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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
■ ventilatory disorders
( 4 ) according to duration
ventilation-perfusion
restrictive ventilatory
diffusion disorders
mismatching
disorders
disorders
Ⅰ. ventilatory disorders
1. restrictive ventilatory disorders
Restrictive hypoventilation is caused by the diseases that affect
the distensibility of the alveolar.
Respiratory movement
forced breathing
▲ Disorders of the respiratory muscles
damage of CNS
Depression of CNS Respiratory movement ↓
drug overdose
neuro-muscular disorders
Respiratory
decreased strength,
myasthenia gravis movement
hypoxia, acidosis
disorder
alveolar distensibility
Restrictive
ventilatory
respiratory failure
disorders
▲ decreased lung compliance
■ etiology
asthma, emphysema, chronic bronchitis, and bronchiectasis.
1 ) central airway obstruction
defined as airway obstruction between the glottis and the carina
expiratory dysnea
three depression sign
expire inspire
2 ) peripheral airway obstruction
forced expiration
·
V Q· V·A/ Q·
A
respiratory failure
3 ) increased of anatomical shunt
Right-to-left shunts or anatomic shunt
Pulmonary A-V
▲ increased of shunt open↑
anatomical-like shunt
pulmonary
consolidation,At true
electasis
shunt↑
anatomical-like
Respiratory
shunt
failure
Ⅲ. Acute respiratory distress syndrome ( ARDS )
[concept]
ARDS is a clinical description of severe lung injury
characterized by increased permeability of alveolar-capillary
membranes, development of protein-rich pulmonary edema,
marked hypoxemia refractory to increase in inspired oxygen
concentration, and the absence of left ventricular 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
1. diffusion disorders
damage of alveolar-capillary membrane increased permeability
diffusion disorders
2. ventilatory disorders
▲edema, type Ⅱalveolar epithelial cells damage decreased lung volume
disorders disorders
pulmonary
RBC↑ blood viscosity ↑
■PaO2↓ vasoconstriction
■ cerebrovascular injury
PaCO2↑, acidosis Cerebral vasodilation Cerebral blood flow↑
GABA↑ pulmonary
encephalopathy