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1、UTHSCSAPediatricResidentCurriculumforthePICURESPIRATORYFAILURE&ARDSRESPIRATORYFAILUREInabilityofthepulmonarysystemtomeetthemetabolicdemandsofthebodythroughadequategasexchange.Twotypesofrespiratoryfailure:HypoxemicHypercarbicEachcanbefurtherdividedintoacuteandchronic.Bothtypesofrespir
2、atoryfailurecanbepresentinthesamepatient.CENTRALETIOLOGIESTrauma:headinjury,asphyxiation,hemorrhageInfection:meningitis,encephalitisTumorsDrugs:narcotics,sedativesNeonatalapneaSeverehypoxemiaorhypercarbiaIncreasedICPfromanyoftheabovecausesOBSTRUCTIVEETIOLOGIESUpperAirwayAnatomic:choa
3、nalatresia,tracheomalacia,tonsillarhypertrophy,laryngealweb,vascularrings,vocalcordparalysis,macroglossiaAspiration:mucus,foreignbody,vomitusInfection:epiglottitis,abscesses,laryngotracheitisTumors:hemangioma,cystichygroma,papilloma,LaryngpospasmLowerAirwayAnatomic:bronchomalacia,lob
4、aremphysemaAspiration:FB,mucus,meconium,vomitusInfection:pneumonia,pertussis,bronchiolitis,CFTumors:teratoma,bronchogeniccystBronchospasmRESTRICTIVEETIOLOGIESLungParenchymaAnatomic:agenesis,cyst,pulmonarysequestrationAtelectasisHyalinemembranediseaseARDSInfection:pneumonia,bronchiect
5、asis,pleuraleffusion,PneumocystiscariniiAirleak:pneumothoraxMisc:hemorrhage,edema,pneumonitis,fibrosisChestWallMuscular:diaphragmatichernia,myastheniagravis,musculardystrophy,botulismSkeletal:hemivertebrae,absentribs,fusedribs,scoliosisMisc:distendedabdomen,flailchest,obesityHYPOXEMI
6、AV/QmismatchMostcommonreason.Bloodperfusesnon-ventilatedlung.Seeninatelectasis,pneumonia,bronchiectasisGlobalhypoventilation:apneaRight-to-leftshuntIntracardiaclesions,e.g.,tetralogyofFallotIncompletediffusionOxygenmustdiffuseacrossincreaseddistancesecondarytointerstitialedema,fibros
7、is,orhyalinemembrane.LowinspiredFiO2:highaltitudeHYPERCARBIAPumpFailureReducedcentraldrive:apnea,metabolicalkalosis,drugs,brainsteminjury,hypoxiaMusclefatigue:musculardystrophyIncreasedpulmonaryworkload:decreasedcompliance,increasedobstructionIncreasedCO2production:fever,seizure,mali
8、gnanthyperth