respiratory failure

RespiratoryFailure.

C r e a t e d B y :

S a a d i y a N a e e m i .

P r e s e n t e d b y : K a l p a n a S u r e s h K u m a r

OUTLINE

1. Respiratory Failure.

2. Types Of Respiratory Failure.

3. Clinical Manifestations.

4. Diagnosis Importance.

5. Gerontologic Considerations.

6. Treatment.

Respiratory Failure:The inability of the cardiac and pulmonary systems to

maintain an adequate exchange of oxygen and CO2 in the

Lungs.

•Types Of Resp i ra to ry Fa i lu re :

Following are the two types of Respiratory Failure:

1 . A c u t e R e s p i r a t o r y F a i l u r e .

2 . C h r o n i c R e s p i r a t o r y F a i l u r e .

Acute Respiratory Failure:Results from inadequate gas exchange for a short

period.

• Insufficient O2 transferred to the bloodHypoxemia (type I)

• Inadequate CO2 removalHypercapnia (Type II)

Acute Respiratory Failure:

Classification• Hypoxemic respiratory failure(Type I)

An arterial oxygen tension lower than 60 mm Hg with a normal or low arterial carbon dioxide tension.

• Hypercapnic respiratory failure(Type II)

CO2 higher than 50 mm Hg.

• Hypoxemic Respiratory Failure (Type I)

Causes1. Ventilation-perfusion (V/Q) mismatch2. Shunt3. Diffusion Limitation4. Alveolar hypoventilation

• Hypoxemic Respiratory Failure(Type I)

1. Ventilation-perfusion (V/Q) mismatch: "V" – ventilation – the air that reaches the alveoli"Q" – perfusion – the blood that reaches the alveoli

o COPD

o Pneumonia

o Asthma

o Atelectasis

o Pulmonary embolus

o COPD:

COPD stands for Chronic Obstructive Pulmonary Disease. It is a progressive disease that makes it hard to breathe.

In COPD, less air flows in and out of the airways because of one or more of the following:

• The airways and air sacs lose their elastic quality.

• The walls between many of the air sacs are destroyed.

• The walls of the airways become thick and inflamed.

• The airways make more mucus than usual, which can clog them.

Partial collapse or incomplete inflation of the lung.

o Atelectasis:

o Pneumonia:Pneumonia is an inflammatory condition of the lung. It is usually

caused by infection with viruses or bacteria.

o Asthma:A respiratory condition marked by attacks of spasm in the bronchi

of the lungs, causing difficulty in breathing. It is usually connected

to allergic reaction or other forms of hypersensitivity.

Pulmonary embolism is the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot.

o Pulmonary embolus:

• Hypoxemic Respiratory Failure (Type I)

2. Shunt

o Anatomic shunt

o Intrapulmonary shunt

o Anatomic shunt:Passes through an anatomic channel of the heart and does not

pass through the lungs.

o Intrapulmonary shunt:Blood flows through pulmonary capillaries without participating in

gas exchange.

• Hypoxemic Respiratory Failure (Type I)

3. Diffusion Limitation:

o Severe emphysema

o Recurrent pulmonary emboli

o Pulmonary fibrosis

o Hypoxemia present during exercise

o Severe Emphysema:Emphysema gradually damages the air sacs (alveoli) in your lungs,

making you progressively more short of breath. Smoking is the leading cause of emphysema.

o Recurrent pulmonary emboli:Pulmonary embolism (PE) occurs when a blood clot dislodges from a

vein, travels through the veins of the body, and lodges in the lung.

o Pulmonary fibrosis:Pulmonary fibrosis occurs when lung tissue becomes damaged. This

thickened, stiff tissue makes it more difficult for your lungs to work properly.

o Hypoxemia present during exercise:An abnormally low concentration of oxygen in the blood.

• Hypoxemic Respiratory Failure

4. Alveolar hypoventilation:

o Restrictive lung diseaseo CNS diseaseo Chest wall dysfunctiono Neuromuscular disease

• Hypercapniac Respiratory Failure (Type II)

Causes:1. Airways and alveoli.

2. Central Nervous System.

3. Chest Wall.

4. Neuromuscular Conditions.

• Hypercapniac Respiratory Failure (Type II)

1. Airways and alveoli:o Asthma.

o Emphysema.

o Bronchitis.

o Cystic fibrosis.

o Bronchitis:Bronchitis is an inflammation of the bronchial tubes.

o Cystic fibrosis:A heriditary disorder causes the production of abnormally thick

mucus, leading to the blockage of bronchi.

• Hypercapniac Respiratory Failure (Type II)

2. Central Nervous System:o Drug overdose.

o Brainstem infarction.

o Spinal cord injuries.

• Hypercapniac Respiratory Failure(Type II)

3. Chest Wall:o Flail chest.

o Fractures.

o Muscle spasm.

• Hypercapniac Respiratory Failure (Type II)

3. Neuromuscular Conditions:o Muscular Dystrophy.

o Multiple Sclerosis.

o Multiple Sclerosis:Multiple sclerosis (MS) is a disease in which your immune system

attacks the protective sheath (myelin) that covers your nerves. Myelin

damage disrupts communication between your brain and the rest of your

body. Ultimately, leading to respiratory failure and other diseases.

• Chronic Respiratory Failure:

The respiratory failure which passes

the acute stage. All of the disorders are same,

just the duration is lengthened.

•Tissue Organ Needs:Major threat is the inability of the lungs to meet the

oxygen demands of the tissues.

• Clinical Manifestations:A sudden decrease in O2 or rapid increase in CO2 indicates a

serious condition

Diagnostic Studies:

o History.

o Physical assessment.

o Chest x-ray.

o ECG.

Gerontologic Considerations:o ↓ Ventilatory capacity.

o Alveolar dilation.

o Larger air spaces.

o Loss of surface area .

o Decreased respiratory muscle strength.

Treatment:

1. Oxygen Therapy.

2. Drug Therapy.

3. Nutritional Therapy.

1. Oxygen Therapy:Oxygen therapy is a treatment that provides you with extra

oxygen, a gas that your body needs to work well.

Nasal canula.Face mask.

2. Drug Therapy:Use of Bronchodilators, Anti-biotics etc

3. Nutritional Therapy:• Maintain protein and energy stores.

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