Notes in Acute Respiratory Failure

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Published	11/02/2023	Acute Respiratory Failure (ARF)• Inability to maintain either: → Normal delivery of {{c4::oxygen}} to tissues OR → The normal removal of {{c4::carbon …
Published	11/02/2023	{{c1::pulse oximeter}} works on basis that {{c2::oxygenated}} Hb and {{c2::deoxygenated}} Hbhave different wavelengths when infrared lights hits them&…
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Published	11/02/2023	hypoxemia vs hypoxia{{c1::Hypoxemia}}: Low oxygen in the blood → Low {{c3::PaO2}}, low {{c3::SaO2}}{{c2::Hypoxia}}: insufficient oxygen delivered…
Published	11/02/2023	Oxygen Dissociation Curve- saturation of {{c1::Hb}} with O2 is dependent on partial pressure of O2 in the blood→ Arterial blood: PaO2 {{c2::100}}…
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Published	11/02/2023	ABG: 7.47/28/50... meaning:→ {{c1::pH}} = 7.47→ {{c1::PCO2}} = 28→ {{c1::PaO2}} = 50
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Published	11/02/2023	V/Q mismatch- most common cause of {{c3::hypoxemia}}- can either be due to low {{c4::ventilation}} (Low V/Q) or low {{c4::perfusion}} (High V/Q)- will…
Published	11/02/2023	High Altitude → reduced inspired {{c2::O2}} = supply is low (low P{{c1::A}}O2) → leading to a low P{{c1::a}}O2 → hypoxemia*with normal A-a gradient&nb…
Published	11/02/2023	Hypoxia related to High Altitude• {{c1::Hyperventilation}} is the most important and immediate adaptation to high altitude → ⬇ {{c2::PaCO2}} and ⬆ {{c…
Published	11/02/2023	Abnormal Shunts → Hypoexmia*normal shunts that do not cause hypoxemia: {{c1::Bronchial}} Blood Flow & {{c1::Thebesian}} Veins{{c2::L}} → {{c2::R}}…
Published	11/02/2023	No SpO2 improvement with 100% FiO2 supplementation → abnormal {{c1::shunt}}
Published	11/02/2023	opiates, benzodiazepenes, and a bottle of vodka → decreased SaO2 and increased CO2 due to hypo{{c1::ventilation}}
Published	11/02/2023	Minute ventilation is inversely proportional to blood {{c1::CO2}} levels
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Published	11/02/2023	Hypoventilation → HypoxemiaCO2 metabolism: {{c1::Alveolar Ventilation}} Equation
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Published	11/02/2023	There is an {{c1::inverse}} relationship between alveolar ventilation and PaCO2*If CO2 production is constant, then PaCO2 is {{c1::inversely}} proport…
Published	11/02/2023	high PaCO2 → low PAO2 → low PaO2
Published	11/02/2023	Hypoventilation also has {{c1::normal}} A-a gradient *because {{c2::PAO2}} and {{c2::PaO2}} are similarly decreasedtreatments: oxygen, non-{{c3::…
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Published	11/02/2023	Vicious cycle of COPD: inadequate time to {{c1::exhale}} → build up of air within the lungs = dynamic {{c2::hyperinflation}} → {{c4::diaphragm}} …
Published	11/02/2023	No disease has one mechanism for hypoxemia
Published	11/02/2023	acute respiratory failure can be in the form of acute respiratory {{c1::distress}} syndrome (ARDS)
Published	11/02/2023	Respiratory failure is a syndrome in which the respiratory system fails in {{c1::oxygenation}} and/or {{c1::carbon dioxide elimination}}- can be …
Published	11/02/2023	Type {{c1::I}} epithelial cells are invovled in {{c2::gas exchange}}Type {{c1::II}} act like stem cells and function as {{c3::repair}} …
Published	11/02/2023	Neonatal respiratory distress syndrome (NRDS)• disease of the newborn caused by a deficiency of {{c1::surfactant}} → alveoli can’t stay open → develop…
Published	11/02/2023	Neonatal respiratory distress syndrome (NRDS)• diagnosis after birth....→ ABG: hypoxemia and hypercapnia• diagnosis before birth....→ amniocentesis to…
Published	11/02/2023	prevention of NRDS- antenatal {{c1::corticosteroid}} therapy to all pregnant individuals at {{c2::23-34::range}} weeks gestation who are at increased …
Published	11/02/2023	ARDS is NOT the same as NRDS
Published	11/02/2023	ARDS→ acute diffuse, inflammatory lung injury that leads to increased pulmonary vascular {{c3::permeability}}, increased lung weight, and loss of {{c4…
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Published	11/02/2023	Disorders associated with development of ARDS- can be direct insult to alveoli (most common being {{c1::pneumonia}} and {{c1::gastric aspiration}})- c…
Published	11/02/2023	ARDS Mimics...• {{c3::Congestive Heart failure}} (ruled in with echocardiogram if pleural effusion, cardiomegaly are seen)• {{c1::Interstitial}} …
Published	11/02/2023	{{c1::Starling}} forces govern the pulmonary microcirculation*altered in {{c5::pulmonary edema}}→ opposing forces of {{c2::hydrostatic}} and {{c3::onc…
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Published	11/02/2023	classic histopathology finding in ARDS: diffuse {{c1::alveolar}} damage and {{c2::hyaline}} membrane (ARDS, AIP, AEP)* non-{{c4::caseating}} granulo…
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Published	11/02/2023	pathophysiology of ARDS1. alveolar epithelium→ loss of tight junction and {{c9::sloughing}} → leakage of {{c2::protein}}-rich fluid into alveolar…
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Published	11/02/2023	COVID ARDS different from normal because excessive {{c1::thrombosis}} → longer duration of disease (not just a couple of weeks)
Published	11/02/2023	Clinical features of ARDS• Depends on underlying {{c1::etiology}}...→ if {{c2::sepsis}}: fever, chills, rigors, low BP, pneumonia features (cough, SOB…
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Published	11/02/2023	Radiographic patterns of ARDS• CXR: bilateral alveolar {{c3::infiltrates}} (diffuse or patchy)• CT chest:→ {{c4::heterogeneous}} and patchy invol…
Published	11/02/2023	Heterogeneous lung units in ARDS- aerated, {{c5::ventral}} regions (`{{c1::baby}} lung') have the highest {{c2::compliance}} → tend to become {{c…
Published	11/02/2023	Principles of treatment of ARDS- recognize and treat the {{c1::cause}}→ control sepsis (antimicrobial, drainage of abscess, surgery) → repair/sta…
Published	11/02/2023	Mechanical ventilation in ARDS- application of {{c1::positive pressure}} to improve oxygenation→ fraction of inspired oxygen (FiO2) and {{c3::pos…
Published	11/02/2023	Steroids in ARDS- corticosteroids → anti-{{c1::inflammatory}} or {{c1::immunomodulatory}} properties → decrease lung injury in ARDS (improve mortality…
Published	11/02/2023	{{c1::Prone}} positioning in ARDS- more homogenous pleural pressure → {{c2::dorsal}} lung is better aerated (better recruitment) → decreasing int…
Published	11/02/2023	Other supportive measures in ARDS- {{c1::diuretics}} to keep lung dry- early {{c2::mobilization}} and physical therapy- treat comorbidities
Published	11/02/2023	Death from ARDSif < {{c1::72}} hours → due to underlying causeif > {{c2::72}} hours → due to multi-organ failure
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