respiratory failure..... presentation by dr priyanka

respiratory failure

1. DR. PRIYANKA GANANI Dnb Registrar

2. Respiratory distress Respiratory distress is a clinical impression Increased rate+ increased work =increased minute ventilation

3. Respiratory failure inability of the lungs to provide sufficient oxygen (hypoxic respiratory failure) or remove carbon dioxide (ventilatory failure) to meet metabolic demands. Inadequate oxygenation/ ventilation when compensatory mechanism fail to maintain gas exchange

4. Respiratory failure Pao 2 < 60 with breathing of room air and Paco 2 > 50 resulting in acidosis, the patient's general state, respiratory effort, and potential for impending exhaustion are more important indicators than blood gas values.

5. Respiratory distress can occur in patients without respiratory disease, and respiratory failure can occur in patients without respiratory distress.

6. The causes: Respiratory load related to lung or airway conditions that affect the respiratory pump failure (respiratory muscle failure) Related to central nervous system

7. Airway/Lung Dysfunction Central Airway Obstruction — Croup — Foreign body — Anaphylaxis — Bacterial tracheitis — Epiglottitis — Retropharyngeal abscess — Bulbar muscle weakness/dysfunction Peripheral Airways/Parenchymal Lung Disease — Status asthmaticus — Bronchiolitis — Pneumonia — Acute respiratory distress syndrome — Pulmonary edema — Pulmonary contusion — Cystic fibrosis — Chronic lung disease (eg, bronchopulmonary dysplasia)

8. Respiratory Pump Dysfunction Decreased Central Nervous System (CNS) Input — Head injury — Ingestion of CNS depressant — Adverse effect of procedural sedation — Intracranial bleeding — Apnea of prematurity Peripheral Nerve/Neuromuscular Junction — Spinal cord injury — Organophosphate/carbamate poisoning — Guillian- Barre´ syndrome — Myasthenia gravis — Infant botulism Muscle Weakness — Respiratory muscle fatigue due to increased work of breathing — Myopathies/Muscular dystrophies

9. Lung/Airway Disease Diseases of the lung or airways affect gas exchange most often by disrupting the normal matching of V/Q or by causing a shunt. usually can maintain a normal Paco2 as lung disease worsens simply by breathing more. hypoxemia is the hallmark of lung disease

10. Causes of hypoxia H ypoxemia due to V/Q mismatch Diffusion block Hypoventilation Right to left shunt ing

11. Ventilation- Perfusion Mismatch Perfusion without ventilation V (low)/Q= 0: SHUNTING V/Q=1 NORMAL N: 0.8 Ventilation without perfusion V/Q (low)= INFINTY ALVEOLAR DEAD SPACE EG:PULMONARY EDEMA EG : PULMONARY EMBOLISM

12. Diffusion diffusion defects manifest as hypoxemia rather than hypercarbia. Refers to process that impair gas exchange at alveolar membrane due to presence of fluid, inflammatory infiltrates, surfactant dysfunction Examples : I nterstitial pneumonia, ARDS, S urfactant dysfunction , Pulmonar y edema ,…

13. Hypoventilation Includes all condition causing pump failure (neuromuscular weakness) causing respiratory muscle dysfunction low respiratory rate and shallow breathing are both signs of hypoventilation. The Paco2 increases in proportion to a decrease in ventilation. Pao2 falls approximately the same amount as the Paco2 increases.

14. Monitoring a Child in Respiratory Distress and Respiratory Failure

15. Clinical Examination Clinical observation is the most important component of monitoring.

16. ABG & Oximetry ABG /CBG/ VBG Oximetry Oximetry provides an invaluable and usually accurate measurement of oxygenation. important to recognize its technical limitations

17. Respiratory failure Acute Chronic

18. Acute Respiratory Failure

19. ARF most common cause of cardiac arrest in children. When presented with a child who has: a decreased level of consciousness, slow/shallow breathing, or increased respiratory drive, the possibility of ARF should be considered

20. First: to assure adequate gas exchange and circulation (the ABCs). Oxygen Administration to maintain …. If Ventilation is or appears to be inadequate ….. Intubation ? Need ICU

21. Arterial gas composition depends on : the gas composition of the atmosphere the effectiveness of alveolar ventilation pulmonary capillary perfusion diffusion across the alveolar capillary membrane

22. Chronic Respiratory Failure

23. CRF is seen most commonly in children who have: Respiratory muscle weakness (muscular dystrophy, anterior horn cell disease) or severe chronic lung diseases (BPD, end- stage cystic fibrosis)

24. usually has an insidious onset Most children do not have dyspnea. PH normal or near normal , unless….. Recognizing need careful monitoring of children at risk for CRF

25. Disordered sleep Daytime hypersomnolence Morning headaches Altered mental status Increased respiratory symptoms Cardiomegaly Decreased baseline oxygenation CRF often presents first during sleep Develops an intercurrent illness , Fever

26. Thank you