Acute Respiratory Distress

Syndrome

Dewi Kartikawati N.
 Acute Respiratory Failure
Results from inadequate gas exchange
Insufficient O2 transferred to the blood
Hypoxemia
Inadequate CO2 removal
Hypercapnia
Gas Exchange Unit
 Acute Respiratory Failure
Not a disease but a condition
Result of one or more diseases involving the
lungs or other body systems
 Acute Respiratory Failure
Classification
Hypoxemic respiratory failure
Hypercapnic respiratory failure
Normal Posterior to Anterior (PA) Chest
X-ray.
Anteroposterior (AP) portable chest radiograph in a
patient with acute respiratory distress syndrome.
This image shows bilateral patchy opacities in
mostly the middle and lower lung zones.
6
Classification of Respiratory Failure
 Acute Respiratory Failure
Hypoxemic respiratory failure
PaO2 <60 mm Hg on inspired O2 concentration
>60%
 Acute Respiratory Failure
Hypercapnic respiratory failure
PaCO2 above normal ( >45 mm Hg)
Acidemia (pH <7.35)
 Hypoxemic Respiratory Failure
Etiology and Pathophysiology
Causes
Ventilation-perfusion (V/Q) mismatch
COPD
Pneumonia
Asthma
Atelectasis
Pulmonary embolus
 Hypoxemic Respiratory Failure
Etiology and Pathophysiology
Causes
Shunt
Anatomic shunt
Intrapulmonary shunt
An extreme V/Q mismatch
 Hypoxemic Respiratory Failure
Etiology and Pathophysiology
Causes
Diffusion limitation
Severe emphysema
Recurrent pulmonary emboli
Pulmonary fibrosis
Hypoxemia present during exercise
Diffusion Limitation

Fig. 68-5
 Hypoxemic Respiratory Failure
Etiology and Pathophysiology
Causes
Alveolar hypoventilation
Restrictive lung disease
CNS disease
Chest wall dysfunction
Neuromuscular disease
 Hypoxemic Respiratory Failure
Etiology and Pathophysiology
Interrelationship of mechanisms
Combination of two or more physiologic
mechanisms
 Hypercapnic Respiratory Failure
Etiology and Pathophysiology
Imbalance between ventilatory supply and
demand
 Hypercapnic Respiratory Failure
Etiology and Pathophysiology
Airways and alveoli
Asthma
Emphysema
Chronic bronchitis
Cystic fibrosis
 Hypercapnic Respiratory Failure
Etiology and Pathophysiology
Central nervous system
Drug overdose
Brainstem infarction
Spinal chord injuries
 Hypercapnic Respiratory Failure
Etiology and Pathophysiology
Chest wall
Flail chest
Fractures
Mechanical restriction
Muscle spasm
 Hypercapnic Respiratory Failure
Etiology and Pathophysiology
Neuromuscular conditions
Muscular dystrophy
Multiple sclerosis
 Respiratory Failure
Tissue Organ Needs
Major threat is the inability of the lungs to
meet the oxygen demands of the tissues
 Respiratory Failure
Clinical Manifestations
Sudden or gradual onset
A sudden decrease in PaO2 or rapid increase in
PaCO2 indicates a serious condition
 Respiratory Failure
Clinical Manifestations
When compensatory mechanisms fail,
respiratory failure occurs
Signs may be specific or nonspecific
 Respiratory Failure
Clinical Manifestations
Severe morning headache
Cyanosis
Late sign
Tachycardia and mild hypertension
Early signs
 Respiratory Failure
Clinical Manifestations
Consequences of hypoxemia and hypoxia
Metabolic acidosis and cell death
Decreased cardiac output
Impaired renal function
 Respiratory Failure
Clinical Manifestations
Specific clinical manifestations
Rapid, shallow breathing pattern
Tripod position
Dyspnea
 Respiratory Failure
Clinical Manifestations
Specific clinical manifestations
Pursed-lip breathing
Retractions
Change in I:E ratio
 Respiratory Failure
Diagnostic Studies
History and physical assessment
ABG analysis
Chest x-ray
CBC, sputum/blood cultures, electrolytes
ECG
Urinalysis
V/Q lung scan
Pulmonary artery catheter (severe cases)