Vinnytsya National Pirogov Memorial Medical University Pathophysiology Department

1. VinnytsyaNational Pirogov Memorial Medical UniversityPathophysiology Department Respiratory failure PhD., Viktoriya Piliponova

2. Normal gas composition in blood: In arterial blood: • pO2: 80-100 mmHg. • pCO2: 40 mmHg. In venous blood : • pO2: 40 mmHg.   • pCO2: 46 mmHg.

4. Raspiration – is function of the organism, which consists in maintaining the gas composition of the blood, supplying tissues with oxygen (O2) and releasing carbon dioxide (CO2).

5. Respiratory failure – is a pathological state that is characterized by disorder of gas exchange between ambient air and circulating blood and leads to inequality of blood gas composition to an organism oxygen necessity.

6. Classification of the external respiratory disorders: • According to the clinical caurse: • Acute (e.g. asphyxia), • Chronic • According to the localization: • Partial • total • According to clinical manifestations: сompensative • decompensative

7. EXTERNAL RESPIRATION is a complex of processes occurring in the lung and providing normal contents of oxygen (О2) and carbon dioxide (СО2)in blood.

8. Three main processes take place in the lungs: • alveolar ventilation, • diffusion • perfusion

9. Classification of respiratory failure according pathogenesis • Primary-dyskinetic (disregulative) • Obstructive • Restrictive • Violation of diffusion • Violation of perfusion

10. Primary-dyskineticrespiratory failure: • Pathology of Respiratory center • Pathology of motoneurons of spinal cord • Disorders of the thorax motility; • Damage of the integrity of thorax and pleural cavity

11. Obstructive – increased resistance to air passage. • Foreign bodies in the upper airways; • Thickening of walls of respiratory tracts; • Spasm of bronci, larynx; • Compression of respiratory tracts from outside

12. Restrictive or diminishing of total volume of alveoli (limitation of pulmonary ventilation) • Inflammation and congestion in the lungs fluids • Partial pulmonary resection • Destruction of part of the lung • Pulmonary fibrosis • Complete stopping of the lungs ventilation • Violation of surfactant synthesis

13. Diffusive: diminishing of total surface of alveoli-capillary membranes for gases diffusion. • thickness of alveolar and capillary membrane and decrease of its permeability for gases • decrease of summary internal surface of alveols

14. Diffusion limitations

15. Disorder of perfusionof lungs (lung blood flow): • right ventricle failure of the heart • left ventricle failure of the heart • vascular insufficiency • embolism , thrombosis of pulmonary artery.

16. Centrogenic • Nervous-muscular • Thoraco-diaphragmal • Broncho-pulmonary • Obstructive • Restrictive • Diffusive Classification of respiratory failure according to VOTCHAL:

17. Classification of respiratory failure according to VOTCHAL: 1.Centrogenic: at the violation of work of the • Respiratory center • Depression of central regulation of breathing as

18. 2. Nervous-muscular: violation of activity of respiratory muscles at the damage of spinal cord.

19. Thoraco-diaphragmal violation of biomechanics of breathing is related to pathology of thorax ; • high standing of diaphragm; • hemothorax, • pneumothorax.

20. Broncho-pulmonary- pathological processes in lungs and respiratory tracts. • kinds • Obstructive • Restrictive • Diffusive

21. Broncho-pulmonary • obstructive form

22. Restrictive form- atreduction of respiratory surface of alveoli:

23. Broncho-pulmonary • diffusive format the thickening of alveolar-capillary membrane The reasons that reduces diffusion: a - the norm; b - alveolar wall thickening; в - in capillary wall thickening; г - swelling in the alveoli д - interstitial edema; e - dilatation capillaries

24. Indexes of respiratory failure

25. Classification of pathological types of breathing: 1.Disorders of the breathing depth and rate: • bradypnea; • tachypnea; • dyspnea; • hyperpnea; 2. Periodic breathing. • Cheyne-Stoke’s breathing. • Biot’s breathing. 3. Terminal breathing. • Apneustic respiration. • Gasping respiration. • Kussmaul’s respiration

26. Dyspnea –characterized by the change of frequency, depth and breathing rhythm and is accompanied by feeling of air insufficiency.

27. Classification of dyspnea:- • Inspiratory • Expiratory • Constant, attack-like (paroxysmal).

28. Inspiratory (develops in case of excitement of respiratory center and restrictive disorders of ventilation) • 1. in the first stage of asphyxia • 2. General disorders of the CNS, • 3. physical exercise in patients with heart failure, • 4. pneumothorax. • Expiratory(develops in case of obstructive disorders of ventilation); • 1. broncial asthma, • 2. In the second stage of asphyxia • 3. emphysema (increased resistance to airflow during exhalation).

29. PERIODICAL BREATHING– is pathological breathing that is characterized by the periods of respiration and periods of absence of breathing (apnea).

30. Cheyne-Stoke’s respiration • Characterized by growing amplitude of respiration till the marked hyperpnoea and then it's diminishing to apnoea followed by a cycle of the respiratory movements also finishing with apnoea.

31. Biot’s respiration • Characterized by constant amplitude but both stop and begin suddenly.

32. Terminal breathing– is characteristic for the terminal states. • Apneustic respiration • Kussmaul’s respiration • Gasping respiration

33. Asphyxia - life-threatening pathological condition caused by acute respiratory failure, which occurs when the blood does not arrive O2, and with blood not derived CO2.

34. Causes of asphyxia: • 1. Compression of airway. • 2. Obstruction of airway. • 3. The presence of fluid in the airways and alveoli. • 4. Pneumothorax. • 5. Strong inhibition RC.

35. Periods of asphyxia: • First period: inspiratory dyspnea. • Second period: expiratory dyspnea • Third period: the observed decrease in the frequency and amplitude of respiration. • There Gasping respiration, followed by respiratory arrest.

36. Asphyxia • 1стадія 2 стадія 3 стадія

37. Atelectasis:is the collapse or closure of a lung resulting in reduced or absent gas exchange. • Primary: is a condition in which lung tissue remains uninflated as a result of insufficient surfactant production • Secondary: is caused by airway obstruction, lung compression or increased recoil of the ling due to diminished pulmonary surfactant

38. Atelectasis

39. HYPOXIA– reduction of oxygen supply to a tissue below physiological levels despite adequate perfusion of the tissue by blood.

40. Classification of hypoxia • by etiology: • Exogenous (hypoxic). • Respiratory. • Circulatory. • Hemic. • Tissue. • Mixed.

41. Exogenous (hypoxic)hypoxia – due to a decrease pO2 in air. • with the rise in altitude, in the mountains • In blood - • Hypoxemia (↓ pO2art) • Hypocapnia (↓ pCO2art) resulting compensatory hyperventilation of the lungs and leads to the gas alkalosis

42. Respiratory hypoxia  that due to failure to transport sufficient oxygen because of inadequate lungs ventilation. • alveolar hypoventilation (bronchial asthma, pneumonia, pulmonary edema, hemothorax) • lowering blood perfusion lung (↓VBC, lack of contractile function of the heart, pulmonary hypertension, and others.) • violation diffusion of oxygen in the lungs (pulmonary edema, fibrosis, pneumoconiosis, etc.). • In blood • ↓ pO2art - arterial hypoxemia. • ↑ pCO2 art – hypercapnia – gas acidosis

43. Anemic hypoxia  that due to reduction of the oxygen-carrying capacity of the blood owing to decreased total hemoglobin or altered hemoglobin constituents. • Causes • Anemia • Hemoglobin inactivation (violation of binding, transport and give oxygen to the tissues).

44. Reasons hemoglobin qualitative changes: • Poisoning CO (carbon monoxide) - carboxyhemoglobin formation. • fires • in garages and on city highways with heavy motor traffic,   • the premises at fault or gas furnace devices. • Methemoglobineformated during poisoning with nitrates and some drugs with an oxidizing capacity. • Hereditary anomalies of hemoglobin (thalassemia, sickle-cell anemia).

45. Histotoxic (tissue) hypoxia  that due to impaired use of oxygen by tissues. • Poisoning with cyanides (they inactivate cytochrome oxidase) • Alcohol, narcotics, some drugs inhibit dehydrogenase of the Krebs cycle. • Deficite Vit B2, nicotinic asid –decreases syntesis respiratory enzyme. • Circulatory hypoxia  that due to failure to transport sufficient oxygen because of inadequate blood flow.