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1、UTHSCSAPediatricResidentCurriculumforthePICURESPIRATORYFAILURE&ARDSRESPIRATORYFAILUREInabilityofthepulmonarysystemtomeetthemetabolicdemandsofthebodythroughadequategasexchange.Twotypesofrespiratoryfailure:HypoxemicHypercarbicEachcanbefurtherdividedintoacut
2、eandchronic.Bothtypesofrespiratoryfailurecanbepresentinthesamepatient.CENTRALETIOLOGIESTrauma:headinjury,asphyxiation,hemorrhageInfection:meningitis,encephalitisTumorsDrugs:narcotics,sedativesNeonatalapneaSeverehypoxemiaorhypercarbiaIncreasedICPfromanyoft
3、heabovecausesOBSTRUCTIVEETIOLOGIESUpperAirwayAnatomic:choanalatresia,tracheomalacia,tonsillarhypertrophy,laryngealweb,vascularrings,vocalcordparalysis,macroglossiaAspiration:mucus,foreignbody,vomitusInfection:epiglottitis,abscesses,laryngotracheitisTumors
4、:hemangioma,cystichygroma,papilloma,LaryngpospasmLowerAirwayAnatomic:bronchomalacia,lobaremphysemaAspiration:FB,mucus,meconium,vomitusInfection:pneumonia,pertussis,bronchiolitis,CFTumors:teratoma,bronchogeniccystBronchospasmRESTRICTIVEETIOLOGIESLungParenc
5、hymaAnatomic:agenesis,cyst,pulmonarysequestrationAtelectasisHyalinemembranediseaseARDSInfection:pneumonia,bronchiectasis,pleuraleffusion,PneumocystiscariniiAirleak:pneumothoraxMisc:hemorrhage,edema,pneumonitis,fibrosisChestWallMuscular:diaphragmatichernia
6、,myastheniagravis,musculardystrophy,botulismSkeletal:hemivertebrae,absentribs,fusedribs,scoliosisMisc:distendedabdomen,flailchest,obesityHYPOXEMIAV/QmismatchMostcommonreason.Bloodperfusesnon-ventilatedlung.Seeninatelectasis,pneumonia,bronchiectasisGlobalh
7、ypoventilation:apneaRight-to-leftshuntIntracardiaclesions,e.g.,tetralogyofFallotIncompletediffusionOxygenmustdiffuseacrossincreaseddistancesecondarytointerstitialedema,fibrosis,orhyalinemembrane.LowinspiredFiO2:highaltitudeHYPERCARBIAPumpFailureReducedcen
8、traldrive:apnea,metabolicalkalosis,drugs,brainsteminjury,hypoxiaMusclefatigue:musculardystrophyIncreasedpulmonaryworkload:decreasedcompliance,increasedobstructionIncreasedCO2production:fever,seizure,malignanthyperth
