10 Respiratory failure ARDS PH.pdf - Main components of the ventilatory system 1 VENTILATION(V PERFUSION(Q DIFFUSION V/Q V/Q Breathing-to supply O2 to

10 Respiratory failure ARDS PH.pdf - Main components of the...

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Main components of the ventilatory system 1
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2 - VENTILATION (V) - PERFUSION (Q) - DIFFUSION V/Q V/Q Breathing -to supply O2 to the blood -to regulate the acid base balance via the CO2 concentration in the blood.
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Respiratory failure is a syndrome of inadequate gas exchange due to dysfunction of one or more essential components of the respiratory system. Disruption in Ventilation Upper & Lower Respiratory Tracts Obstruction due to trauma or infectious processes Chest Wall & Diaphragm Trauma : Pneumothorax, Hemothorax Neuromuscular disease Nervous System Trauma Poisoning or Overdose Disease Disruption in Diffusion Low concetration of oxygen in air Damaged Alveoli Disruption in Perfusion Alteration in Blood Flow Changes in Hemoglobin Pulmonary Shunting 3 Pathophysiology of RF
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Respiratory failure Results from inadequate gas exchange Insufficient O 2 transferred to the blood Hypoxemia Inadequate CO 2 removal Hypercapnia -Not a disease but a condition -Result of one or more diseases involving the lungs or other body systems 5
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Classification of Respiratory Failure TYPE I TYPE II Norm: pH 7,35- 7,45 PaO2 75-100 mmHg PaCO2 32-45 mmHg Hb oxygen 95-98% Hypoxemia is always present
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Type III Respiratory Failure Perioperative RF -Increased atelectasis due to low functional residual capacity in the setting of abnormal abdominal wall mechanics . -Often results in type I or type II respiratory failure. -Can be ameliorated by anesthetic or operative technique, posture, post- operative analgesia. Type IV Respiratory Failure S hock Type IV describes patients who are intubated and ventilated in the process of resuscitation for shock Goal of ventilation is to stabilize gas exchange and to unload the respiratory muscles, lowering their oxygen consumption 7
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Distinction between Acute and Chronic RF Acute RF Develops over minutes to hours ↓ pH quickly to <7.2 Example; Pneumonia Chronic RF Develops over days ↑ in HCO3 ↓ pH slightly Polycythemia, Cor pulmonale Example; COPD
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Acidosis presence of a process which tends to pH by virtue of gain of H + or loss of HCO 3- Alkalosis presence of a process which tends to pH by virtue of loss of H + or gain of HCO 3- respiratory vs metabolic Respiratory processes which lead to acidosis or alkalosis through a primary alteration in ventilation and resultant excessive elimination or retention of CO 2 Metabolic processes which lead to acidosis or alkalosis through their effects on kidneys and the consequent disruption of H + and HCO 3- control Acidemia reduction in arterial pH (pH<7,35) Alkalemia increase in arterial pH (pH>7,45)
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Respiratory failure Etiology V/Q mismatch: Dead space ventilation Alveoli that are normally ventilated but poorly perfused Anatomic dead space Gas in the large conducting airways that does not come in contact with the capillaries e.g pharynx Physiologic dead space Alveolar gas that does not equilibrate fully with capillary blood Dead space ventilation increase Alveolar-capillary interface destroyed (emphysema) Blood flow is reduced (CHF, PE) Overdistended alveoli (positive- pressure ventilation) 10
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  • Fall '19
  • Krzysztof Okoń

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