呼吸衰竭respiratoryfailure英文课件

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1、RespiratoryFailureDr.SatSharmaUnivofManitobaRESPIRATORYFAILURE“inabilityofthelungtomeetthemetabolicdemandsofthebody.Thiscanbefromfailureoftissueoxygenationand/orfailureofCO2homeostasis.”RESPIRATORYFAILUREDefinitionRespirationisgasexchangebetweentheorganismanditsen

2、vironment.FunctionofrespiratorysystemistotransferO2fromatmospheretobloodandremoveCO2fromblood.ClinicallyRespiratoryfailureisdefinedasPaO2<60mmHgwhilebreathingair,oraPaCO2>50mmHg.Respiratorysystemincludes:CNS(medulla)Peripheralnervoussystem(phrenicnerve)Respiratory

3、musclesChestwallLungUpperairwayBronchialtreeAlveoliPulmonaryvasculaturePotentialcausesofRespiratoryFailureHYPOXEMICRESPIRATORYFAILURE(TYPE1)PaO2<60mmHgwithnormalorlowPaCO2normalorhighpHMostcommonformofrespiratoryfailureLungdiseaseisseveretointerferewithpulmonaryO

4、2exchange,butoverallventilationismaintainedPhysiologiccauses:V/QmismatchandshuntHYPOXEMICRESPIRATORYFAILURECAUSESOFARTERIALHYPOXEMIA1.FiO22.Hypoventilation(PaCO2)Hypercapnic3.V/QmismatchRespiratoryfailure(eg.COPD)4.Diffusionlimitation?5.Intrapulmonaryshunt-pneum

5、onia-Atelectasis-CHF(highpressurepulmonaryedema)-ARDS(lowpressurepulmonaryedema)CausesofHypoxemicRespiratoryfailureCausedbyadisorderofheart,lungorblood.EtiologyeasiertoassessbyCXRabnormality:-NormalChestx-rayCardiacshunt(righttoleft)Asthma,COPDPulmonaryembolismHyp

6、erinflatedLungs:COPDCausesofHypoxemicRespiratoryfailure(cont’d.)FocalinfiltratesonCXRAtelectasisPneumoniaAnexampleofintrapulmonaryshuntCausesofHypoxemicRespiratoryFailure(cont’d.)DiffuseinfiltratesonCXRCardiogenicPulmonaryEdemaNoncardiogenicpulmonaryedema(ARDS)Int

7、erstitialpneumonitisorfibrosisInfectionsDiffusepulmonaryinfiltratesHypercapnicRespiratoryFailure(TypeII)PaCO2>50mmHgHypoxemiaisalwayspresentpHdependsonlevelofHCO3HCO3dependsondurationofhypercapniaRenalresponseoccursoverdaystoweeksAcuteHypercapnicRespiratoryFailur

8、e(TypeII)AcuteArterialpHislowCauses-sedativedrugoverdose-acutemuscleweaknesssuchasmyastheniagravis-severelungdisease:alveolarventilationcannotbemaintain