内科学-呼吸衰竭

According to mechanisms
• Pump failure • Lung failure
9
Etiology
Airway obstruction
• Airway inflammation, tumor, foreign bodies, fibrosis scar COPD and asthma
• Peripheral respiratory failure
• Dyspnea
According to onset of respiratory failure
• Acute, develops in seconds or hours • Chronic, develops in days or longer, elevated HCO3• Acute onset of Chronic respiratory failure • Have no definitive borderline
5
Introduction (cont.)
Short-term survival is more than 80% for acute respiratory failure not preceded by additional lung disease or systemic illness Multi-system organ failure or pre-existing renal, liver, or chronic gastrointestinal disease with malnutrition substantially worsens outlook About 17% of patients placed on mechanical ventilation require assistance for more than 14 days Among those requiring this amount of mechanical ventilation, elderly patients have a 9% survival and younger patients a 36% survival
Intubation via mouth tracheotomy
Monitoring and ventilation
3
Contents 0f outline
Definition Etiology & Pathogenesis Classification Clinical manifestations Diagnosis Treatment
Acidosis
Male, 32 Fever, cough with sputum for 3 days No finding on physical examination Diagnosis: pneumonia X－ray: shadow in left lower lobe
August 20, 2003 2
7
Classification
According to pathophysiology and arterial blood gas analysis:
Type I: A failure of gas exchange Hypoxemia, PaO2 < 60 mmHg
Type II: A failure of ventilation PaO2 < 60 mmHg, PaCO2 > 50 mmHg
4
Introduction
Be a frequently encountered medical problem A major cause of death in China Mortality from COPD, which ends in death from respiraபைடு நூலகம்ory failure, continues to increase More than 70% of patients with pneumonia are attributed to respiratory failure About 1/3 patients in ICU in the United States, about 500 000 persons, receive mechanical ventilation each year
PaO2 > 60 mmHg, PaCO2 >50 mmHg Iatrogenic
8
Classification
According to the involved site
• Central respiratory failure
• Change of respiratory rhythm and frequency
Respiratory failure
1
August 16, 2003
Acute shortness of breath Anxiety
• RR 40/min, Cyanosis • ABG: PaO2 61mm Hg(FiO2 1.0)
PaCO2 35 mmHg, pH 7.20 • X-ray: clouded glass • Diagnosis：ARDS
6
Definition
Be a clinical syndrome of respiratory and metabolism dysfunction caused by any condition that severely affects the lung’s ability to maintain arterial oxygenation or carbon dioxide elimination. Both acute or chronic respiratory failure may be divided into two main categories. • A failure of gas exchange – hypoxemia • A failure of ventilation – hypercapnia