1) Respiratory failure is a condition where the lungs cannot properly oxygenate the blood and remove carbon dioxide, classified as Type I (hypoxemic) or Type II (hypercapnic). 2) It can result from problems affecting gas exchange in the lungs, respiratory control centers in the brain, or the chest wall muscles. 3) Common causes of Type I respiratory failure include pneumonia, ARDS, and severe asthma, while Type II is often due to conditions that decrease breathing, such as COPD.

1. Respiratory Failure
by
By
Dr. Adel Hamada
Lecturer of Chest Diseases
Faculty of Medicine Zagazig University

2. It is a condition in which the lung cannot
fulfill its primary function of maintaining
adequate gas exchange leading to PaO2 less
than 60mmHg and/or PaCO2 more than 50
mmHg .
Definition

3. - Hypxemia without hypercapnia.
-Level of PaO2 is less than 60mmHg at rest. While breathing
room air at see level
-As severe pneumonia and ARDS.
-Hypoxemia with hypercapnia.
-As 1. Depression of Respiratory centre
-2. Disease of the respiratory bellows
-3. COPD
Type I R.F (Hypoxaemic R.F):
Type II R.F (Hypercapnic R.F) :as

4. Gases Values
PaO2 80-100mmHg.
PaCO2 35- 45mmHg.
PH 7.35 - 7.45
HCO-
3 22 -27 ml equivalent
SaO2 97-99%.
Normal values of arterial blood gases
Where P = partial pressure, a = arterial, O2= oxygen,
CO2 = carbon dioxide, HCO-
3 = serum bicarbonate
level, SaO2 = oxygen saturation of arterial blood

5. Pathogenesis
Type I
1- ventilation
perfusion mis-
match
2- Shunt effect
Type II
Alveolar
Hypoventilation

6. Causes of alveolar
hypoventilation
generator Pump Effector organ

7. Presentation of
respiratory failure
hypoxemia
hypercapnea
Both
Manifestation of precipitating cause
Plus

8. Dyspnea
Impaired
mental status
headache
Tachycardia
Papiledema
Cyanosis
Lung
examination
Symptoms
signs
Tremors

9. Treatment of
respiratory failure
A B C D E
Maintain adequate
oxygen delivery
Mechanical ventilation
if indicated
Treatment of cause

10. Life threatening conditions
Acute severe asthma
COPD exacerbation
Severe pneumonia
Acute Respiratory Distress Syndrome
Acute massive pulmonary embolism

11. Acute severe asthma

14. An exacerbation of COPD is:
“an acute event characterized by a
worsening of the patient’s respiratory
symptoms that is beyond normal day-
to-day variations and leads to a
change in medication.”

15. Manage Exacerbations: Key Points
 The most common causes of COPD exacerbations
are viral upper respiratory tract infections and
infection of the tracheobronchial tree.
 Diagnosis relies exclusively on the clinical
presentation of the patient complaining of an acute
change of symptoms that is beyond normal day-to-
day variation.
 The goal of treatment is to minimize the impact of
the current exacerbation and to prevent the
development of subsequent exacerbations.

16.  Short-acting inhaled beta2-agonists with or without
short-acting anticholinergics are usually the
preferred bronchodilators for treatment of an
exacerbation.
 Systemic corticosteroids and antibiotics can shorten
recovery time, improve lung function (FEV1) and
arterial hypoxemia (PaO2), and reduce the risk of
early relapse, treatment failure, and length of
hospital stay.
 COPD exacerbations can often be prevented.
Manage Exacerbations: Key Points

17. Impact on
symptoms
and lung
function
Negative
impact on
quality of life
Increased
economic
costs
Accelerated
lung function
decline
Increased
Mortality
EXACERBATIONS
Consequences Of COPD Exacerbations

18. Manage Exacerbations: Assessments
Arterial blood gas measurements (in hospital): PaO2 < 8.0
kPa with or without PaCO2 > 6.7 kPa when breathing room air
indicates respiratory failure.
Chest radiographs: useful to exclude alternative diagnoses.
ECG: may aid in the diagnosis of coexisting cardiac problems.
Whole blood count: identify polycythemia, anemia or
bleeding.
Purulent sputum during an exacerbation: indication to begin
empirical antibiotic treatment.
Biochemical tests: detect electrolyte disturbances, diabetes,
and poor nutrition.
Spirometric tests: not recommended during an exacerbation.

19. Manage Exacerbations: Treatment Options
Oxygen: titrate to improve the patient’s hypoxemia with a target
saturation of 88-92%.
Bronchodilators: Short-acting inhaled beta2-agonists with or
without short-acting anticholinergics are preferred.
Systemic Corticosteroids: Shorten recovery time, improve lung
function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk
of early relapse, treatment failure, and length of hospital stay. A
dose of 30-40 mg prednisolone per day for 10-14 days is
recommended.

20. Antibiotics should be given to patients with:
 Three cardinal symptoms: increased
dyspnea, increased sputum volume, and
increased sputum purulence.
 Who require mechanical ventilation.
Manage Exacerbations: Treatment Options

21. Noninvasive ventilation (NIV):
 Improves respiratory acidosis, reduces
respiratory rate, severity of dyspnea,
complications and length of hospital stay.
 decreases mortality and needs for intubation.
Manage Exacerbations: Treatment Options

22. Manage Exacerbations: Indications for
Hospital Admission
 Marked increase in intensity of symptoms
 Severe underlying COPD
 Onset of new physical signs
 Failure of an exacerbation to respond to initial
medical management
 Presence of serious comorbidities
 Frequent exacerbations
 Older age
 Insufficient home support

26. Severe pneumonia

27. ATS/IDSA Recommendations for Empirical Antibiotic
Treatment of Community-Acquired Pneumonia

28. Definition:
Form of acute lung injury characterized by non cardiogenic pulmonary
edema and refractory hypoxemia that is produced by neutrophil-
mediated cytotoxicity to lung cells (alveolar epithelium and capillary
endothelium) as a result of a wide variety of insults to the lung, either
directly or indirectly
Acute Respiratory Distress
Syndrome

29. The Berlin Definition of Acute Respiratory Distress Syndrome

30. ETIOLOGY OF ARDS
Clinical Disorders Associated with Development of (ARDS)

31. RESCUE STRATEGIES
FOR REFRACTORY
HYPOXEMIA
MANAGEMENT OF ARDS
VENTILATORY
MANAGEMENT
SUPPORTIVE
TREATMENT

32. Acute massive pulmonary embolism
Risk factors of
pulmonary
embolism

35. Treatment
Anticoagulant
Thrombolytic Therapy if
haemodynamically unstable

36. THANK
YOU