1
Respiratory Failure
Bai Chunxue
Department of Respiratory disease
Zhongshan Hospital
Fudan University
Chapter 7
复旦呼研所
2
Key Words
? Respiratory failure
? Acute respiratory distress
syndrome(ARDS)
? dyspnea
? Hypoxemia
? hypercapnia
? Respiratory Support
? Mechanical ventilation
? Positive end-expiratory pressure (PEEP)
复旦呼研所
3
Respiratory Failure Definition
Chapter 7
?Type I,II Respiratory Failure
?Centrol,Non-Centrol Respiratory
Failure
?Acute & Chronic Respiratory Failure
复旦呼研所
4
ACUTE RESPIRATORY
FAILURE
Bai Chun-Xue
Department of Respiratory diseases
Zhongshan Hospital
复旦呼研所
5
?respiratory dysfunction resulting
in abnormalities of oxygenation
or ventilation
?impair or threaten the function of
vital organs
Definition 复旦呼研所
6
Type I
?Parenchyma
?Edema
?Vascular disease
?Chest Wall & Pleural
disease
Type II
?Airway
obstruction
?Neuromuscular
disease
Pathogeny 复旦呼研所
7
hypoxemia
Perfusion
Diffusion
Ventilation
CO 2
CO 2
O 2 O 2
Clinical Findings
复旦呼研所
8
P A
O
2
，P
ACO
2
（kP
a)
hypercapnia
CO2
O2
Clinical Findings
复旦呼研所
9
? cyanosis,restlessness
? confusion,anxiety,delirium
? tachypnea,tachycardia
? hypertension,cardiac arrhythmias
? tremor
Hypoxemia 复旦呼研所
10
?Dyspnea and headache
?peripheral and conjunctiva
hyperemia
?hypertension,tachycardia,tachypnea
?impaired consciousness
?papilledema,and asterixis
Hypercapnia 复旦呼研所
11
Diagnosis
PaO2<8 kPa
PaCO2 >6.66 kPa
复旦呼研所
12
?specific therapy directed toward
the underlying disease;
?respiratory supportive care
directed toward the maintenance of
adequate gas exchange;
?general supportive care,
Treatment 复旦呼研所
13
Nonventilatory
aspects
Ventilatory
aspects
A,Respiratory Support 复旦呼研所
14
? SaO2 of ≥90% (PaO2 about 60 mm Hg),
? Hypoxemia in patients with obstructive airway
disease is usual easily corrected by using low-
flow oxygen by nasal cannula (1–3 L/min) or
Venturi mask (24–28%),
? Higher concentrations of oxygen are necessary
to correct hypoxemia in patients with ARDS,
pneumonia,and other parenchymal lung
diseases,
Nonventilation 复旦呼研所
15
经鼻面罩机械通气治疗前后血气变化（ X± S）
白春学,等, 应用国产呼吸器经鼻面罩治疗慢性阻塞性肺病
所致呼吸衰竭 9例报告, 上海医学 1993;16:102
复旦呼研所
16
Tracheal
intubation
Mechanical
ventilation
Ventilation
复旦呼研所
17
? Hypoxemia which is not quickly
reversed by supplemental oxygen
? Airway obstruction
? Impaired airway protection
? Inadequate handling of secretions
? Facilitation of mechanical
ventilation
Tracheal intubation–Indications
18
Tracheal intubation 复旦呼研所
19
? Apnea
? Acute hypercapnia that is not
quickly reversed by appropriate
specific therapy
? Severe hypoxemia
? Progressive patient fatigue despite
appropriate treatment
Mechanical ventilation–Indications
20
? Assisted mechanical ventilation
(AMV) or assist/control (A/C)
? Synchronized intermittent
mandatory ventilation (SIMV)
? Pressure support ventilation (PSV)
Mechanical ventilation–Modes
21
? Pressure control ventilation (PCV)
? Continuous positive airway pressure
(CPAP)
? Positive end-expiratory pressure
(PEEP)
Mechanical ventilation–Modes
22
? Atelectasis of the centrolateral lung
and overdistention of the intubated
lung
? Barotrauma,manifested by
subcutaneous emphysema,
pneumomediastinum,subpleural air
cysts,pneumothorax,or systemic
gas embolism
Mechanical ventilation–Complications
23
? Subtle parenchymal lung injury
? Acute respiratory alkalosis
? Hypotension
? Ventilator-associated pneumonia,
mortality rate of this disorder is
about 50–60%
Mechanical ventilation–Complications
24
? Nutrition
? Psychological and emotional support
? Skin care
? Meticulous avoidance of nosocomial
infection and complications of
tracheal tubes
B.General Supportive Care 复旦呼研所
25
Course &
Prognosis
复旦呼研所
26
?Prognosis of acute respiratory failure
caused by uncomplicated sedative or
narcotic drug overdose is excellent
?Acute respiratory failure in patients
with COPD who do not require
intubation and mechanical ventilation
has a good immediate prognosis
Course & Prognosis 复旦呼研所
27
?ARDS associated with sepsis has
an extremely poor prognosis,with
mortality rates of about 90%,
?Survival rates of 62% to weaning,
43% to hospital discharge,and
30% to 1 year after hospital
discharge,
Course & Prognosis 复旦呼研所
28
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复旦呼研所
Respiratory Failure
Bai Chunxue
Department of Respiratory disease
Zhongshan Hospital
Fudan University
Chapter 7
复旦呼研所
2
Key Words
? Respiratory failure
? Acute respiratory distress
syndrome(ARDS)
? dyspnea
? Hypoxemia
? hypercapnia
? Respiratory Support
? Mechanical ventilation
? Positive end-expiratory pressure (PEEP)
复旦呼研所
3
Respiratory Failure Definition
Chapter 7
?Type I,II Respiratory Failure
?Centrol,Non-Centrol Respiratory
Failure
?Acute & Chronic Respiratory Failure
复旦呼研所
4
ACUTE RESPIRATORY
FAILURE
Bai Chun-Xue
Department of Respiratory diseases
Zhongshan Hospital
复旦呼研所
5
?respiratory dysfunction resulting
in abnormalities of oxygenation
or ventilation
?impair or threaten the function of
vital organs
Definition 复旦呼研所
6
Type I
?Parenchyma
?Edema
?Vascular disease
?Chest Wall & Pleural
disease
Type II
?Airway
obstruction
?Neuromuscular
disease
Pathogeny 复旦呼研所
7
hypoxemia
Perfusion
Diffusion
Ventilation
CO 2
CO 2
O 2 O 2
Clinical Findings
复旦呼研所
8
P A
O
2
，P
ACO
2
（kP
a)
hypercapnia
CO2
O2
Clinical Findings
复旦呼研所
9
? cyanosis,restlessness
? confusion,anxiety,delirium
? tachypnea,tachycardia
? hypertension,cardiac arrhythmias
? tremor
Hypoxemia 复旦呼研所
10
?Dyspnea and headache
?peripheral and conjunctiva
hyperemia
?hypertension,tachycardia,tachypnea
?impaired consciousness
?papilledema,and asterixis
Hypercapnia 复旦呼研所
11
Diagnosis
PaO2<8 kPa
PaCO2 >6.66 kPa
复旦呼研所
12
?specific therapy directed toward
the underlying disease;
?respiratory supportive care
directed toward the maintenance of
adequate gas exchange;
?general supportive care,
Treatment 复旦呼研所
13
Nonventilatory
aspects
Ventilatory
aspects
A,Respiratory Support 复旦呼研所
14
? SaO2 of ≥90% (PaO2 about 60 mm Hg),
? Hypoxemia in patients with obstructive airway
disease is usual easily corrected by using low-
flow oxygen by nasal cannula (1–3 L/min) or
Venturi mask (24–28%),
? Higher concentrations of oxygen are necessary
to correct hypoxemia in patients with ARDS,
pneumonia,and other parenchymal lung
diseases,
Nonventilation 复旦呼研所
15
经鼻面罩机械通气治疗前后血气变化（ X± S）
白春学,等, 应用国产呼吸器经鼻面罩治疗慢性阻塞性肺病
所致呼吸衰竭 9例报告, 上海医学 1993;16:102
复旦呼研所
16
Tracheal
intubation
Mechanical
ventilation
Ventilation
复旦呼研所
17
? Hypoxemia which is not quickly
reversed by supplemental oxygen
? Airway obstruction
? Impaired airway protection
? Inadequate handling of secretions
? Facilitation of mechanical
ventilation
Tracheal intubation–Indications
18
Tracheal intubation 复旦呼研所
19
? Apnea
? Acute hypercapnia that is not
quickly reversed by appropriate
specific therapy
? Severe hypoxemia
? Progressive patient fatigue despite
appropriate treatment
Mechanical ventilation–Indications
20
? Assisted mechanical ventilation
(AMV) or assist/control (A/C)
? Synchronized intermittent
mandatory ventilation (SIMV)
? Pressure support ventilation (PSV)
Mechanical ventilation–Modes
21
? Pressure control ventilation (PCV)
? Continuous positive airway pressure
(CPAP)
? Positive end-expiratory pressure
(PEEP)
Mechanical ventilation–Modes
22
? Atelectasis of the centrolateral lung
and overdistention of the intubated
lung
? Barotrauma,manifested by
subcutaneous emphysema,
pneumomediastinum,subpleural air
cysts,pneumothorax,or systemic
gas embolism
Mechanical ventilation–Complications
23
? Subtle parenchymal lung injury
? Acute respiratory alkalosis
? Hypotension
? Ventilator-associated pneumonia,
mortality rate of this disorder is
about 50–60%
Mechanical ventilation–Complications
24
? Nutrition
? Psychological and emotional support
? Skin care
? Meticulous avoidance of nosocomial
infection and complications of
tracheal tubes
B.General Supportive Care 复旦呼研所
25
Course &
Prognosis
复旦呼研所
26
?Prognosis of acute respiratory failure
caused by uncomplicated sedative or
narcotic drug overdose is excellent
?Acute respiratory failure in patients
with COPD who do not require
intubation and mechanical ventilation
has a good immediate prognosis
Course & Prognosis 复旦呼研所
27
?ARDS associated with sepsis has
an extremely poor prognosis,with
mortality rates of about 90%,
?Survival rates of 62% to weaning,
43% to hospital discharge,and
30% to 1 year after hospital
discharge,
Course & Prognosis 复旦呼研所
28
------END------
复旦呼研所
