Description
The illness known as respiratory failure occurs when either one or both of the respiratory system's two gas exchange processes—oxygenation and carbon dioxide elimination—fail. It can be categorized as either hypoxemic or hypercapnic in real life. When arterial carbon dioxide tension is normal or low and arterial oxygen tension (PaO2) is less than 60 mm Hg, hypoxemic respiratory failure (type I) is present (PaCO2). The most prevalent type of respiratory failure, which is characterized by the fluid filling or collapse of alveolar units, is connected to almost all acute lung illnesses.
Résumé
- Respiratory failure, a common ICU occurrence, stems from the failure of the ventilatory system to exchange carbon dioxide for oxygen. This failure can be categorized as Type 1 (hypoxemic) due to lung issues or Type 2 (hypercapnic) resulting from pump (muscle or brain) malfunctions.
- Hypoxemic respiratory failure presents with TAO2 levels below 80, while hypercapnic failure shows PCO2 levels above 45. Common causes for hypoxemia include pulmonary edema, pneumonia, and acute lung injury. Hypercapnic failure is linked to CNS depression, neuropathies, myopathies, and obstructive airway diseases like COPD and asthma.
- A case study highlighted obesity hypoventilation syndrome (OHS) in a morbidly obese patient with drowsiness and type 2 respiratory failure, evidenced by high bicarbonate levels. Differentiating OHS from obstructive sleep apnea (OSA) involves identifying hypoventilation as the primary issue.
- Management of type 2 respiratory failure requires ABG monitoring to maintain pH above 7.25. Chest X-rays, CT scans, and pulmonary function tests aid in diagnosis. Treatment options range from CPAP therapy to bilevel therapy and, in severe cases, bariatric surgery or tracheostomy.
- Type 1 respiratory failure, characterized by alveolar or circulatory issues, necessitates oxygen therapy and investigations to identify the underlying cause. Management strategies include CPAP or NIV therapy, progressing to intubation and prone positioning for severe cases.
- Non-invasive ventilation (NIV), delivered via face mask or helmet, supports breathing without intubation. Invasive ventilation, on the other hand, requires endotracheal intubation and precise parameter settings. Tidal volume is determined by ideal body weight, adhering to ARDS net trial recommendations.
- Prone positioning can improve oxygenation, requiring trained staff and careful monitoring. Additional therapies include high-flow nasal cannula (HFNC) for oxygen delivery and extra corporeal membrane oxygenation (ECMO) for severe cases, where blood is oxygenated outside the body. Physiotherapy and optimal nutrition are critical components of patient recovery.
Exemple de certificat
À propos des intervenants
Dr Viny Kantroo
MRCP (Londres), DNB Maladies respiratoires, IDCCM (Soins intensifs), EDARM"
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