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Respiratory Failure
Definition
A condition in which the respiratory system is unable to provide an adequate amount of oxygen or to remove carbon dioxide efficiently
Normal PaO2: 75-100 mm Hg
Normal PaCO2: 35-45 mm Hg
Hypoxia is a decrease in O2 reaching tissues
Hypercapnia is an increase in CO2 in the blood
Normal pH: 7.35-7.45
Arterial Blood Gas
Measurement of arterial blood gases
Type I Respiratory Failure (hypoxemia)
Type 2 Respiratory Failure (hypercapnia + hypoxemia)
Acute Respiratory Failure
● Trauma● Pulmonary embolism● Overdose● Stroke
Acute Respiratory Distress Syndrome (ARDS)
Respiratory failure characterized by rapid onset of widespread inflammation of the lungs
Symptoms include:
● Shortness of breath● Rapid breathing● Bluish skin coloration
ARDS Pathomechanism
● Diffuse damage to the alveolar-capillary interface● Leakage of protein rich fluid leads to edema and formation of
hyaline membranes in alveoli● Diffuse alveolar damage to type I and II pneumocytes
SPARTAS
Sepsis
Pancreatitis/Pneumonia
Aspiration
uRemia
Trauma
Amniotic fluid embolism
Shock
Neonatal Respiratory Distress System
A lack of surfactant in premature infants causes collapse of alveoli. Underdeveloped type II pneumocytes don’t produce enough surfactant.
Pneumothorax
Collection of air in pleural space between the chest and the lung
Pulmonary Embolism
Embolic blockage of an artery in the lung by an insoluble bolus, typically arising from a DVT
Chronic Respiratory Failure
● Cystic Fibrosis● Neurologic abnormalities● COPD
Cystic Fibrosis
● Defective CFTR gene■ CFTR is involved in the production of
sweat, digestive fluids and mucous
● Fluids that should be thin are thickened
● Thickened lung mucous predisposes to infections
Treatment
● Removal or reversal of causative agent● Ventilatory support
Mrs. Puffer is a 35-year-old single mother, just getting off the night shift. She
reports to the ED in the early morning with shortness of breath. She has cyanosis of
the lips. She has had a productive cough for 2 weeks. Her temperature is 38.9,
blood pressure 110/76, heart rate 108, respirations 32, rapid and shallow. Breath
sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest
X-ray indicates bilateral pneumonia.
What values would you expect to see on her ABG?
a. Normal PaCO2, Elevated PaO2
b. Decreased PaCO2, Decreased PaO2
c. Elevated PaCO2, Normal PaO2