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Respiratory Failure

Critical Care

Describe and explain the two major classification of acute respiratory failure (hypoxemic) Hypoxemic: PaO2 ≤60mmHg on ≥60% FiO2 → Oxygenation failure (inadequate O2 transfer at alveoli and pulmonary capillary bed) – Causes: V/Q mismatch, shunt, impairing diffusion, and alveolar hypoventilation
Describe and explain the two major classification of acute respiratory failure (hypercapnic) PaCO2 >45 with pH <7.35 → Ventilation failure (respiratory system unable to remove sufficient CO2: to maintain normal PaCO2) – Causes: airways and alveoli (airway obstruction and air trapping), CNS (dec. drive to breathe), chest wall, N/M conditions
Ventilation/Perfusion mismatch secretions in airway (ex: COPD), secretions in alveoli (ex: pneumonia, bronchospasm/asthma), Alveolar collapse (atelectasis), Pain
Intrapulmonary shunting blood moves from r-heart to l-heart without oxygenating in the lungs
Impaired diffusion alveolar capillary membranes are damaged > stiff > compromises gas exchange
Conditions affecting pulmonary vascular bed Emphysema and recurrent PE
Cause membrane to become more fibrotic (glow gas transport) ARDS, pulmonary fibrosis, interstitial lung disease
Alveolar Hypoventilation Low ventilation leads to high CO2 and low PaO2 as a result of restrictive lung diseases, CNS diseases, chest wall dysfunction, acute asthma, and N/M disease
Renal compensation Kidneys reabsorb/retain HCO3 as needed, to compensate for state of acidosis (takes days to take effect) → minimizes change in arterial pH
Cardiovascular Compensation Heart + lungs attempting to compensate for increased O2 delivery! Hypercapnia → vasodilation → cerebral blood flow → mild ICP → HA! Slower RR @ night → severe morning HA! Cyanosis = late sign!
Interpret signs of impaired ventilatory function. a. Restlessness, changes in LOC (confusion → coma) b. Tachypnea / dyspnea / cough c. Auscultation of lungs d. Tachycardia e. Substernal retractions f. Diaphoretic (+ g-k)
Created by: ariellebtan