

Rise in PaCO2
Decrease in pH
Decrease in PaO2 (normal or mildly increased A-a gradient)

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24
Q

Decrease in pH
delta pH =?

A

0.008 x delta PaCO2

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25
Hypoventilation Patm O2 =? PAO2 =? PACO2 =? PAH2O =? PvO2 =? PaO2 =?
150mmHg 50 80 47 40 45
26
Acute Hypercapnic Respiratory Failure Decreased muscle strength leads to?
Decrease in VT Increase in RR Microatelectasis, surfactant inactivation
27
Acute Hypercapnic Respiratory Failure Decrease in VT and Increase in RR leads to?
Decrease in VE and VA Rise in PaCO2, Decrease in pH
28
Acute Hypercapnic Respiratory Failure Microatelectasis, surfactant inactivation leads to?
Decreased compliance Decreased PaO2 (Increased A-a gradient)
29
Acute Hypercapnic Respiratory Failure Asthma/COPD flare Limited Expiratory flow, bronchospasm and mucus leads to respiratory muscle fatigue how?
Increased work of breathing
30
Acute Hypercapnic Respiratory Failure Asthma/COPD flare Hyperinflation, flattened diaphragms leads to Respiratory muscle fatigue how?
Inefficient breathing
31
Acute Hypercapnic Respiratory Failure Asthma/COPD flare Fever leads to respiratory muscle fatigue how?
increased ventilatory demand
32
Acute Hypercapnic Respiratory Failure Asthma/COPD flare Increased VD/VT leads to Respiratory muscle fatigue how?
increased work of breathing
33
Classifications of Hypoxia
Hypoxemic Anemic Circulatory Histotoxic
34
Hypoxemic Hypoxia affects what portions of this equation DO2 =(Hb x 1.34 x SaO2) + (PaO2 x 0.003) x CO
SaO2 PaO2
35
Anemic Hypoxia affects what portions of this equation DO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003) x CO
Hb
36
Circulatory Hypoxia affects what portions of this equation DO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003) x CO
CO
37
Histotoxic Hypoxia affects what portions of this equation DO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003) x CO
O2 delivery is normal but metabolic pathways are blocked
38
Hypoxemic Respiratory Failure PaO2 < ? w/ normal or low ? and normal or high ?
60mmHg PaCO2 pH
39
What is the most common form of respiratory failure?
Hypoxemic
40
In hypoxemic respiratory failure what is sever to interfere w/ pulmonary O2 exchange? What is maintained?
lung disease ventilation
41
What is the physiologic cause of Hypoxemic Respiratory Failure?
V/Q Mismatch and shunt
42
Causes of Hypoxemic Respiratory Failure: Pathophysiology (5)
1. Decreased FiO2 2. Hypoventilation (PaCO2) 3. V/Q mismatch (eg. COPD) 4. Diffusion limitation 5. Intrapulmonary shunt
43
Causes of Hypoxemic Respiratory Failure: Pathophysiology Hypoventilation and V/Q mismatch also are forms of what?
Hypercapnic Respiratory Failure
44
Causes of Hypoxemic Respiratory Failure: Pathophysiology Intrapulmonary shunt examples?
pneumonia Atelectasis CHF (high pressure pulmonary edema) ARDS (low pressure pulmonary edema)
45
Sorting causes of hypoxemic respiratory failure: Value of CXR Clear Chest x-ray can mean
PE Asthma COPD Intracardiac shunt R to L
46
Sorting causes of hypoxemic respiratory failure: Value of CXR Focal abnormality on Chest x-ray can be?
Pneumonia Atelectasis Pneumothorax
47
Sorting causes of hypoxemic respiratory failure: Value of CXR Diffuse Infiltrates on Chest x-ray can be?
Cardiogenic pulmonary edema noncardiogenic pulmonary edema Interstitial pneumonitis or fibrosis Infections
48
The Alveolar gas equation PAO2 =?
FiO2 (Patm - PH2O) - PaCO2/R R = Respiratory quotient = 0.8
49
Mount Everest (8848m) PIO2 =? PAO2 =? PACO2 =? PAH2O =? PvO2 =? PaO2 =?
.21 x 253 = 53mmHg 43 7.5 ? ? 34
50
Hypoxemia with a Normal A-a gradient means?
low FiO2 Hypoventilation
51
Hypoxemia with increased A-a gradient means?
V/Q mismatch Shunt
52
Hypoxemic Respiratory Failure Normal A-a gradient Is PaCO2 elevated? Yes =? No =?
Hypoventilation High altitude Low inspired PO2
53
Hypoxemic Respiratory Failure Increased A-a gradient Does PaO2 improve w/ supplemental O2? Yes =? No =?
V/Q mismatch Shunt
54
V/Q mismatch can be from?
Airway disease (COPD, asthma, CF, BOS) Interstitial Lung Disease (IPF, sarcoid, NSIP, DIP) Alveolar Filling Pulmonary Vascular Disease (thromboembolism Fat embolism
55
Shunt can be from?
Alveolar filling Atelectasis Intrapulmonary vascular shunt (pulmonary AVM) Intracardiac Shunt (PFO, ASD, VSD)
56
Examples of Alveolar Filling include?
Pulmonary edema LVHF MV disease ALI/ARDS of any case Pneumonia Trauma Alveolar Hemorrhage Alveolar proteinosis Drugs TRALI Acute interstitial pneumonitis Acute eosinophilic pneumonia BOOP Aspiration Upper airway obstruction Near drowning
57
Principles of management for respiratory failure Hypoxemia is? Primary objective is to? Secondary objective is to? Treatment of? Patient's CNS and CVS must be?
life threatening reverse and prevent hypoxemia control PaCO2 and respiratory acidosis underlying disease monitored and treated
58
Oxygen Therapy Titration is based on?
SaO2, PaO2 levels and PaCO2
59
Oxygen Therapy Goal is to?
prevent tissue hypoxia
60
Oxygen Therapy Tiissue hypoxia occurs (normal Hb & CO) venous PaO2 < ? arterial PaO2
20mmHg or SaO2 < 40% 38mmHg or SaO2 < 70%
61
Oxygen Therapy Increase arterial PaO2 to > ?
PaO2 > 60 mmHg (SaO2 > 90%) or venous SaO2 > 60%
62
Oxygen Therapy O2 dose is based on what two factors?
flow rate (L/min) or FiO2 (%)
63
Oxygen Therapy PEEP is utilized to reduce?
FiO2
64
100% O2 flow rate (L/min) = what FiO2 (%) NC 1 2 3 4 5 6
24 28 32 36 40 44
65
100% O2 flow rate (L/min) = what FiO2 (%) Venturi Mask 3 6 9 12 15
24 28 35 40 50
66
100% O2 flow rate (L/min) = what FiO2 (%) NRB 4-10
60-80
67
Risks of O2 therapy O2 toxicity Very high levels (>100mmHg) can lead to? Lower levels (FiO2 > 60%) and longer exposure leads to? PaO2 > 150 can cause? FiO2 35-40% can be safely tolerated for how long?
CNS toxicity and seizures capillary damage, leak and pulmonary fibrosis retrolental fibroplasia indefinitely
68
Risks of O2 therapy CO2 narcosis PaCO2 may increased significantly to cause? PaCO2 increases secondary to combination of what?
respiratory acidosis, somnolence and coma abolition of hypoxic drive to breathe increased deadspace (worsening of VQ mismatch)
69
Hypercapnic Respiratory Failure Management goals are?
Prevent respiratory arrest in patients who are rapidly deteriorating Restore adequate gas exchange
70
Hypercapnic Respiratory Failure Management How to restore adequate gas exchange?
NPPV Intubation and mechanical ventilation

Acute Care I (30 decks)

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