225897406 respiratory failure

8/20/2019 225897406 Respiratory Failure

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Ronald Chrisbianto Gani

405090223

Faculty of Medicine

Tarumanagara University

EMERGENCY MEDICINE BLOCK

RESPIRATORY FAILURE


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RESPIRATORY FAILURE


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RESPIRATORY FAILURE

• Inadequate blood oxygenation or cabon

dioxide removal

• Classified as

– Hypercapnic Respiratory Failure

– Hypoxemic Respiratory Failure

Fishman’s Pulmonary Diseases & Disorders 4th Ed


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ETIOLOGY

• Central nervous system

– Sedative/narcotic overdose

– Meningoencephalitis

–

Tumirs or vascularabnormalities of medulla

– Strokes

– Severe myxedema

– Hepatic failure

– Advanced Uremia

– Obesity-hypoventilation

syndrome

• Perpipheral Nervous

system or Chest Wall

– GBS

–

Mysathenia Gravis – Polymiositis

– Muscular dystrophies

– Acute Poliomyelitis

–

Traumatic Spinal CordInjury

– Severe kyphoscoliosis

– Flail chest, morbid obesity



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ETIOLOGY

• Airways

– Epiglotitis

– Foreign body aspiration

– Tracheal tumor – COPD

– Asthma

– Advanced cystic fibrosis

• Alveoli

– Pulmonary edema

– Diffuse pneumonia

– Pulmonary hemmorhage – Aspiration of stomach

contents

– Near-drowning



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CLASSIFICATION



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PATHOPHYSIOLOGY



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PATHOPHYSIOLOGY



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MANAGEMENT

• Blood gas analysis for confirmation

• Triage, based on

– Acuity of the respiratory failure

– Degree of hypoxemia, hypercapnia, acidemia

– Presence of co-morbidities (cardiac/renal disease)

• Airway Management

– Emergency intubation or ventilator depends on

clinical condition and arterial blood gas test



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MANAGEMENT

• Correction of Hypoxemia and Hypercapnia

– Hypoxemia correction to PaO2 60mmHg,

higher in patients with coronary or CVD

– May use face mask or Venturi Mask (high flow O2)

– May require intubation or ventilator

• Search for underlying cause



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MANAGEMENT

• Monitoring

– Acute : RR, tidal volume, use of accessory muscles,

paradoxical breathing movement

– Mechanical ventilation related complications

– Status asthmaticus hypotension due to intrinsic

PEEP alter ventilator, implement sedation or

paralytic agents



14/19Fishman’s Pulmonary Diseases & Disorders 4th Ed


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COMPLICATIONS



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PROGNOSIS

• Acute hypoxemic respiratory failure

– Survival rate 60%

– Worse outcomes in old patients and patients with

pre-existing lung disease

– 2/3 survivors impaired pulmonary function



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PROGNOSIS

• Acute hypercapnic respiratory failure

– Mortality depends on

• Patient physiological reserve (cardiac, renal, hepatic

status, patient’s age)

• Underlying causes

• Severity of respiratory failure (pH and PCO2)

• Complications after onset (sepsis, pneumonia, GI bleed)

• Cachexia and hime confinement poor outcome



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REFERENCES

• Fishman AP, Elias JA, Fishman JA, Grippi MA,

editors. Fishman’s Pulmonary Diseases and

Disorders. 4th Ed. New York : McGraw-Hill,

2008

• Marx JA, Hockberger RS, Walls RM, Adams JG,

editors. Rosen’s Emergency Medicine

Concepts and Clinical Practice. 7th Ed.Philadelpia : Mosby Elsevier, 2010

225897406 respiratory failure

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