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Respiratory Failure Bharneedharan Surendaran bs1021@ic.ac.ukTILO'S COVERED I. Cardiovascular and respiratory investigations: Outline and interpret clinical tests for cardiovascular and respiratory disease II. Lung Disorders: Summaries the pathophysiology, presentation and management of lung tissue disorders. III. Heart and Lung Mechanics: Explain the mechanical factors associated with heart and lung function Key Learning Points I. Recap of Phase 1A Respiratory II. Four Types of Respiratory Failure III. Acute Respiratory Failure IV. Treatments High Yield concepts will be bolded on the slides. LECTURE TIMELINE 1.Recap of 2.Respiratory 3.Acute 4.Treatment Phase 1A Failure Respiratory FailureSBA 1 A 55-year-old man attends your respiratory clinic. He undergoes spirometry testing. After testing, you find out he has a total lung capacity of 5500mL, with a inspiratory capacity of 3000mL and a residual volume of 1000mL. However , the rest of the findings are missing. Please calculate the expiratory reserve volume? A.2000mL B.2500mL C.4500mL D.1500mLLung Capacities, V olumes and V entilations KEY FACT 1. Volumes will not overlap, and capacities are SUM of Volumes. 2. Minute Ventilation= Tidal volume * breathing rate 3. Alveolar Ventilation= (Tidal Volume –Dead Space) * breathing rateCompliance and Elastance Compliance: How the lung changes shape under air pressure Elastance: How the lung can recoil to original volume after air pressu.e What are the formulas for Compliance and Elastance? .Ventilation and PerfusionSBA 1 A 55-year-old man attends your respiratory clinic. He undergoes spirometry testing. After testing, you find out he has a total lung capacity of 5500mL, with a inspiratory capacity of 3000mL and a residual volume of 1000mL. However , the rest of the findings are missing. Please calculate the expiratory reserve volume? A.2000mL B.2500mL C.4500mL D.1500mLSBA 2 A 55-year-old man attends A+E. He appears confused and cyanotic. He is placed on 15L/min oxygen. An ABG is done showing hypoxaemia with normal levels of carbon dioxide and bicarbonate. This patient has a past medical history of COPD and heart failure. On a chest X-RAY there is bilateral pulmonary infiltrates but not due to a cardiac cause. What type of respiratory failure does he have? A. Type 1 B. Type 2 C. Type 3 D. Type 4 Basic Facts of Respiratory Failure Respiratory Failure: When your respiratory systems stops working leading to a reduction in gas exchange leading to abnormal levels of oxygen and carbon dioxide can if serious can lead to death. Can anyone tell me any organs that could fail and lead to respiratory failure? Brainstem/CNS, PNS and NMJ (Nervous System) Lungs (Airway Disease, Infection, Trauma) Heart (Circulation Failure) Muscles (Diaphragm or Thoracic Muscles or Extra Thoracic Muscles) Classifying Respiratory Failure based on time Acute Respiratory Failure: Sudden Failure in the Respiratory System Can anyone tell me a cause of ACUTE respiratory failure? Causes of Acute Failure: Infection, Trauma, Sepsis, NMS, GBS Chronic Respiratory Failure: Long term/progressive Failure in the Respiratory System Can anyone tell me a cause of CHRONIC respiratory failure? Causes of Chronic Failure: COPD, CF, Lobectomy, Muscular Dystrophy, Heart Failure Acute on Chronic Failure: Sudden failure of the lung on the background of having chronic lung disease Can anyone tell me a cause of Acute on CHRONIC respiratory failure? Causes of Acute on Chronic Failure: Infective exaercebation of COPD and CF, After operation, Myasthenic crisisType 1 versus Type 2 Respiratory FailureType 1 versus Type 2 Respiratory FailureType 1 versus Type 2 Respiratory FailureType 3 versus Type 4 Respiratory FailureType 1-4 Respiratory FailureSBA 2 A 55-year-old man attends A+E. He appears confused and cyanotic. He is placed on 15L/min oxygen. An ABG is done showing hypoxaemia with normal levels of carbon dioxide and bicarbonate. This patient has a past medical history of COPD and heart failure. On a chest X-RAY there is bilateral pulmonary infiltrates but not due to a cardiac cause. What type of respiratory failure does he have? A. Type 1 B. Type 2 C. Type 3 D. Type 4SBA 3 A 55-year-old man attends A+E. He appears confused and cyanotic. From a collateral history, his symptoms have an acute onset of under a week 1. He undergoes a CXR and has bilateral infiltrates. He has no cardiac history and only a history of COPD. Finally he has a p02/FIO2 less than 40kPa Does he fit the criteria for acute respiratory distress syndrome? A. No B. YesAcute Lung Injury Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome: Clinical Syndrome of acute onset of low oxygen and pulmonary infiltrates (fluids in lungs) without heart failure. Can you name three signs/symptoms of ARDS? Symptoms/Signs of ARDS: Difficulty Breathing, high heart rate and breathing rate, crackles of auscultation, cyanosis, low oxygen saturations on ABG and pulse ox Criteria to Diagnose ARDS (BERLIN) ARDS can lead to infection, heart failure, poor perfusion, increased level of carbon dioxide, systemic effectsSBA 3 A 55-year-old man attends A+E. He appears confused and cyanotic. From a collateral history, his symptoms have an acute onset of under a week 1. He undergoes a CXR and has bilateral infiltrates. He has no cardiac history and only a history of COPD. Finally he has a p02/FIO2 less than 40kPa Does he fit the criteria for acute respiratory distress syndrome? A. No B. YesManagement of ARDSSBA 4 A 55-year-old man is currently on CPAP for acute respiratory distress syndrome. The team want to see if this patient requires ECMO. Thus, they decide to calculate a Murray score for this patients. Which option has the correct four parameters needed to calculate the Murray score? A. PaO2/FIO2, AXR, PEEP, Elastance B. AO2/FIO2, CXR, PEEP , Elastance C. PAO2/FICO2, CXR, PEEP, Compliance D. PAO2/FIO2, CXR, PEEP, Compliance E. A02/FIO2, CXR, CPAP , ComplianceMurray Score CXR-> Chest X-RAY if there is any white/fluid in the lung fields. PEEP-> Positive end expiratory pressure (ventilation pressure) Murray Score 0 = normal 1-2.5 Mild ➢2.5 Severe ➢3 → ECMOSBA 4 A 55-year-old man is currently on CPAP for acute respiratory distress syndrome. The team want to see if this patient requires ECMO. Thus, they decide to calculate a Murray score for this patients. Which option has the correct four parameters needed to calculate the Murray score? A. PaO2/FIO2, AXR, PEEP, Elastance B. AO2/FIO2, CXR, PEEP , Elastance C. PAO2/FICO2, CXR, PEEP, Compliance D. PAO2/FIO2, CXR, PEEP, Compliance E. A02/FIO2, CXR, CPAP , ComplianceThank you for watching Bharneedharan Surendaran bs1021@ic.ac.ukSBA 5 A 55-year-old man is currently on CPAP for acute respiratory distress syndrome. The team want to see if this patient requires ECMO. Thus, they decide to calculate a Murray score for this patients. The patient has a A02/FIO2 less than 100, has a Chest X-RAY with 2 quadrant infiltrated, a PEEP of 12-14 and Compliance of 40 ml/cmH20. Which level of Murray score below would they be categorized in? A. Normal B. ECMO C. Severe D. Mild ECMO (LAST RESORT) ECMO (Extracorporeal Membrane Oxygenation) is a machine that takes over the lung and heart function allowing the patient’s lungs and heart to recov. Used in severe heart and lung failure.ECMO Inclusion and Exclusion CriteriaECMO Limitations/Issues we need to deal with Hemodynamics: Heart Rate and Blood Time to Access and Geographical inequity of ECMO Last Resort for patients, no other option Pressure Machienes ifthisfails Expensive for NHS ECMO Limitations/Issues INFECTION ECMO has a high mortality rate Obtaining Access: Need to use important vessels e.g. Clotting/Bleeding internal jugularvein, subclavian and femoral veinSBA 5 A 55-year-old man is currently on CPAP for acute respiratory distress syndrome. The team want to see if this patient requires ECMO. Thus, they decide to calculate a Murray score for this patients. The patient has a A02/FIO2 less than 100, has a Chest X-RAY with 2 quadrant infiltrated, a PEEP of 12-14 and Compliance of 40 ml/cmH20. Which level of Murray score below would they be categorized in? A. Normal B. ECMO C. Severe D. MildThank you for watching Bharneedharan Surendaran bs1021@ic.ac.uk