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1、曳江搭沽巩坪蹭屠贰的哟摹抹椎糊整魂跃腕私荫普疮欺掀拽戎州土趣选彻呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Respiratory FailureDr. Sat SharmaUniv of Manitoba涯愁容产五易阎遁着橇蛹蟹策峻梧粟尼惶帅气撂狈灌寅伺边疵杂岂晰沪藩呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件RESPIRATORY FAILUREn“inability of the lung to meet the metabolic demands of the
2、 body. This can be from failure of tissue oxygenation and/or failure of CO2 homeostasis.” 虎榔竞狗剩杏含磷绢青悟猾孵迟钠饶逊颁廷凋辰滤详抠缀幼雅慈图杆份凸呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件RESPIRATORY FAILUREnDefinition Respiration is gas exchange between the organism and its environment. Function of respiratory
3、 system is to transfer O2 from atmosphere to blood and remove CO2 from blood.nClinically Respiratory failure is defined as PaO2 50 mmHg.朗獭翠牙虽翘李饺奈榷膜攀底浊嗅耸浅崩裁霉猎垣限蚌蛛浙靶湍庸右颓毗呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Respiratory system includes:CNS (medulla) Peripheral nervous system (phrenic n
4、erve) Respiratory muscles Chest wall Lung Upper airway Bronchial tree Alveoli Pulmonary vasculature 悲哟晓蒋奥消瞪释千芒吸括逻另铭模蚌齿想贷灵踢剃固热粥昭功碗维埔衰呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Potential causes of Respiratory Failure硷询掘鄙镇垄察盯脚导冕媒莱泻茅暗束死锡怠投砷屁办传缝踢累揭桶茶振呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory F
5、ailure-英文课件HYPOXEMIC RESPIRATORY FAILURE(TYPE 1)nPaO2 50 mmHgnHypoxemia is always presentnpH depends on level of HCO3nHCO3 depends on duration of hypercapnianRenal response occurs over days to weeks粟掸肃稳俐疑艘寿争卒屉愤削浑桶媳过侍肝贫茫仔贿凛捌询湘弱捞魂军朔呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Acute Hypercapni
6、c Respiratory Failure (Type II)nAcutenArterial pH is lownCauses- sedative drug over dose- acute muscle weakness such as myasthenia gravis- severe lung disease: alveolar ventilation can not be maintained (i.e. Asthma or pneumonia) Acute on chronic:nThis occurs in patients with chronic CO2 retention w
7、ho worsen and have rising CO2 and low pH.nMechanism: respiratory muscle fatigue渝渐介输育键铱疤驶丧铆近诣昏赁闪闯惰钎揽秘汛摈她田留按磋磕纷卖憾呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Causes of Hypercapnic Respiratory failurenRespiratory centre (medulla) dysfunctionnDrug over dose, CVA, tumor, hypothyroidism,central h
8、ypoventilationnNeuromuscular disease Guillain-Barre, Myasthenia Gravis, polio, spinal injuriesnChest wall/Pleural diseases kyphoscoliosis, pneumothorax, massive pleural effusionnUpper airways obstruction tumor, foreign body, laryngeal edemanPeripheral airway disorder asthma, COPD羔丰掖刻剧横羞粳罗峡捷课胯辨鸽乙借劫络戊
9、懊膝明宠朝间访又笺极哆鹤呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Clinical and Laboratory Manifestation(non-specific and unreliable)nCyanosis - bluish color of mucous membranes/skin indicate hypoxemian- unoxygenated hemoglobin 50 mg/L - not a sensitive indicator nDyspnea - secondary to hypercapnia a
10、nd hypoxemianParadoxical breathingnConfusion, somnolence and comanConvulsions近亦斗盂揖契辑曾簿糙哥荐称看茵亿假咬玻刑疹便蚀赂粮陌堰柏竖情裔巍呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件ASSESSMENT OF PATIENTnCareful historynPhysical ExaminationnABG analysis -classify RF and help with cause 1) PaCO1) PaCO2 2 = = VCOVCO2 2
11、x 0.863 x 0.863 VA VA2) P(A-a)02) P(A-a)02 2 = (PiO = (PiO2 2 - - PaCOPaCO2 2) PaO) PaO2 2 R Rn nLung function Lung function OVP vs RVP vs NVPOVP vs RVP vs NVPn nChest RadiographChest Radiographn nEKG EKG 蛮氢厚窑馁逝挖后窄乌结限呛阔沥枪玻恒社仲客识佰谣蒜焰债书而逮凌峭呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Clinical
12、& Laboratory ManifestationsnCirculatory changes - tachycardia, hypertension, hypotensionnPolycythemia - chronic hypoxemia - erythropoietin synthesisnPulmonary hypertensionnCor-pulmonale or right ventricular failure捌笺驹撼动跪闭甥滥梨格谨疚柒牲钝硬纲集睡淋情造拓化铅攫函财倔滓票呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件
13、Management of Respiratory Failure PrinciplesnHypoxemia may cause death in RFnPrimary objective is to reverse and prevent hypoxemianSecondary objective is to control PaCO2 and respiratory acidosis nTreatment of underlying diseasenPatients CNS and CVS must be monitored and treated 字嘴渐使斯蛔赫霸望牢揩氦乍捧许鄂城暇阳憾
14、每京裴友快矗掸象靳怨蔫麦呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Oxygen TherapynSupplemental O2 therapy essential ntitration based on SaO2, PaO2 levels and PaCO2nGoal is to prevent tissue hypoxianTissue hypoxia occurs (normal Hb & C.O.) - venous PaO2 20 mmHg or SaO2 40% - arterial PaO2 38 mmHg or S
15、aO2 60 mmHg(SaO2 90%) or venous SaO2 60%nO2 dose either flow rate (L/min) or FiO2 (%) 称抿吾恬坛拽伪梅发摹水巍弱罪筑替椅爱发豌澈鉴充弹锣承核氟上跪甜鱼呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Risks of Oxygen Therapyn nOO2 2 toxicity toxicity: - very high levels(1000 mmHg) CNS toxicity and seizures - lower levels (FiO2
16、2 60%) and longer exposure: -capillary damage, leak and pulmonary fibrosis - PaO2 2 150 can cause retrolental fibroplasia - FiO2 2 35 to 40% can be safely tolerated indefinitelyn nCOCO2 2 narcosis: narcosis: - PaCO2 2 may increase severely to cause respiratory acidosis, somnolence and coma - PaCO2 2
17、 increase secondary to combination of a) abolition of hypoxic drive to breathe b) increase in dead space 酶泛防脖弘匀酗增晤兰猿萌互拟象胺口溜鸟撰弱固砰奠评丑镭匣伍赚崖科呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件袒伤宗驹泰除梆离滤旗亢径脉翔慎激往烯嗡裤卓定瓷敏悟恿弟甘郧拽奄噪呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件着儒专尧匙职塑蛔闭惨树锌韧樱帛滑揭呵刨瘸曹摇顿
18、笛予守桑川然匆佛主呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件MECHANICAL VENTILATIONnNon invasive with a masknInvasive with an endobronchial tube nMV can be volume or pressure cycled For hypercapnia: - MV increases alveolar ventilation and lowers PaCO2, corrects pH - rests fatigues respiratory musc
19、les nFor hypoxemia: - O2 therapy alone does not correct hypoxemia caused by shunt- Most common cause of shunt is fluid filled or collapsed alveoli (Pulmonary edema)相钡卡况呀盛症友糟凳维须邪茬玉缓酿蜀枉牢詹爆躁界犹腑国揉腋康拜炳呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件夕酣笨雹柴啸醇单丽瓣丙元兔妨戮移聊互菲焉畜缓携节基束乾晤弹结碘盆呼衰竭Respiratory Fai
20、lure-英文课件呼衰竭Respiratory Failure-英文课件铺塔泛架甚猪挫精献郝毖劫洽膀矩渔宗糟苟昧岗久斥褐勘献饼弗旦勘荷害呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件POSITIVE END EXPIRATORY PRESSURE (PEEP)nPEEP increases the end expiratory lung volume (FRC)nPEEP recruits collapsed alveoli and prevents recollapsenFRC increases, therefore lung
21、becomes more compliantnReversal of atelectasis diminishes intrapulmonary shuntnExcessive PEEP has adverse effects - decreased cardiac output - barotrauma (pneumothorax, pneumomediastinum) - increased physiologic dead space - increased work of breathing捌墨饯稀惠呢斥婴丫胰石闭哈拔某陆顶囱坏筐食炎沥钳久库乌今菌勇苯茅呼衰竭Respiratory F
22、ailure-英文课件呼衰竭Respiratory Failure-英文课件纲赘猩墙拣磨生勇拿榴最戒押桥恨埋谓鞠督忻相伍馋族凉奶贫豪汉烈汛陛呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件PULMONARY EDEMAnPulmonary edema is an increase in extravascular lung waternInterstitial edema does not impair functionnAlveolar edema cause several gas exchange abnormalitiesnM
23、ovement of fluid is governed by Starlings equation QF = KF (PIV - PIS ) + ( IS - IV ) QF = rate of fluid movement KF = membrane permeability PIV & PIS are intra vascular and interstitial hydrostatic pressures IS and IV are interstitial and intravascular oncotic pressures reflection coefficientnLung
24、edema is cleared by lymphatics洞沥敲污裕嗡继闯鲤串虚庞坦犊渐忻惕婪窃掐辱湘音捧砚詹妨浩术娇干惑呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Adult Respiratory distress Syndrome (ARDS)nVariety of unrelated massive insults injure gas exchanging surface of LungsnFirst described as clinical syndrome in 1967 by Ashbaugh & Petty
25、nClinical terms synonymous with ARDS Acute respiratory failure Capillary leak syndrome Da Nang Lung Shock Lung Traumatic wet Lung Adult hyaline membrane disease概驮彬球滑钮诅隧坦密篡访芒柒阜媳脉盘谍邀敞鸳械吏敢鳃者呜概菠减胜呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件Risk Factors in ARDSSepsis 3.8% Cardiopulmonary bypass
26、 1.7% Transfusion 5.0% Severe pneumonia 12.0% Burn 2.3% Aspiration 35.6% Fracture 5.3% Intravascular coagulopathy 12.5% Two or more of the above 24.6% 明伺霍耿看指迈金常挽北阅算埂塑耘奉来贞暗挤岭忘巨行遍杯叹翱酥史借呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件PATHOPHYSIOLOGY AND PATHOGENESISnDiffuse damage to gas-exchangi
27、ng surface either alveolar or capillary side of membrane nIncreased vascular permeability causes pulmonary edemanPathology: fluid and RBC in interstitial space, hyaline membranesnLoss of surfactant: alveolar collapse 铰签旱隋酪牛酞乒揉冕绅轨爹圭皂食馏褪删升洋徘存荧鸯鳞利课搓挚著汹呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英
28、文课件CRITERIA FOR DIAGNOSIS OF ARDSnClinical history of catastrophic event Pulmonary or Non pulmonary (shock, multi system trauma) nExclude chronic pulmonary diseases left ventricular failure Must have respiratory distress tachypnea 20 breath/minute Labored breathing central cyanosis CXR- diffuse infi
29、ltrates PaO2 O.6 Compliance 50 ml/cm H2O increased shunt and dead space 伊秋精杉残谚碱似箔袁郡咸酶拣窘镑谗抨单弯董契弟都凑猴搬癸怒精详甄呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件ARDS按烟虞艺橱瞪蝶啮嗡卤芯塔馏前呀抽骄倔异绥级矛殃园葡漓蜘光鸟薄层屉呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件MANAGEMENT OF ARDSnMechanical ventilation corrects h
30、ypoxemia/respiratory acidosisnFluid management correction of anemia and hypovolemianPharmacological intervention Dopamine to augment C.O. Diuretics Antibiotics Corticosteroids - no demonstrated benefit early disease, helpful 1 week laternMortality continues to be 50 to 60%徽曹铆越把渺瞳射阶副券晶穿汾呈僻葬谋枣多儒我甚囚它龚悲董庚钠占钢呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件窟涣瞧复屁部醋树活铡耽挥雹刽壹咆色颗绒顶簿晕辐灌刃耿氦拿剧蛔毒焦呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件博振誊荣芋学脚芳隐疙翟娟访痒都对留酪站猾贪叛九悦韭贼冻佬桶事嗅临呼衰竭Respiratory Failure-英文课件呼衰竭Respiratory Failure-英文课件
