Respiratory Failure

Mandy Ng
Mind Map by Mandy Ng, updated more than 1 year ago
Mandy Ng
Created by Mandy Ng over 6 years ago
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Mind Map on Respiratory Failure, created by Mandy Ng on 15/02/2015.

Resource summary

Respiratory Failure
  1. An inability of the lungs to maintain arterial blood gas (ABG) at normal levels when a subject breathes air at rest
    1. Failure for oxgenation
      1. Failure for CO2 removal
        1. Failure for both
        2. General guideline: PO2 < 60mmHg and/or PCO2 > 50mmHg
          1. Physiological causes
            1. Hypoventilation
              1. Upper airway obstruction
                1. Dec. PO2 + Inc. PCO2
                2. Weakness/ paralysis of respiratory muscles
                  1. Chest wall injury
                  2. Alveolar ventilation/ perfusion mismatching
                    1. Chronic obstructive lung disease
                      1. Restrictive disease
                        1. Dec. PO2 + Inc. PCO2/ Normal PCO2
                        2. Pneumonia
                        3. Impaired diffusion
                          1. Lung edema
                            1. Adult respiratory distress syndrome (Shock lung)
                              1. Dec. PO2 + Normal PCO2/ Dec. PCO2
                                1. N. PCO2 due to high solubility coefficient of CO2
                          2. Types
                            1. Type I
                              1. Gas exchange failure
                                1. PO2 < 60mmHg ; PCO2 < 50mmHg
                                2. Type II
                                  1. Ventilatory failure
                                    1. PO2 < 60mmHg ; PCO2 > 50mmHg
                                  2. Hypoxemia
                                    1. Causes
                                      1. Hypoventilation
                                        1. Diffusion impairment
                                          1. Shunt
                                            1. Blood passing process X do gas exchange
                                            2. V/Q mismatching
                                            3. Detection
                                              1. Cyanosis
                                                1. Tachycardia
                                                  1. CNS (mental clouding)
                                                    1. PaO2
                                                    2. Effects
                                                      1. Tissue hypoxia: Dec. O2 delivery
                                                        1. (CNS, myocardium)
                                                          1. Ceasation of aerobic oxidation
                                                            1. Anaerobic glycolysis
                                                              1. Metabolic acidosis (lactic acid)
                                                              2. Physiological changes
                                                                1. Mild (PaO2 60mmHg)
                                                                  1. Mental performance impaired
                                                                    1. Vision impaired
                                                                      1. Mild hyperventilation
                                                                      2. Severe (PaO2 < 40mmHg)
                                                                        1. CNS (Headache, sleepy, clouding of consciousness)
                                                                          1. CVS (Tachycardia, mild hypertension)
                                                                            1. Pulmonary (hypertension)
                                                                            2. Very severe (PaO2 Dec.)
                                                                              1. CNS (Permanent damage)
                                                                                1. CVS (Bradycardia, hypotension)
                                                                                  1. Pulmonary (Severe hypertension)
                                                                                    1. Renal (Proteinuria)
                                                                                2. Hypercapnia
                                                                                  1. Causes
                                                                                    1. Hypoventilation
                                                                                      1. V/Q mismatching
                                                                                        1. Injudicious use of O2 therapy
                                                                                          1. Hypoxic ventilatory drive abolished --> V dec.
                                                                                            1. Hypoxic pulmonary vasoconstriction abolished--> worsening of V/Q inequality
                                                                                              1. i.e. Only giving O2 but not improving ventilation
                                                                                            2. Effects
                                                                                              1. Moderate hypercapnia
                                                                                                1. Inc. cerebral blood flow
                                                                                                  1. Headache
                                                                                                    1. More blood--> Inc. cerebral pressure
                                                                                                  2. Severe hypercapnia
                                                                                                    1. Narcotic
                                                                                                      1. Clouding of consciousness
                                                                                                  3. Acidosis
                                                                                                    1. Respiratory acidosis (Inc. PCO2)
                                                                                                      1. Metabolic acidosis (lactic acid)
                                                                                                        1. Renal compensation: HCO3- retention
                                                                                                      2. Management
                                                                                                        1. Treatment for underlying disease
                                                                                                          1. Antibiotic therapy for infection
                                                                                                            1. Specific treatment for neuromuscular disorder
                                                                                                            2. Treatment for airway obstruction
                                                                                                              1. Removal of secretion
                                                                                                                1. Encouragement to cough
                                                                                                                  1. Aspiration of secretion (brochoscopy)
                                                                                                                    1. Prevent viscous secretion by adequate hydration
                                                                                                                      1. Drubs to liquefy sputum
                                                                                                                      2. Bronchoconstriction
                                                                                                                        1. Use of bronchodilators
                                                                                                                      3. Treatment for hypoxemia
                                                                                                                        1. Oxygen therapy (if necessary)
                                                                                                                          1. Chronic obstructive disease: 25-30% O2
                                                                                                                            1. Shock lung: 60% O2
                                                                                                                              1. Effectiveness: evaluated by oximeter: SO2 > 90% = safe
                                                                                                                              2. Mechanical ventilation
                                                                                                                                1. For neuromuscular disorder
                                                                                                                              3. Treatment for hypercapnia
                                                                                                                                1. Mechanical ventilation
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