RESPIRATORY FAILURE

CLINICAL FEATURE OF RESPIRATORY FAILURE -
 -breathlessodrs at rest ,
 -raised respiratory rate,
 - central cynosis,
 -drowsiness,
 - confusion or unconsciousness.


DEFINATION.
- PaO2 < 60 mm ofHg
-PaCO2>50 mm of Hg
-Type 1 respiratory failure - low PaO2 & low or normal PaCO2.
-Type 2 respiratory failure -low PaO2 & raised PaCO2
 TYPES OF RF -
1. Acute hypoxia without hypercapnia - acute type 1
2. Chronic hypoxia without hypercapnia - chronic type 1
3. Acute hypoxia with hypercapnia - acute type 2
4. Chronic hypoxia with hypercapnia -chronic type 2
ACUTE TYPE 1 RF-
¥causes -
-pneumonia
-pulm edema
-acute respiratory distress syndrome
.-pulm embolism
- pneumothorax
¥ management -
  - treat underlying condition.
  - high conc of oxygen
  - artificial ventilation.
CHRONIC TYPE 1 FAILURE -
¥ Causes -
 -disease associated wit pulm fibrosis
-chronic chest wall or neuromuscular diseases.
- chronic pulm deema pulm thromboembolism
¥ MANAGEMENT -
 1. Treat underlying cause.
 2. Oxygen therapy
 3. Artificial ventilation.
 4. Venesection to reduce haematocrit for polycythemic
 5. Diuretics to reduce peripheral edema
ACUTE TYPE 2 RF-
¥Causes -
- depressant drug like diazepam, opiates & alcohol.
- brainstem damage from stroke & trauma
-disorders of nerves & neuromuscular transmission like GBS
-Disorders of muscles - acute polymyositis
- severe airflow obstruction.
- chest injuries resulting in tension pneumothorax, flial chest
¥ Management -
 - treat underlying condition.
 -oxygen therapy 24% oxygen.
 - removal of secretions by coughing or emergency bronchoscopic aspirations
 - bronchodilators
 - assisted ventilation.
 CHRONIC TYPE 2 PF-
¥Causes -
 - COPD
 -Chestwall abnormalities like gross kyphoscoliosis
 - central hypoventilation
¥ Management-
- treat underlying cause
- oxygen therapy carries the risk of rise in PaCO2 resulting in confusion, drowsiness.
- measure ABG levels before oxygen therapy.
- do not give more than 24% oxygen.
 - give oxygen continously not intermittently. At a rate of 1-2 litre / min
- stimulant drugs advocated like doxapram hydrochloride
-mechanical ventilation reserved for non respondant.
- supportive treat includes antibiotics, nebulisers,clearing secretions by coughing, suction.