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respiratory failure..... presentation by dr priyanka
- 1. DR. PRIYANKA GANANI Dnb Registrar
- 2. Respiratory distress ⦿ Respiratory distress is a clinical impression ⦿ Increased rate+ increased work =increased minute ventilation
- 3. Respiratory failure ⦿ inability of the lungs to provide sufficient oxygen (hypoxic respiratory failure) or remove carbon dioxide (ventilatory failure) to meet metabolic demands. ⦿ Inadequate oxygenation/ ventilation when compensatory mechanism fail to maintain gas exchange
- 4. Respiratory failure ⦿ Pao2 < 60 with breathing of room air and ⦿ Paco2 > 50 resulting in acidosis, ⦿ the patient's general state, respiratory effort, and potential for impending exhaustion are more important indicators than blood gas values.
- 5. ⦿ Respiratory distress can occur in patients without respiratory disease, and ⦿ respiratory failure can occur in patients without respiratory distress.
- 6. The causes: ⦿ Respiratory load related to lung or airway ⦿ conditions that affect the respiratory pump failure (respiratory muscle failure) ⦿ Related to central nervous system
- 7. Airway/Lung Dysfunction ● Central Airway Obstruction ⦿ — Croup ⦿ — Foreign body ⦿ — Anaphylaxis ⦿ — Bacterial tracheitis ⦿ — Epiglottitis ⦿ — Retropharyngeal abscess ⦿ — Bulbar muscle weakness/dysfunction ● Peripheral Airways/Parenchymal Lung Disease ⦿ — Status asthmaticus ⦿ — Bronchiolitis ⦿ — Pneumonia ⦿ — Acute respiratory distress syndrome ⦿ — Pulmonary edema ⦿ — Pulmonary contusion ⦿ — Cystic fibrosis ⦿ — Chronic lung disease (eg, bronchopulmonary dysplasia)
- 8. Respiratory Pump Dysfunction ● Decreased Central Nervous System (CNS) Input ⦿ — Head injury ⦿ — Ingestion of CNS depressant ⦿ — Adverse effect of procedural sedation ⦿ — Intracranial bleeding ⦿ — Apnea of prematurity ● Peripheral Nerve/Neuromuscular Junction ⦿ — Spinal cord injury ⦿ — Organophosphate/carbamate poisoning ⦿ — Guillian-Barre´ syndrome ⦿ — Myasthenia gravis ⦿ — Infant botulism ● Muscle Weakness ⦿ — Respiratory muscle fatigue due to increased work of breathing ⦿ — Myopathies/Muscular dystrophies
- 9. Lung/Airway Disease ⦿ Diseases of the lung or airways affect gas exchange most often by disrupting the normal matching of V/Q or by causing a shunt. ⦿ usually can maintain a normal Paco2 as lung disease worsens simply by breathing more. ⦿ hypoxemia is the hallmark of lung disease
- 10. Causes of hypoxia ⦿ Hypoxemia due to V/Q mismatch ⦿ Diffusion block ⦿ Hypoventilation ⦿ Right to left shunting
- 11. Ventilation-Perfusion Mismatch Perfusion without ventilation V (low)/Q= 0: SHUNTING V/Q=1 NORMAL N: 0.8 Ventilation without perfusion V/Q (low)= INFINTY ALVEOLAR DEAD SPACE EG:PULMONARY EDEMA EG : PULMONARY EMBOLISM
- 12. Diffusion ⦿ diffusion defects manifest as hypoxemia rather than hypercarbia. ⦿ Refers to process that impair gas exchange at alveolar membrane due to presence of fluid, inflammatory infiltrates, surfactant dysfunction ⦿ Examples : Interstitial pneumonia, ARDS, Surfactant dysfunction, Pulmonary edema,…
- 13. Hypoventilation ⦿ Includes all condition causing pump failure (neuromuscular weakness) causing respiratory muscle dysfunction ⦿ low respiratory rate and shallow breathing are both signs of hypoventilation. ⦿ The Paco2 increases in proportion to a decrease in ventilation. ⦿ Pao2 falls approximately the same amount as the Paco2 increases.
- 14. Monitoring a Child in Respiratory Distress and Respiratory Failure
- 15. Clinical Examination ⦿ Clinical observation is the most important component of monitoring.
- 16. ABG & Oximetry ⦿ ABG /CBG/ VBG ⦿ Oximetry - Oximetry provides an invaluable and usually accurate measurement of oxygenation. - important to recognize its technical limitations
- 17. Respiratory failure ⦿ Acute ⦿ Chronic
- 19. ARF ⦿ most common cause of cardiac arrest in children. When presented with a child who has: ⦿ a decreased level of consciousness, ⦿ slow/shallow breathing, or increased ⦿ respiratory drive, the possibility of ARF should be considered
- 20. First: ⦿ to assure adequate gas exchange and circulation (the ABCs). ⦿ Oxygen Administration to maintain … . ⦿ If Ventilation is or appears to be inadequate ….. ⦿ Intubation ? Need ICU
- 21. Arterial gas composition depends on : ⦿ the gas composition of the atmosphere ⦿ the effectiveness of alveolar ventilation ⦿ pulmonary capillary perfusion ⦿ diffusion across the alveolar capillary membrane
- 23. CRF is seen most commonly in children who have: ⦿ Respiratory muscle weakness (muscular dystrophy, anterior horn cell disease) or ⦿ severe chronic lung diseases (BPD, end- stage cystic fibrosis)
- 24. ⦿ usually has an insidious onset ⦿ Most children do not have dyspnea. ⦿ PH normal or near normal , unless….. ⦿ Recognizing need careful monitoring of children at risk for CRF
- 25. ⦿ Disordered sleep ⦿ Daytime hypersomnolence ⦿ Morning headaches ⦿ Altered mental status ⦿ Increased respiratory symptoms ⦿ Cardiomegaly ⦿ Decreased baseline oxygenation ⦿ CRF often presents first during sleep ⦿ Develops an intercurrent illness , Fever