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Respiratory failure Flashcards

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1
Q

Respiratory insufficiency

A

The inability of the respiratory system to provide adequate gas exchange and keep the levels of CO2 and/or O2 within a normal range. ALTERED V/Q RATE

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2
Q

Limits of respiratory sufficiency in arterial blood

A

PO2 larger or equal to 60 mmHg
&
PCO2 smaller or equal to 50 mmHg

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3
Q

Limits of respiratory insufficiency in arterial blood

A

PO2 smaller than 60 mmHg and PCO2 larger than 50 mmHg

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4
Q

ventilation

A

breathing (getting air in)

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5
Q

diffusion

A

gases get diffused passively from higher to lower partial pressure areas in between capillaries and alveoli (ALVEOLO-CAPILLARY BARRIER)

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6
Q

perfusion

A

the amount of blood that reaches the alveoli

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7
Q

Minute ventilation

A

the total volume of gas entering the lungs per minute. VE=tidal volume*respiratory rate

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8
Q

Alveolar ventilation

A

the volume of gas entering the alveoli per unit of time. VA=(tidal volume-dead space)*respiratory rate

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9
Q

Dead space ventilation

A

the volume of gas per unit of time that comes in to the respiratory system but does not reach the alveoli. VD=dead space*respiratory rate

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10
Q

VENTILATION/PERFUSION RATIO

A

the amount of air that reaches the alveoli divided by the amount of blood reaching the alveoli in a unit of time V/Q

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11
Q

adequate V/Q

A

0,8

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12
Q

Increased V/Q rate

A

Proper ventilation, hypoperfusion

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13
Q

Decreased V/Q rate

A

Alveolar hypoventilation, correct perfusion

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14
Q

Inadequate transfer of O2 can be a problem in

A

ventilation (environment-> alveoli) or perfusion (alveoli -> pulmonary circulation)

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15
Q

Factors affecting diffusion

A 
Thickness
Surface area (atelectasis)
Contact time
Gas solubility (CO2 has higher solubility than O2)
Pressure difference
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16
Q

Consequences of respiratory insufficiency

A

Hypoxemia and/or hypercapnia

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17
Q

Hypoxemia and hypercapnia

A

Total respiratory insufficiency

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18
Q

Hypoxemia without hypercapnia

A

Partial respiratory insufficiency

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19
Q

Types of respiratory failure

Study These Flashcards
A
  1. ventilation failure
  2. 1 obstructive
  3. 2 restrictive
  4. diffusion failure
  5. V/Q mismatch failure
20
Q

Obstructive lung disease aetiology

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A

Bronchitis
tracheal collapse
foreign body

21
Q

Obstruction can lead to

Study These Flashcards
A

alveolar rupture (emphysema)

22
Q

restrictive lung disease

Study These Flashcards
A

deacreased lung volume due to decreased ability of the lungs to expand

23
Q

Restrictive lung disease aetiology

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A
  1. insufficient contraction of the respiratory muscles due to
  2. 1 neuromuscular disease
  3. 2 pain
  4. Increased resistance to lung expansion
  5. 1 pleural disease
  6. 2 anatomical abnormalities
  7. 3 thoracic or mediastinal mass
  8. pulmonary disease that alters lung elasticity
24
Q

Intrapulmonary causes of restrictive respiratory insufficiency

Study These Flashcards
A
  • oedema
  • interstitial pneumonia
  • alveolar fibrosis
25
Intrapulmonary causes of restrictive respiratory insufficiency lead to
reduced elasticity and thus decreased volume of inspired or expired air in each breath (tidal volume) Hypoxemia and hypercapnia Exhaustion of respiratory muscles
26
Extrapulmonary causes of restrictive respiratory insufficiency
Pulmonary compression Pleural effussion Pneumothorax Tumors/masses
27
Extrapulmonary causes of restrictive respiratory insufficiency lead to
Reduced ventilation (though with Normal Perfusion), and thus decreased volume of inspired or expired air in each breath (tidal volume) Hypoxemia and hypercapnia Exhaustion of respiratory muscles
28
Clinical signs of restrictive lung disease
Tachypnoea, shallow respiration | Mixed dyspnoea
29
RESPIRATORY INSUFFICIENCY DUE TO DIFFUSION ALTERATIONS can be caused because of
Increased thickness of alveolo-capillary barrier (fibrosis or oedema) or decreased contact surface (emphysema or obstructed blood vessel)
30
Why mild diffusion defect leads to hypoxia only?
CO2 has 20x higher diffusion rate
31
Hypercapnia is a sign of
Severe diffusion defect
32
Diffusion takes how much time in normal resting conditions?
0,3s
33
What is the contact time of diffusion in rest and why?
0,75 s, because then during exercise when blood is moving faster there is possibility to get adequate gas exchange
34
What happens in moderate diffusion alteration?
Hypoxia during excersise not in rest, may lead to hypocapnia because of the impaired O2/CO2 balance and the much faster diffusion rate of CO2
35
What happens in severe diffusion alteration?
Hypoxia and hypercapnia also during rest. Eventually metabolic acidosis
36
Does hyperventilation work for hypoxia/hypercapnia?
More effective for hypercapnia -> can lead to hypocapnia
37
HIGH V/Q mismatch failure
Some area is poorly perfused, due to thromoembolism
38
Consequences of high V/Q mismatch failure?
Increases in dead space: Useless ventilatory effort
39
LOW V/Q mismatch failure
Poorly ventilated area
40
Compensatory mechanism of high V/Q failure
bronchoconstriction
41
Consequences of low V/Q mismatch
Heart gets poorly oxygenated blood -> increased cardiac effort
42
Compensatory mechanism of low V/Q mismatch failure
Hypoxic vasoconstriction and pulmonary artery hypertension
43
Hypoxia can be
hypoxic anaemic circulatory histotoxic
44
Hypoxic hypoxia aetiology
High altitude Respiratory failure Blend of arterial and venous blood
45
Hypoxia compensatory mechanism
• HYPERVENTILATION: due to stimulation of the peripheral chemoreceptor located on the carotid body • POLYCITAEMIA: due to increased production of EPO • SHIFTED BLOOD FLOW: cutaneous and visceral vasoconstriction and cerebral and coronary vasodilation • PRODUCTION OF 2,3 DPG. It is an enzyme produced in RBC’s in response to hypoxia. It decreases HB affinity for O2, easing its releases to tissues. • CIRCULATORY (increased Cardiac output): Tachycardia increased stroke volume
46
HYPERCAPNIA consequences
Hyperventilation (Respiratory centre stimulation) – Central vasoconstriction and peripheral and cerebral vasodilation • Increased intracranial pressure • CNS excitation  depression if prolonged – Renal: •  Elimination of H+ and bicarbonate retention  bladder stones – Increase bone resorption (carbonate as a pH buffer): osteoporosis – Potassium: hyperpotassemia. Reduced kidney excretion due to H+ excretion

Clinical pathology (8 decks)

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