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Respiratory Failure

复旦呼研所. Chapter 7. Respiratory Failure. Bai Chunxue Department of Respiratory disease Zhongshan Hospital Fudan University. 复旦呼研所. Key Words. Respiratory failure Acute respiratory distress syndrome(ARDS) dyspnea Hypoxemia hypercapnia Respiratory Support Mechanical ventilation

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Respiratory Failure

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  1. 复旦呼研所 Chapter 7 Respiratory Failure Bai Chunxue Department of Respiratory disease Zhongshan Hospital Fudan University

  2. 复旦呼研所 Key Words • Respiratory failure • Acute respiratory distress syndrome(ARDS) • dyspnea • Hypoxemia • hypercapnia • Respiratory Support • Mechanical ventilation • Positive end-expiratory pressure (PEEP)

  3. 复旦呼研所 Chapter 7 Respiratory Failure Definition Type I、II Respiratory Failure Centrol、 Non-Centrol Respiratory Failure Acute & Chronic Respiratory Failure

  4. 复旦呼研所 ACUTE RESPIRATORY FAILURE Bai Chun-Xue Department of Respiratory diseases Zhongshan Hospital

  5. 复旦呼研所 Definition • respiratory dysfunction resulting in abnormalities of oxygenation or ventilation • impair or threaten the function of vital organs

  6. 复旦呼研所 Pathogeny Type II • Airway obstruction • Neuromuscular disease Type I Parenchyma Edema Vascular disease Chest Wall & Pleural disease

  7. 复旦呼研所 Ventilation CO 2 Diffusion O O 2 2 CO 2 Perfusion Clinical Findings hypoxemia

  8. 复旦呼研所 Clinical Findings hypercapnia CO2 PAO2 ，P ACO2（kPa) O2

  9. 复旦呼研所 Hypoxemia • cyanosis, restlessness • confusion, anxiety, delirium • tachypnea, tachycardia • hypertension, cardiac arrhythmias • tremor

  10. 复旦呼研所 Hypercapnia • Dyspnea and headache • peripheral and conjunctiva hyperemia • hypertension, tachycardia,tachypnea • impaired consciousness • papilledema, and asterixis

  11. 复旦呼研所 Diagnosis PaO2<8 kPa PaCO2 >6.66 kPa

  12. 复旦呼研所 Treatment • specific therapy directed toward the underlying disease; • respiratory supportive care directed toward the maintenance of adequate gas exchange; • general supportive care.

  13. 复旦呼研所 A. Respiratory Support Nonventilatory aspects Ventilatory aspects

  14. 复旦呼研所 Nonventilation • SaO2 of ≥90% (PaO2 about 60 mm Hg). • Hypoxemia in patients with obstructive airway disease is usual easily corrected by using low-flow oxygen by nasal cannula (1–3 L/min) or Venturi mask (24–28%). • Higher concentrations of oxygen are necessary to correct hypoxemia in patients with ARDS, pneumonia, and other parenchymal lung diseases.

  15. 复旦呼研所 经鼻面罩机械通气治疗前后血气变化（X±S） 白春学,等. 应用国产呼吸器经鼻面罩治疗慢性阻塞性肺病所致呼吸衰竭9例报告. 上海医学 1993;16:102

  16. 复旦呼研所 Ventilation Tracheal intubation Mechanical ventilation

  17. Tracheal intubation–Indications • Hypoxemia which is not quickly reversed by supplemental oxygen • Airway obstruction • Impaired airway protection • Inadequate handling of secretions • Facilitation of mechanical ventilation

  18. 复旦呼研所 Tracheal intubation

  19. Mechanical ventilation–Indications • Apnea • Acute hypercapnia that is not quickly reversed by appropriate specific therapy • Severe hypoxemia • Progressive patient fatigue despite appropriate treatment

  20. Mechanical ventilation–Modes • Assisted mechanical ventilation (AMV) or assist/control (A/C) • Synchronized intermittent mandatory ventilation (SIMV) • Pressure support ventilation (PSV)

  21. Mechanical ventilation–Modes • Pressure control ventilation (PCV) • Continuous positive airway pressure (CPAP) • Positive end-expiratory pressure (PEEP)

  22. Mechanical ventilation–Complications • Atelectasis of the centrolateral lung and overdistention of the intubated lung • Barotrauma, manifested by subcutaneous emphysema, pneumomediastinum, subpleural air cysts, pneumothorax, or systemic gas embolism

  23. Mechanical ventilation–Complications • Subtle parenchymal lung injury • Acute respiratory alkalosis • Hypotension • Ventilator-associated pneumonia, mortality rate of this disorder is about 50–60%

  24. 复旦呼研所 B.General Supportive Care • Nutrition • Psychological and emotional support • Skin care • Meticulous avoidance of nosocomial infection and complications of tracheal tubes

  25. 复旦呼研所 Course & Prognosis

  26. 复旦呼研所 Course & Prognosis • Prognosis of acute respiratory failure caused by uncomplicated sedative or narcotic drug overdose is excellent • Acute respiratory failure in patients with COPD who do not require intubation and mechanical ventilation has a good immediate prognosis

  27. 复旦呼研所 Course & Prognosis • ARDS associated with sepsis has an extremely poor prognosis, with mortality rates of about 90%. • Survival rates of 62% to weaning, 43% to hospital discharge, and 30% to 1 year after hospital discharge.

  28. 复旦呼研所 ------END------

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