1. ACUTE RESPIRATORY FAILURE 高雄長庚醫院胸腔內科 王逸熙

3. WHAT IS ACUTE RESPIRATORY FAILURE ? Rapid and significant compromise in the system’s ability to adequately exchange carbon dioxide and /or oxygen

5. Distinctions Between Acute and Chronic Respiratory failure Category Characteristic Hyercapnic Paco2 > 45 mmHG Respiratory failure Acute Develops in min to h Chronic Develops over several days or longer Hypoxemic PaO2 < 55 mmHg,when FiO2≧0.60 Respiratory Failure Acute Develops in min to h Chronic Develops over several days or longer

6. RESPIRATORY FAILURE HYPERCAPNIA HYPOXEMIA ACUTE CHRONIC ACUTE CHRONIC

8. Two types of respiratory failure HYPERCAPNIA ( “PUMP FAILURE” ) HYPOXEMIA ( “LUNG FAILURE” ) Central Nerve System Component Peripheral Nerve System/ Chest Bellows component Airways Component Alveolar Component

11. Causes of Acute Respiratory Failure Type 1 respiratory failure Type 2 respiratory failure Parenchymal process Increased load Pneumonia Upper airway obstruction Pulmonary edema Asthma cadiogenic COPD noncardiogenic Pulmonary hemorrhage Neurological etiology Progressive interstitial process Central respiratory depression Pulmonary vascular Spinal cord injury Pulmonary embolism Peripheral nerve Pulmonary hypertension Neuromuscular junction

14. Risk Factor of ARDS Sepsis Aspiration of gastric contents Pulmonary contusion Pneumonia Near drowning Smoke inhalation/burn Trauma Pancreatitis Multiple transfusions Pulmonary embolism Disseminated intravascular coagulation

15. Clinical Disorders Associated with ARDS Direct Lung Injury Indirect Lung Injury Aspiration of gastric contents Severe sepsis Pulmonary contusion Major trauma Toxic gas (smoke) inhalation Multiple long-bone fractures Near-drowning Hypovolemic shock Diffuse pulmonary infection Hypertransfusion Acute pancreatitis Drug overdose Reperfusion injury Post-lung transplantation Post-cardiopulmonary bypass

23. ACUTE RESPIRATORY FAILURE IN THE SURGICAL PATIENT

24. Risk Factors for Postoperative Pulmonary Complication Factors related to the patient COPD Advance age Extensive (and recent) smoking history Obesity Factors related to the surgery Thoracic and upper abdominal procedures Emergency surgery Prolonged anesthesia time (>3 h) Large intraoperative blood transfusion requirements

25. Incidence of Respiratory failure Following surgery Procedure Incidence of postoperative Respiratory Failure TAAA repair 8-33 % AAA repair 5-24 % Lung resection 4-15 % CABG 5-8% All types 0.8 %

38. Causes of Postoperative Respiratory Failure Factors extrinsic to the lung Depression of central respiratory drive(anesthetics, opioids, sedatives) Phrenic nerve injury/ diaphragmatic paralysis Obstructive sleep apnea Factors intrinsic to the lung Atelectasis Pneumonia Aspiration Acute lung injury (ARDS) Volume overload/ congestive heart failure Pulmonary embolism Bronchospasm/ COPD