Respiratory Failure Flashcards

Question

What is type 2 resp failure

Answer 1

PaO2 <8 | PaCO2 >6

Answer 2

``` Alveolar hypoventilation with or without V/Q mismatch Ventilation issue Asthma COPD OSA Fibrosis Drugs CNS tumour Trauma Neuromuscular Thoracic wall disease ```

Answer 3

``` Hypercapnia Headache Peripheral vasodilation Tachycardia Bounding pulse Tremor Papilloedema Confusion Drowsy Coma ```

Answer 4

``` Treat underlying cause Beware of hypoxic drive Controlled O2 Check ABG regularly Consider NIPPV if CO2 rising Bipap Intubation if this fails ECMO ```

Answer 5

RHF due to pulmonary hypertension caused by respiratory disease

Answer 6

Chronic lung disease - COPD = most common - Fibrosis - Severe asthma - Bronchiectasis - CF ``` Pulmonary vascular - PE - Vasculitis - PPH - ARDS - Sickle Neuromuscular - MS / MG Chest deformity / scoliosis Hypoventilation - OSA / adenoids Cerebrovascular ```

Answer 7

``` Asymptomatic Dyspnoea = main Sx Fatigue Syncope CYanosis Tachycardia Raised JVP RV heave Loud P2 Pansystolic murmur - tricuspid regurgitation Hepatomegaly Peripheral oedema ```

Answer 8

FBC - polycythaemia ABG CXR ECG - RAD / RVH

Answer 9

Enlarged RA and RV | Prominent pulmonary arteries

Answer 10

``` Treat cause Treat res failure Treat cardiac failure LTOT often needed Venesection if haemocrit >55% Heart and lung transplant in the young ```

Answer 11

``` Extreme OSA COPD Bronchiectasis Chest wall abnormality Resp muscle weakness e.g. MND Central hypoventilation ```

Answer 12

``` SOB Orthopnoea Oedema 2 cor pulmonale Morning headache due to rise in CO2 Chest infection Disturbed sleep ```

Answer 13

Elevated CO2 | Decreased O2

Answer 14

Lung function test Overnight oximetry CO2 monitoring Spirometry

Answer 15

Restrictive | Drop in vital capacity lying flat

Answer 16

Non-invasive ventilation Oxygen Tracheostomy if pH <7.25

Answer 17

COPD with pH 7.25-7.35 Type 2 res failure Cardiopulmonary oedema resistant to CPAP Weaning from tracheostomy

Answer 18

Normal capillary wedge pressure

Answer 19

Continuous +Ve airway pressure | Keeps airway expanded so air can move in and out

Answer 20

OSA CCF Acute pulmonary oedema

Answer 21

Bilevel +Ve airway pressure | Involves high or low pressures to correspond to ventilation

Answer 22

Type 2 resp failure Usually due to COPD If pH <7.35 despite medical therapy

Answer 23

* Non-invasive ventilation (NIV) delivers ventilatory support to improve respiratory failure via an inter- face that does not cross the larynx.

Answer 24

* CPAP applies a constant pressure throughout the respiratory cycle and works by splinting open and recruiting collapsed alveoli, thus reducing pulmonary circulatory shunting and improving lung compli- ance. * This improves oxygenation and reduces the work of breathing. * CPAP is often included under NIV, technically it does not provide ventilatory support as there is no assistance with inspiration.

Answer 25

* Worsening Type 1 respiratory failure by either bridging to or avoiding intubation. * Acute cardiogenic pulmonary oedema by improving lung compliance and oxygenation when drug treatment has been optimised. CPAP also assists in the translocation of interstitial fluid to the alveolar capillaries surrounding the alveoli, further improving gas exchange. * In the domiciliary setting, CPAP can be used as a treatment of obstructive sleep apnoea/ hypoapnoea syndrome (OSAHS) by splinting open the airways and improving oxygenation.

Answer 26

* Acute exacerbation of COPD * Decompensated OSA * Respiratory failure secondary to neuromuscular weakness or chest wall deformity.

Answer 27

* For both CPAP and NIV, there should be continuous pulse oximetry and ECG monitoring for the first 2 hours, and regular RR, pulse, BP measurements and assessments of consciousness. * ABG should be taken as a minimum at 1, 4 and 12 hours after the initiation of NIV. This will guide changes in settings, escalation plans to intubation and ceilings of treatment.

Answer 28

1. Impaired consciousness or confusion – the patient will not be able to trigger sufficient breaths and should be assessed for intubation immediately. 2. Life-threatening hypoxaemia. 3. Haemodynamic instability or arrest. NIV reduces preload so can lower blood pressure further, so patients should be considered for admission to ICU. 4. Facial surgery or burns. 5. Undrained pneumothorax: the positive pressure ventilation may convert a simple pneumothorax to a tension pneumothorax. 6. Vomiting. 7. Inability to protect airway, e.g. GCS < 8.

Respiratory Failure Flashcards

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