Acute Respiratory Failure

Is a clinical condition in which the pulmonary system fails to maintain adequate gas exchange PaO2 value less PaO2 than 60 mmHg while breathing air or PaCo2 PaCo2 of more than 50 mmHg.

RF Respiratory failure exists whenever the exchange of O2 for Co2in the lungs can¶t O2 Co2 can¶ keep up with the rate of O2 consumption O2 & CO2 production in the cells of the body. . CO2 This results in a fall in arterial O2 tension O2 (hypoxemia) & arise in arterial CO2 CO2 tension (hypercapnia).

Causes of acute Respiratory Failure *intrapulmonary* Lower air way and alveoli Pulmonary circulation Alveolar capillary membrane .

thorax pleura.Extra pulmonary causes Brain.spinalcord. upper air way obstruction. .neuromuscular system.

in which the PaO2 is less than50 PaO2 than50 mmHg and the PaCO2 is normal or low. PaCO2 *the major pathophysiologic mechanisms are ventilationventilationperfusion (V/Q) mismatching and Right to Left shunting .R.Classifications of A.F}.F Type1 Type1{hypoxemic R.

Classifications of A. Pathophysiology caused by alveolar hypoventilation.R.F Type2 Type2{hypercapnic/hypoxaemic respiratory failure}. . in which the Paco2>45 mmHg. Paco2 accompanied by a lower than normal PaO2 PaO2.

. Hypercapnia may be present. depending on the cause.Pathophysiology Hypoxemia is the result of impaired gas exchange and the hall mark of acute respiratory failure.

. ventilation / perfusion (V/Q) mismatching and intrapulmonary shunting.Patho The main cause of hypoxemia are alveolar hypoventilation.

Path *Type1 *Type1 respiratory failure results from V/Q mismatching and intrapulmonary shunting. *Type2 *Type2 respiratory failure results from alveolar hypoventilation which may be accompanied by V/Q mismatching and intrapulmonary shunting. .

This can be the result of increasing metabolic oxygen needs or decreasing ventilation.1-Alveolar hypoventilation Occurs when the amount of oxygen being brought into the alveoli is insufficient to meet the metabolic needs of the baby. .

Alveolar hypoventilation Hpoxemia caused by alveolar hypoventilation is characterized by hypercapnia and commonly results from extra pulmonary disorder. .

Alveolar hypoventilation It is characterized by ABG values that reflect an increase in PaCO2.and a decrease in PaO2 . or PaO2 hypercapnic/hypoxemic respiratory failure. . and a decrease in PaCO2 SaO2 SaO2.

VentilationVentilation-perfusion mismatching Normally alveolar ventilation is approximately 4 L/m & capillary perfusion is approximately 5 L/m . . Thus the normal ventilation to perfusion ratio is 4:5 .

Situations in which ventilation exceeds perfusion (V/Q>o. .Ventilation ± perfusion mismatching V/Q may vary from low to high ratios.8)are considered dead (V/Q>o.8 space producing. (high v/q units).

(low V/Q).8) are considered shunt producing. . Significant alterations in relationship result in hypoxemia.VentilationVentilation-perfusion mismatching Situations in which perfusion exceeds ventilation (V/Q<o.

e.VentilationVentilation-perfusion mismatching V/Q mismatching occurs when ventilation and blood flow are mismatched in various regions of the lung in excess of what is normal i. . (there is a greater than normal variability in these V/Q matching the overall ratio of ventilation to perfusion is disturbed and hypoxemia develops).

.VentilationVentilation-perfusion mismatching V/Q mismatching is the most common cause of hypoxemia and is usually the result of alveoli that are partially collapsed or partially filled with fluid.

.V/Q Mismatch Hypoxemia results when alveoli are under ventilated relative to the normal amount of perfusion (blood flow) they receive. Un oxygenated blood passing by underunderventilated alveoli mixes with oxygenated blood and lowers the PaO2.

.V/Q Mismatch Decreased ventilation relative to perfusion is the mechanism of hypoxemia is such conditions as Asthma . COPD and pulmonary edema. resulting in impaired oxygenation. Bronchospasm . mucus plugging and atelectasis can also reduce ventilation of well perfused alveoli.

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