Alterations in

Respiratory Function

Objectives

List the clinical manifestations of common alterations in respiratory function

Outline the critical care management of patients with alterations in respiratory function

Common Alterations in Respiratory Function

Pulmonary Oedema

Lower Respiratory Tract Infection

Traumatic Injury

Neurological Disease

Adult Respiratory Distress Syndrome

Chronic Obstructive Pulmonary Disease

Upper Respiratory Tract Infection Atelectasis

Industrial Diseases

Obesity

Acute Obstructive Airways Diseases

Case

75yo ♀ BIBA w/ 1/52 HO ↑ SOB Sp02 86% on RA 98% on HM @ 6LPM.

HR 155, BP 105/55, peripherally cool. T: 38.6 GCS 14 (E: 4 V: 4 M:6)

Assessment

Physical Assessment ↓ R) chest wall expansion Tactile fermatas ↓ AE R) lower lobe

Blood work-up ↑ WCC

CXR

ECG

Case

Case

Management

O2 therapy Circulatory support IVABs Monitor

Lower Respiratory Tract Infection

Pneumonia Bacterial Viral Aspiration

Tuberculosis

Pulmonary Oedema

Alteration in hydrostatic and/or osmotic pressure

Traumatic Injury

Rib #s

Traumatic Injury

Rib #s Pleural Effusion

Traumatic Injury

Rib #s Pleural Effusion Pneumothorax

Tension pneumothorax Heamothorax

Traumatic Injury

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Chest Drains

Neurological Disease

Spinal cord disease Motor nerve disease Infectious disease Muscle-wasting disease

Acute Obstructive Pulmonary Disease

Acute Bronchitis

Acute Obstructive Pulmonary Disease

Acute Bronchitis Asthma

Chronic Obstructive Pulmonary Disease

Bronchiectasis

Chronic Obstructive Pulmonary Disease

Bronchiectasis Cystic Fibrosis Chronic Bronchitis

Chronic Obstructive Pulmonary Disease

Bronchiectasis Cystic Fibrosis Chronic Bronchitis Pulmonary Emphysema

Industrial Illness

Organo-phosphate poisoning Asbestosis Coal workers’ pneumoconiosis

Adult Respiratory Distress Syndrome

“The acute onset of severe respiratory distress and cyanosis that was refractory to oxygen therapy and associated with diffuse CXR abnormality and decreased lung compliance”.

Adult Respiratory Distress Syndrome

Severe hypoxemia Loss of lung compliance Secondary disease

Reduced perfusion Increased capillary permeability Direct tissue and capillary insult Other mechanism

Despite primary disease, same pathology exists

Adult Respiratory Distress Syndrome

Signs and Symptoms Tachypnoea Cyanosis Diaphoresis Tachycardia Hyperventilation Scattered crackles Increased work of breathing Agitation Lethargy Decreased LOC

Adult Respiratory Distress Syndrome

Signs and Symptoms Acute onset (usually within 4 hours or 2-4

days of initial trauma) Bilateral Infiltrates Two Categories:

PaO2/Fio2 ratio < 300 (ALI) PaO2/Fio2 ratio < 200 (ARDS)

(ALI is milder than ARDS that may or may not progress onto ARDS)

Adult Respiratory Distress Syndrome

Treatment ABC Mechanical ventilation Monitor Treatment of underlying disease Medications Prone Positioning (189±34 v 83±14)

Nutritional Support

Oxygen Therapy

Nasal Prongs Low flow 2 – 4 LPM

Oxygen Therapy

Hudson Mask Variable flow 6 – 15 LPM ~40–60%

Oxygen Therapy

Non-Rebreather Mask High flow Inflate bag ~90-95%

Oxygen Therapy

Venturi Mask High flow Adjust oxygen to flow rate

Oxygen Therapy

Bag mask ventilation High flow 100% Respiratory support

Alterations in

Respiratory Function