Respiratory Failure

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Respiratory FailureRespiratory Failure

Bai Chunxue

Department of Respiratory disease

Zhongshan Hospital

Fudan University

Chapter 7

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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)

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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

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ACUTE RESPIRATORY ACUTE RESPIRATORY FAILUREFAILURE

Bai Chun-Xue

Department of Respiratory diseases

Zhongshan Hospital

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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

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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

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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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