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Respiratory FailureRespiratory Failure
Bai Chunxue
Department of Respiratory disease
Zhongshan Hospital
Fudan University
Chapter 7
复旦呼研所
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Key WordsKey Words
Respiratory failure Acute respiratory distress syndrome(ARD
S) dyspnea Hypoxemia hypercapnia Respiratory Support Mechanical ventilation Positive end-expiratory pressure (PEEP)
复旦呼研所
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Respiratory Failure Respiratory Failure DefinitionDefinition
Chapter 7
Type I 、 II Respiratory Failure Centrol 、 Non-Centrol Respiratory Failure Acute & Chronic Respiratory Failure
复旦呼研所
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ACUTE RESPIRATORY ACUTE RESPIRATORY FAILUREFAILURE
Bai Chun-Xue
Department of Respiratory diseases
Zhongshan Hospital
复旦呼研所
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respiratory dysfunction resulting in abnormalities of oxygenation or ventilation
impair or threaten the function of vital organs
DefinitionDefinition 复旦呼研所
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Type I Parenchyma Edema Vascular disease Chest Wall & Pleural
disease
Type IIAirway
obstruction
Neuromuscular disease
PathogenyPathogeny 复旦呼研所
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hypoxemia
Perfusion
Diffusion
Ventilation
CO2
CO2
O2 O2
Clinical Findings复旦呼研所
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PAO
2 ,P
ACO
2
(kP
a)hypercapnia
CO2
O2
Clinical Findings复旦呼研所
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cyanosis, restlessness
confusion, anxiety, delirium
tachypnea, tachycardia
hypertension, cardiac arrhythmias
tremor
HypoxemiaHypoxemia 复旦呼研所
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Dyspnea and headache
peripheral and conjunctiva hyperemia
hypertension, tachycardia,tachypnea
impaired consciousness
papilledema, and asterixis
HypercapniaHypercapnia 复旦呼研所
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DiagnosisDiagnosis
PaO2<8 kPa
PaCO2 >6.66 kPa
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specific therapy directed toward the underlying disease;
respiratory supportive care directed toward the maintenance of adequate gas exchange;
general supportive care.
TreatmentTreatment 复旦呼研所
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Nonventilatory
aspects
Ventilatory
aspects
A. Respiratory SupportA. Respiratory Support 复旦呼研所
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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.
NonventilationNonventilation 复旦呼研所
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经鼻面罩机械通气治疗前后血气变化(经鼻面罩机械通气治疗前后血气变化( X±SX±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
复旦呼研所
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Tracheal
intubation
Mechanical
ventilation
VentilationVentilation复旦呼研所
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Hypoxemia which is not quickly reversed by supplemental oxygen
Airway obstruction Impaired airway protection Inadequate handling of secretions Facilitation of mechanical ventilation
Tracheal intubation–IndicaTracheal intubation–Indicationstions
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Tracheal intubationTracheal intubation 复旦呼研所
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Apnea Acute hypercapnia that is not quickly r
eversed by appropriate specific therapy
Severe hypoxemia Progressive patient fatigue despite app
ropriate treatment
Mechanical ventilation–Mechanical ventilation–IndicationsIndications
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Assisted mechanical ventilation (AMV) or assist/control (A/C)
Synchronized intermittent mandatory ventilation (SIMV)
Pressure support ventilation (PSV)
Mechanical ventilation–Mechanical ventilation–ModesModes
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Pressure control ventilation (PCV) Continuous positive airway pressure
(CPAP) Positive end-expiratory pressure
(PEEP)
Mechanical ventilation–Mechanical ventilation–ModesModes
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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
Mechanical ventilation–Mechanical ventilation–ComplicationsComplications
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Subtle parenchymal lung injury Acute respiratory alkalosis Hypotension Ventilator-associated pneumonia, m
ortality rate of this disorder is about 50–60%
Mechanical ventilation–Mechanical ventilation–ComplicationsComplications
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Nutrition Psychological and emotional support Skin care Meticulous avoidance of nosocomial i
nfection and complications of tracheal tubes
B.General Supportive B.General Supportive CareCare
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Course & Prognosis
复旦呼研所
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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
Course & Prognosis 复旦呼研所
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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.
Course & Prognosis 复旦呼研所
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复旦呼研所