白春學-呼吸衰竭1課件

1、Respiratory FailureBai ChunxueDepartment of Respiratory diseaseZhongshan HospitalFudan UniversityChapter 7復旦呼研所1Key WordsRespiratory failure Acute respiratory distress syndrome(ARDS)dyspnea Hypoxemiahypercapnia Respiratory Support Mechanical ventilation Positive end-expiratory pressure (PEEP) 復旦呼研所2

2、Respiratory Failure DefinitionChapter 7Type I、II Respiratory Failure Centrol、 Non-Centrol Respiratory Failure Acute & Chronic Respiratory Failure 復旦呼研所3ACUTE RESPIRATORY FAILUREBai Chun-XueDepartment of Respiratory diseasesZhongshan Hospital復旦呼研所4respiratory dysfunction resulting in abnormalities of

3、 oxygenation or ventilationimpair or threaten the function of vital organs Definition復旦呼研所5Type IParenchymaEdemaVascular diseaseChest Wall & Pleural diseaseType IIAirway obstructionNeuromuscular diseasePathogeny復旦呼研所6hypoxemiaPerfusionDiffusionVentilationCO2CO2O2O2Clinical Findings復旦呼研所7Dyspnea and

4、headache peripheral and conjunctiva hyperemiahypertension, tachycardia,tachypneaimpaired consciousnesspapilledema, and asterixis Hypercapnia復旦呼研所10DiagnosisPaO26.66 kPa復旦呼研所11specific therapy directed toward the underlying disease; respiratory supportive care directed toward the maintenance of adequ

5、ate gas exchange; general supportive care. Treatment復旦呼研所12Tracheal intubation Mechanical ventilation Ventilation復旦呼研所16Hypoxemia which is not quickly reversed by supplemental oxygenAirway obstructionImpaired airway protectionInadequate handling of secretionsFacilitation of mechanical ventilation Tr

6、acheal intubationIndications17Tracheal intubation復旦呼研所18ApneaAcute hypercapnia that is not quickly reversed by appropriate specific therapySevere hypoxemiaProgressive patient fatigue despite appropriate treatmentMechanical ventilationIndications19Subtle parenchymal lung injury Acute respiratory alka

7、losis Hypotension Ventilator-associated pneumonia, mortality rate of this disorder is about 5060% Mechanical ventilationComplications23Nutrition Psychological and emotional supportSkin care Meticulous avoidance of nosocomial infection and complications of tracheal tubesB.General Supportive Care復旦呼研所

8、24Course & Prognosis 復旦呼研所25Prognosis of acute respiratory failure caused by uncomplicated sedative or narcotic drug overdose is excellentAcute respiratory failure in patients with COPD who do not require intubation and mechanical ventilation has a good immediate prognosis Course & Prognosis復旦呼研所26ARDS associated with sepsis has an extremely poor prognosis, with mortality rates of about 90%. Survival ra