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)