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Questions and Answers
What is the definition of acute respiratory failure (ARF)?
A condition in which the respiratory system fails in one or both of its gas-exchange functions, namely oxygenation and elimination of Carbon Dioxide (CO2)
What are the conventional criteria for defining acute respiratory failure?
PaO2 < 60 mmHg and/or PaCO2 > 45 mmHg & pH < 7.35, or both
What is the normal range for PaO2 in arterial blood?
80-100 mmHg
What is the general treatment for acute respiratory failure?
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What are the two components of the respiratory system that can fail, leading to respiratory failure?
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What is the difference between Type I and Type II respiratory failure?
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What are the two main categories of causes of acute respiratory failure?
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What are some common clinical features of acute respiratory failure?
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What is the most common cause of hypoxaemia in respiratory failure?
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What are the determinants of gas exchange in the lungs?
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What is the main difference between a shunt and dead space in V/Q mismatch?
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What is the main difference between Type 1 and Type 2 respiratory failure?
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What is the primary goal of managing respiratory failure?
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What is the priority in managing respiratory failure?
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What is the main difference between stagnant hypoxia and anemic hypoxia?
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What are the early and late respiratory features of hypoxia?
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What are the effects of hypercarbia on the oxy-haemoglobin dissociation curve?
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What are the clinical manifestations of hypercarbia at different levels of PaCO2?
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What is the main cause of Type II respiratory failure?
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What is the effect of hypoxia on the cardiovascular system?
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What is the effect of hypoxia on the neurological system?
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What is the effect of hypercarbia on the respiratory system?
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whats the Mechanisms of hypoxaemia
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example of shunt
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example of dead space ventilation
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Determinates of Gas Exchange
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What are the causes of hypoxia in acute respiratory failure?
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Who is at risk of CO2 retention
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Management of Respiratory Failure-Failure to oxygenate
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Management of Respiratory Failure-Failure to ventilate
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mechanisms' of hypercarbia
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Study Notes
Acute Respiratory Failure (ARF)
- Defined as a condition in which the respiratory system fails in one or both of its gas-exchange functions: oxygenation and elimination of carbon dioxide
- Classified into two types: Type I (Failure to Oxygenate) and Type II (Failure to Ventilate)
Type I Respiratory Failure: Failure to Oxygenate
- Characterized by hypoxaemia (PaO2 < 60 mmHg)
- Mechanisms of hypoxaemia: low fraction of inspired oxygen (FiO2), V/Q mismatch, diffusion defect
- Causes: intrapulmonary diseases (COPD, pneumonia), extrapulmonary diseases (pulmonary oedema, cardiac failure), and others
Type II Respiratory Failure: Failure to Ventilate
- Characterized by hypercapnia (PaCO2 > 45 mmHg) and usually accompanied by hypoxaemia
- Caused by hypoventilation due to various factors such as central nervous system disorders, peripheral nervous system disorders, and others
Clinical Features of Acute Respiratory Failure
- Variable and dependent on the underlying cause, degree of hypoxaemia, hypercarbia, and acidosis
- Symptoms: dyspnoea, tachypnoea, orthopnoea, inability to speak, use of accessory muscles, intercostal retractions, paradoxical abdominal movement, noisy breathing, anxiety, restlessness, confusion, lethargy, and coma
Mechanisms and Features of Hypoxaemia
- Defined as deficient oxygenation of arterial blood (PaO2 < 80 mmHg)
- Causes: stagnant hypoxia, anaemic hypoxia, histotoxic hypoxia
- Clinical features: respiratory, cardiovascular, neurological, and skin-related symptoms
Mechanisms and Features of Hypercarbia
- Defined as deficient elimination of carbon dioxide (PaCO2 > 45 mmHg)
- Causes: hypoventilation due to various factors
- Clinical features: tachypnoea, dyspnoea, headache, restlessness, agitation, confusion, coma, and death in severe cases
Management of Respiratory Failure
- General goals of therapy: maintain airway patency, optimise oxygen delivery, optimise CO and ensure adequate Hb, minimise oxygen demand, identify and treat the underlying cause, and prevent complications
- Specific therapies: oxygen therapy, NIV, IPPV, PEEP, CPAP, and others
ABG Analysis and Interpretation
- VBG and ABG normal values: pH, PvO2, PvCO2, HCO3-, BE
- Interpretation of ABG results: assessment of oxygenation, ventilation, and acid-base status
Case Study
- 25-year-old female with mild SOB and chest pain, presented to ED with negative cardiac troponin level
- ABG results: PaO2 = 70 mmHg, pH = 7.25, PaCO2 = 51 mmHg, HCO3- = 24 mEq/L
- Diagnosis and management of acute respiratory failure
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Description
Test your knowledge on acute respiratory failure, its classification, causes, clinical features, and treatment. Review your understanding of anatomy and physiology related to breathing.