Respiratory insufficiency

Created by Jiří Kofránek

Respiratory insufficiency (failure)

Symptoms

Cardiopulmonary monitoring

https://www.wikiskripta.eu/w/Kardiopulmon%C3%A1ln%C3%AD_monitoring

Stuffiness Shortness of breath (dyspnoea)

But shortness of breath is also present in anemia

Shortness of breath is also present in cardiac failure - mainly of the left heart (pulmonary edema)

Tachypnea

involvement of auxiliary respiratory muscles

Cyanosis

>=50 g O2/l reduced Hb

150 g/l <75%

it will not be for anemia

50 g/l - anemia, pale

polycythemia vera >165 g/l men 160 women

JAK2 mutation clonal mutation (cyanosis)

g/l *0.06205784→ mmol/l

mmol/l*16.114→ g/l

https://egolem.online/bloodgases/#pribeh2a.md

central

differentiation from peripheral: tongue

but be careful. peripheral may be masked by hypoperfusion (fingers are pale)

peripheral

disorders of consciousness - disorientation - up to delirium

https://www.wikiskripta.eu/w/Glasgow_Coma_Scale

GCS, 15-13 OK, 12 -9 moderate, 8-3 impaired consciousness

GCS 15 ok

Respiratory rate

Respiratory frequency above 22 - saturation OK,

Respiratory rate 30 - attention

Laboratory measurement

O2 saturation

90% - PO2 60 mmHg

Respiratory frequency above 22 - saturation OK,

Respiratory rate 30 - attention

O2 and CO2 saturation curves

https://egolem.online/bloodgases/#pribeh2a.md

Masks the reduction in saturation

Oxygen supplementation

Heart rate

Horowitz Index (1970)

PaO2/FiO2 norm 100 mmHg/0.21 = approximately 500 (300-500 is the norm)

P-F ratio PaO2 300-500 is the norm

300 - 200 light damage

200-100 medium damage

100 and below - severe injury (ARDS)

https://en.wikipedia.org/wiki/Horowitz_index

Measurement of acid-base balance (Astrup) - PO2, PCO2, pH

PaO2 <60 mmHg

(60 mmHg corresponds to approx. 90% saturation)

PCO2 > 50 mmHg

pH <7.3 -> consider artificial ventilation

According to arterial PaO2, PaCO2

Type 1 partial (hypoxic)

Low PaO2

PaCO2 normal or low (respiratory alkalosis)

PaO2 <60 mmHg

PaCO2 norm or low → Respiratory alkalosis

From the onset of lung disease (before the respiratory muscles tire)

Type 2 global (hypoxic-hypercapnic)

PaCO2 >50 mm Hg -> respiratory acidosis

PaO2<60 mmHg

PaCO2 >50mmHg

According to time

Acute

Within a week

Acute onset - aspiration, ARDS (3 days)

Chronic

Months, years

It can become acute

COPD, Astma

Restrictive lung disorders

Causes of respiratory failure

hypoventilation

Obstruction

Diffusion

Perfusion → ventilation-perfusion V/Q ratio

Kyphoscoliosis

u seniorů

Obesity

Muscular dystrophy (Duchenne muscular dystrophy, Amyotrophic lateral sclerosis)

Myasthenia gravis

antibodies against nicotinic receptors (to acetylcholine) ← Ig (worsening during the day)

aphragmatic fatigue (after tachypnea)

CNS trauma, stroke

Spinal cord injury C3-C5 (phrenicus)

Opiates

PaC02 will increase - respiratory acidosis

Foreign body in the respiratory tract

Tumor, enlarged lymph nodes

Athma, COPD

VA/Q

Pneumonia

Cardiogenic edema

Noncardiogenic edema

ARDS

difúzní edém (RTG obraz mléčného skla)

tlak v zaklínění <18 /vyločení kardiální příčiny

Sepsis, gastric juice inspiration, hot air...

Acute respiratory distress

Ventilation without perfusion: dead space

Right-to-left shunts (RL shunts)

there is no ventilation but there is perfusion

Hyperventilation

PaO2 will decrease

Breathing pattern of low -CO2 - hypocapnia

Tongue-out dogs hyperventilate the dead space, not the alveoli

... at the same time they do not hyperventilate the alveoli - alveolar ventilation does not change

The goal is cooling - thermoregulation

Hyperventilation

Kussmaul respiration

kusmaulovo dýcháníKussmaul respiration

PaO2 will only increase slightly

PaCO2 will decrease

Compensation of metabolic acidosis

Buffers

bicarbonate

proteins

hemoglobin

phosphate (IC)

Oxygen delivery

Energy generation

https://www.physiome.cz/mito_0/

https://www.physiome.cz/mito_3/