Respiratory

Respiratory Failure

Professor Adnan M. Al-Jubouri MBCHB (Baghdad), MRCP (UK), FRCP (Edin.)

Definition

Abnormal blood gases due to diseases of the respiratory system or its control (i.e. : respiratory centre) when the patient is breathing at the sea level & at rest.

Physiology

For proper respiration, you need to have 3 important functions : 1- Proper ventilation. 2- Proper perfusion. 3- Proper exchange of gases.

Classifications

Clinically, respiratory failure is classified into 2 types depending on the presence or absence of Hypercapnoea. Type I : Hypoxia is associated with Normo or Hypocapnoea. Type II : Hypoxia is associated with Hypercapnoea.

Type IRespiratory Failure

The main pathogenetic factor in the production of type I RF is Ventilation-Perfusion Mismatching.


Causes
1- Restrictive defects of ventilation * Infiltrative lung diseases. * Pneumonias. * Cardiac pulmonary edema. * ARDS. * Sudden pneumothorax. * Sudden pleural effusion.

Pulmonary Fibrosis

CT- Lymphangitis Ca

Sarcoidosis

Causes
1- Restrictive defects of ventilation * Infiltrative lung diseases. * Pneumonias. * Cardiac pulmonary edema. * ARDS. * Sudden pneumothorax. * Sudden pleural effusion.

Pneumonia

Causes
1- Restrictive defects of ventilation * Infiltrative lung diseases. * Pneumonias. * Cardiac pulmonary edema. * ARDS. * Sudden pneumothorax. * Sudden pleural effusion.

Pulmonary Oedema

Pulmonary Oedema

Causes

1- Restrictive defects of ventilation * Infiltrative lung diseases. * Pneumonias. * Cardiac pulmonary edema. * ARDS. * Sudden pneumothorax. * Sudden pleural effusion.

2- Obstructive defects of ventilation

* Acute asthmatic attack. * Acute bronchiolitis.

Asthma

Bronchiolitis



3- Vascular causes

* Pulmonary thromboembolism. * Pulmonary vasculitis.

PTE

Clinical Features

* Sings & symptoms of the underlying cause. * Sings & symptoms of hypoxia as : SOB, restlessness, agitation, confusion, & central cyanosis. Here, the patient has progressive SOB associated with tachypnoea (shallow & rapid breathing), & the central cyanosis is obvious on minimal exertion that can be corrected by O2 therapy for more than 30% concentration.

Diagnosis

* The Dx is mostly clinical. * Dx of the underlying cause. * Lab. Investigations. * Radiological investigations. * & this is confirmed by arterial blood gases analysis.

Treatment

1- Rx of the underlying cause. 2- General Rx : * Rest in bed. * O2 therapy (Liberal).

Type IIRespiratory Failure

The main pathogenetic factor in the production of type II RF is Hypoventilation.

Causes

1- COPD.2- Hypodynamic causes : * Respiratory centre depression (Trauma, Tumors, Vascular accident, Anesthesia). * Nerves’ affection (Intercostal & Phrenic n.) as in : Gullian-Barre syndrome, Poliomyelitis * Muscles, as in : Myopathies & Myasthenia Gravis. * Thoracic cage, as in : Kyphoscoilosis & flail chest. End stage of type I respiratory failureى3 -

COPD

Causes
1- COPD.2- Hypodynamic causes : * Respiratory centre depression (Trauma, Tumors, Vascular accident, Anesthesia). * Nerves’ affection (Intercostal & Phrenic n.) as in : Gullian-Barre syndrome, Poliomyelitis * Muscles, as in : Myopathies & Myasthenia Gravis. * Thoracic cage, as in : Kyphoscoilosis & flail chest. End stage of type I respiratory failureى3 -

Clinical Features

1- The clinical features of the underlying cause. 2- The clinical features of Hypoxia. 3- The clinical features of Hypercapnoea : * Headache. * Palpitation. * Tremor. * Drowsiness. * Confusion & coma.

Diagnosis

1- Clinically. 2- Investigations : * Lab. investigations. * Radiological investigations. * Arterial blood gases analysis.

Treatment

1- Rx of the cause. 2- General measures that improve alveolar ventilation & it means improvement of the hypoxia & hypercapnoea. These General measures include : * O2 Therapy. * Airway clearance. * Assisted ventilation.


THANX