Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Respiration
external respiration pulmonary ventilation and
gas exchange in lung
transport of gas
internal respiration
Respiratory failure
concept and classification
1. respiratory insufficiency
The condition in which the lungs can not take in
sufficient oxygen or expel sufficient carbon dioxide to
meet the needs of the cells of the body. Also called
pulmonary insufficiency.
2. respiratory failure
Respiratory failure is a syndrome in which the respiratory
system fails in one or both of its gas exchange functions:
oxygenation and carbon dioxide elimination.
In practice, respiratory failure is defined as a PaO2 value
of less than 60 mm Hg while breathing air or a PaCO2 of more
than 50 mm Hg.
3 classification
1 according to PaCO2
ventilatory disorders
gas exchange disorders
4 according to duration
gas exchange
disorders
ventilation-perfusion
mismatching
diffusion disorders
obstructive ventilatory
disorders
restrictive ventilatory
disorders
. ventilatory disorders
1. restrictive ventilatory disorders
Restrictive hypoventilation is caused by the diseases that affect
the distensibility of the alveolar.
Respiratory movement
forced breathing
decreased
etiology
asthma, emphysema, chronic bronchitis, and bronchiectasis.
Obstruction
is located in the
three
depression
Obstruction is located in the
sign
airway inside the thorax
expiratory dysnea
expire
inspire
forced expiration
. gas-exchanging dysfunction
1. diffusion disorders
The diffusion impairment is characterized by
a disruption in the exchange of O2 or CO2 or
both across the alveolar-capillary membrane.
Causes:
reduction and/or thicken of alveolar-capillary
membrane or reduction of the diffuse time.
2. ventilation/perfusion imbalance
The dysfunction of gas exchange can arise secondary to ventilation
/perfusion mismatching.
V
A
VA/ Q
Top
1.2L/min
0.4L/min
3.0
Middle
1.8L/min
2.0L/min
0.9
Bottom
2.1L/min
3.4L/min
0.6
VA/ Q
functional shunt>30%
(2) increased ratio of VA/Q
poor perfusion in relation to their ventilation with air
VA/Q
poor perfusion
of anatomical shunt
bronchiectasi
s
increased
of
anatomical-like shunt
pulmonary
consolidation,
Atelectasis
anatomicallike shunt
anatomic shunt
Pulmonary A-V
shunt open
true
shunt
Respiratory
failure
[etiology]
shock from any cause,
multisystem trauma,
infection including bacterial and nonbacterial pneumonia,
inhaled toxic substances,
overdose of some drug,
acute pancreatitis.
[ pathogenesis of ARDS]
1 direct injury of damage factor
2 indirect injury of inflammation medium
ARDS
increased permeability
diffusion disorders
2. ventilatory disorders
edema, type alveolar epithelial cells damage
airway obstruction
obstructive ventilatory
restrictive ventilatory
disorders
disorders
inflammation medium
3 VA/Q mismatching
30mmHg
respiratory center(+)
respiratory movement
respiratory movement
PaCO2
respiratory movement
respiratory movement
reaction
cardiovascular center(+)
rate
redistribution of blood
injurious changes
flow
pulmonary hypertension
cardiovascular
co pulmonale
PaO2
Pulmonary
wall
pulmonary
vasoconstrictio
n
vascular
Stenosis
blood resistance
chronic pulmonary
thickening
and
hypertension
pulmonary arterial embolism, capillary
hardening
damage
afterload to right
ventricle
Hypoxia, acidosis
myocardial systolic
and diastolic function(-)
difficulty breathing
Restricted diastolic co pulmonale
that
may occur if blood levels of carbon dioxide increase to 80 mm Hg or
higher.
[pulmonary encephalopathy]
cerebrovascular
PaCO2, acidosis
hypoxia
Cerebral vasodilation
injury
Intracranial pressure
CSF pH 7.25
GABA
lysosomal membrane stability
pulmonary
encephalopath
y
nerve cell necrosis