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Classes of ARF
Hypoxemic & Hypercapnic
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Causes of Hypoxemic Resp Failure
- V/Q Mismatch
- Shunting
- Diffusion Limitation
- Hypoventilation
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Causes of Hypercapnic Resp Failure
- Abnormalities in:
- Airway & alveoli
- central nervous system
- chest wall
- neuromuscular conditions
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Diagnosis of ARF & ARDS
Pulse Ox, ABG, CXR, CBC, electrolytes, ECG, cultures, V/Q scan/Pulmonary angiography, End Tidal CO2, hemodynamic monitoring
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Oxygen Therapy
Nasal Cannula, face mask, BiPAP/CPAP, mechanical ventilation
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Risk of Oxygen Therapy
- Oxygen Toxicity:
- exposure >60% O2 for more than 48 hrs
- CO2 Narcosis
- Blunted response of chemoreceptors in medulla due to chronic hypercarbia
- Proved oxygen to improve ABGs
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Mobilization of Secretions
Coughing, positioning, hydration, humidification, chest physical therapy, airway suctioning
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How do drugs offer relief?
relief of bronchospasm, reduce airway inflammation, reduce pulmonary congestion, treat pulmonary infections, reduce anxiety & restlessness
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ARDS
Alveolar capillary membrane becomes damaged and more permeable to fluid.
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Fluid filled capillaries in ARDS cause:
- severe dyspnea, refractory hypoxemia, reduced lung compliance, diffuse pulmonary infiltrates
- (lung fluid overload)
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ARDS' ABGs
PaO2 < 50 mm Hg OR FiO2 >40% w/ PEEP > 5 cm H2O
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Hallmark of ARDS
PaO2/FiO2 ratio below 200 despite increased FiO2 by mask, cannula, or ETT
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Complications of ARDS
nosocomial pneumonia, barotrauma & volupressure trauma, stress ulcers, renal failure, multi-organ dysfunction syndrome
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Selected Aspects of Care (ARDS)
High flow oxygen therapy, mechanical ventilation with PEEP, prone positioning, lateral rotation therapy, ECMO
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Maintenance of Fluid Balance
- Fine line between overload and depletion
- Mild fluid restrictions/diuretics prn
- Assessment: I&O, lung sounds, edema, weight gain/loss
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Other Tx Options
Surfactant replacement therapy, partial liquid ventilation, methylprednisolone, prostaglandin E1, monoclonal antibodies, high frequency jet ventilataion
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