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Respiratory failure Guo Yubiao, M.D & Ph.D   Pulmonary & Critical Care Medicine  The first Affiliated Hospital of Sun-Yat Set University
Male, 32 Fever, cough with sputum for 3 days No finding on physical examination Diagnosis : pneumonia  X - ray : shadow in left lower lobe  August 16, 2003 August 20, 2003 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intubation via mouth tracheotomy Monitoring and ventilation
Contents 0f outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction (cont.) ,[object Object],[object Object],[object Object],[object Object]
Definition   ,[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Pump Failure (泵衰竭) ,[object Object],[object Object],[object Object]
Lung Failure (肺衰竭) ,[object Object],[object Object],[object Object],[object Object]
Mechanisms & Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Mechanisms of hypoxemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25  20  15  10  5  肺泡分压 (kPa) 0  2  4  6  8  10 肺泡通气量 (l/min) P A CO2 P A O2 P A C O 2   =0.863*VC O2 /VA
Mechanisms of hypoxemia ––   Diffusion abnormality ( 弥散障碍 ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],100 80 60 40 动脉氧分压 0.25  0.5  0.75 血液通过肺泡毛细血管时间
Mechanisms of hypoxemia ,[object Object],[object Object],V/Q=0.8 V/Q>0.8 V/Q<0.8 Q > V (A-V shunt) Normal V > Q (dead space effect)
( 二 ) 通气 / 血流比例  V/Q 肺泡死腔通气 V/Q > 0.8 静 - 动脉分流 V/Q < 0.8 正常通气 / 血流 V/Q 0.8 VD  PaCO 2 - PeCO 2 VT  PaCO 2 Qs  CcO 2   - CaO 2 Q T   CcO 2   - CvO 2 V A   4.2L(R2.1, L2.1) Q  5.0L(R2.5, L2.5) 见于肺不张, ARDS 见于 COPD 正常 Mechanisms of hypoxemia
Mechanisms of hypoxemia ,[object Object],[object Object],800 100 20 10 肺泡氧分压 2  4  6  8  10 肺泡通气量 (l/min) 400 动脉氧分压 (kPa)
Mechanisms of hypercapnia ,[object Object],[object Object],[object Object]
Influence of hypoxemia  Central nervous system   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Influence of hypoxemia Cardiovascular system ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Influence of hypoxemia Respiratory system
Influence of hypoxemia haematological system   ,[object Object],[object Object]
Influence of hypoxemia Renal & Digestive system ,[object Object],[object Object]
Influence of hypercapnia  Central nervous system ,[object Object],[object Object],[object Object],[object Object]
Influence of hypercapnia   Cardiovascular system ,[object Object],[object Object],[object Object],[object Object],[object Object]
Influence of hypercapnia   Respiratory system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
pH  pH     26.6mmHg
Influence of hypercapnia urinary  system ,[object Object],[object Object],[object Object]
Influence of hypoxemia & hypercapnia Acid-base balance and electrolytes ,[object Object],[object Object],[object Object],[object Object],[object Object],pH = HCO 3 - PaCO 2
Clinical manifestation Acute respiratory failure (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Clinical manifestation Acute respiratory failure (2)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clinical manifestation Acute respiratory failure (3)
Clinical manifestation Chronic respiratory failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic criteria   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic criteria   The acute respiratory distress syndrome (ARDS)   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment   (outline of principle) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Etiology Management ,[object Object],[object Object],[object Object]
Causes of Upper Airway Obstruction ,[object Object],[object Object],[object Object],[object Object]
Treatment   Keep airway open  保持气道通畅 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment   Keep airway open 保持气道通畅 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Oxygen therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Oxygen therapy ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treatment Oxygen therapy
Nasal cannula/prongs 鼻导管吸氧 ,[object Object]
Simple oxygen mask 常规面罩 ,[object Object],[object Object]
Venturi mask  Venturi 面罩 ,[object Object]
Treatment Oxygen therapy ,[object Object],[object Object],[object Object],[object Object]
Treatment Ensure adequate ventilation, correct CO2 retention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Non-invasive positive pressure ventilation, NIPPV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Different kind of masks  各款口鼻面罩
Treatment Mechanical ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Management of electrolyte and acid-base disturbance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you!

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13 respiratory failure

  • 1. Respiratory failure Guo Yubiao, M.D & Ph.D Pulmonary & Critical Care Medicine The first Affiliated Hospital of Sun-Yat Set University
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  • 3. Intubation via mouth tracheotomy Monitoring and ventilation
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  • 18. ( 二 ) 通气 / 血流比例 V/Q 肺泡死腔通气 V/Q > 0.8 静 - 动脉分流 V/Q < 0.8 正常通气 / 血流 V/Q 0.8 VD PaCO 2 - PeCO 2 VT PaCO 2 Qs CcO 2 - CaO 2 Q T CcO 2 - CvO 2 V A 4.2L(R2.1, L2.1) Q 5.0L(R2.5, L2.5) 见于肺不张, ARDS 见于 COPD 正常 Mechanisms of hypoxemia
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  • 29. pH  pH  26.6mmHg
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  • 52. Different kind of masks 各款口鼻面罩
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