Acute Respiratory Failure

Send This

Download

Comment

Favourite

more

Rating :

Rate It:

Embed :

Songwut on Sep 22, 2012 Says :

good slide

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

5 Favorites

soso-199420112011, favourited this 1 Years ago.

nemahesh, favourited this 1 Years ago.

amart6, favourited this 3 Years ago.

dawntalt, favourited this 4 Years ago.

blerdi, favourited this 4 Years ago.

First Prev [1] Next Last

Notes

Hide Notes

Slide 1 :

Acute Respiratory Failure Cindy Kin Trauma Conference 6 August 2007 Stanford Surgery

Slide 2 :

Acute Respiratory Failure Failure in one or both gas exchange functions: oxygenation and carbon dioxide elimination In practice: PaO2<60mmHg or PaCO2>46mmHg Derangements in ABGs and acid-base status

Slide 3 :

Acute Respiratory Failure Hypercapnic v Hypoxemic respiratory failure ARDS and ALI

Slide 4 :

Hypercapnic Respiratory Failure (PAO2 - PaO2) Alveolar Hypoventilation V/Q abnormality ??PI max increased normal Nl VCO2 PaCO2 >46mmHg Not compensation for metabolic alkalosis Central Hypoventilation Neuromuscular Problem ??VCO2 V/Q Abnormality Hypermetabolism Overfeeding

Slide 5 :

The Case of Patient RV 71M s/p L AKA revision. PMH: CAD s/p CABG, COPD on home O2 and CPAP, DM, CVA, atrial fibrillation PACU: L pleural effusion, hypotension, altered mental status. Sent to ICU for monitoring. POD#1: ?RR overnight, intermittently hypoxic. BiPAP 40%: 7.34/65/63/35/+10 Preintubation: 7.28/91/81/43

Slide 6 :

Slide 7 :

Hypercapnic Respiratory Failure Alveolar Hypoventilation Brainstem respiratory depression Drugs (opiates) Obesity-hypoventilation syndrome ??PI max Central Hypoventilation Neuromuscular Disorder nl?PI max Critical illness polyneuropathy Critical illness myopathy Hypophosphatemia Magnesium depletion Myasthenia gravis Guillain-Barre syndrome

Slide 8 :

Hypercapnic Respiratory Failure (PAO2 - PaO2) Alveolar Hypoventilation V/Q abnormality ??PI max increased normal Nl VCO2 PaCO2 >46mmHg Not compensation for metabolic alkalosis Central Hypoventilation Neuromuscular Disorder ??VCO2 V/Q Abnormality Hypermetabolism Overfeeding

Slide 9 :

Hypercapnic Respiratory Failure V/Q abnormality Increased Aa gradient Nl VCO2 ??VCO2 V/Q Abnormality Hypermetabolism Overfeeding

Slide 10 :

Hypercapnic Respiratory Failure V/Q abnormality Increased Aa gradient Nl VCO2 ??VCO2 V/Q Abnormality Hypermetabolism Overfeeding Increased dead space ventilation advanced emphysema ?PaCO2 when Vd/Vt >0.5 Late feature of shunt-type edema, infiltrates

Slide 11 :

Hypercapnic Respiratory Failure V/Q abnormality Increased Aa gradient Nl VCO2 ??VCO2 V/Q Abnormality Hypermetabolism Overfeeding VCO2 only an issue in pts with ltd ability to eliminate CO2 Overfeeding with carbohydrates generates more CO2

Slide 12 :

Hypoxemic Respiratory Failure Is PaCO2 increased? Hypoventilation ?(PAO2 - PaO2)? Hypoventilation alone ?Respiratory drive Neuromuscular dz Hypovent plus another mechanism Shunt ?Inspired PO2 High altitude ?FIO2 ?(PAO2 - PaO2) No No Yes Yes

Slide 13 :

The Case of Patient ES 77F s/p MVC. Injuries include multiple L rib fxs, L hemopneumothorax s/p chest tube placement, L iliac wing fx. PMH: atrial arrhythmia, on coumadin. INR>2 HD#1 RR 30s and shallow. Pain a/w breathing deeply. Placed on BiPAP overnight PID#1 BiPAP 80%: 7.45/48/66/32/+10

Slide 14 :

Slide 15 :

Hypoxemic Respiratory Failure V/Q mismatch V/Q mismatch DO2/VO2 Imbalance PvO2>40mmHg PvO2<40mmHg ?DO2: anemia, low CO ?VO2: hypermetabolism

Slide 16 :

Hypoxemic Respiratory Failure V/Q mismatch SHUNT V/Q = 0 DEAD SPACE V/Q = 8 Atelectasis Intraalveolar filling Pneumonia Pulmonary edema Pulmonary embolus Pulmonary vascular dz Airway dz (COPD, asthma) Intracardiac shunt Vascular shunt in lungs ARDS Interstitial lung dz Pulmonary contusion

Slide 17 :

Slide 18 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Severe ALI B/L radiographic infiltrates PaO2/FiO2 <200mmHg (ALI 201-300mmHg) No e/o ?L Atrial P; PCWP<18

Slide 19 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Develops ~4-48h Persists days-wks Diagnosis: Distinguish from cardiogenic edema History and risk factors

Slide 20 :

Slide 21 :

Inflammatory Alveolar Injury

Slide 22 :

Inflammatory Alveolar Injury Pro-inflmm cytokines (TNF, IL1,6,8)

Slide 23 :

Inflammatory Alveolar Injury Pro-inflmm cytokines (TNF, IL1,6,8) Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium

Slide 24 :

Inflammatory Alveolar Injury Fluid in interstitium and alveoli Pro-inflmm cytokines (TNF, IL1,6,8) Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium

Slide 25 :

Inflammatory Alveolar Injury Fluid in interstitium and alveoli Impaired gas exchange ? Compliance ? PAP Pro-inflmm cytokines (TNF, IL1,6,8) Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium

Slide 26 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Exudative phase Fibrotic phase Proliferative phase Diffuse alveolar damage

Slide 27 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Direct Lung Injury Infectious pneumonia Aspiration, chemical pneumonitis Pulmonary contusion, penetrating lung injury Fat emboli Near-drowning Inhalation injury Reperfusion pulmonary edema s/p lung transplant

Slide 28 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Indirect Lung Injury Sepsis Severe trauma with shock/hypoperfusion Burns Massive blood transfusion Drug overdose: ASA, cocaine, opioids, phenothiazines, TCAs. Cardiopulmonary bypass Acute pancreatitis

Slide 29 :

Hypoxemic Respiratory Failure Acute Respiratory Distress Syndrome Complications Barotrauma Nosocomial pneumonia Sedation and paralys

CHF Diastolic Heart ...

Management of Conges...

Acute Coronary Syndr...

Sleep Apnea and Hear...

Acute Hepatitis B Wh...

Acute Coronary Syndr...

Free Powerpoint Templates

	SlidesOnline 4 Years ago.



13000 Views, 6 favourite
Sepsis; Severe trauma with shock/hypoperfusion; Burns; Massive blood transfusion; Drug overdose: AS more Sepsis; Severe trauma with shock/hypoperfusion; Burns; Massive blood transfusion; Drug overdose: ASA, cocaine, opioids, phenothiazines, TCAs. … less
More By User Flag as inappropriate Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details. Cancel