呼吸衰竭英文版专家讲座.pptx

Respiratory FailureBai ChunxueDepartment of Respiratory diseaseZhongshan HospitalFudan UniversityChapter 7复旦呼研所复旦呼研所1呼吸衰竭英文版第1页Key WordsRespiratory failure Acute respiratory distress syndrome(ARDS)dyspnea Hypoxemiahypercapnia Respiratory Support Mechanical ventilation Positive end-expiratory pressure(PEEP)复旦呼研所复旦呼研所2呼吸衰竭英文版第2页Respiratory Failure DefinitionChapter 7Type I、II Respiratory Failure Centrol、Non-Centrol Respiratory Failure Acute&Chronic Respiratory Failure 复旦呼研所复旦呼研所3呼吸衰竭英文版第3页ACUTE RESPIRATORY FAILUREBai Chun-XueDepartment of Respiratory diseasesZhongshan Hospital复旦呼研所复旦呼研所4呼吸衰竭英文版第4页respiratory dysfunction resulting in abnormalities of oxygenation or ventilationimpair or threaten the function of vital organs Definition复旦呼研所复旦呼研所5呼吸衰竭英文版第5页Type IParenchymaEdemaVascular diseaseChest Wall&Pleural diseaseType IIAirway obstructionNeuromuscular diseasePathogeny复旦呼研所复旦呼研所6呼吸衰竭英文版第6页hypoxemiaPerfusionDiffusionVentilationCO2CO2O2O2Clinical Findings复旦呼研所复旦呼研所7呼吸衰竭英文版第7页PAO2，P ACO2（kPa)hypercapniaCO2O2Clinical Findings复旦呼研所复旦呼研所8呼吸衰竭英文版第8页 cyanosis,restlessness confusion,anxiety,delirium tachypnea,tachycardia hypertension,cardiac arrhythmias tremor Hypoxemia复旦呼研所复旦呼研所9呼吸衰竭英文版第9页Dyspnea and headache peripheral and conjunctiva hyperemiahypertension,tachycardia,tachypneaimpaired consciousnesspapilledema,and asterixis Hypercapnia复旦呼研所复旦呼研所10呼吸衰竭英文版第10页DiagnosisPaO26.66 kPa复旦呼研所复旦呼研所11呼吸衰竭英文版第11页specific therapy directed toward the underlying disease;respiratory supportive care directed toward the maintenance of adequate gas exchange;general supportive care.Treatment复旦呼研所复旦呼研所12呼吸衰竭英文版第12页Nonventilatory aspects Ventilatory aspects A.Respiratory Support复旦呼研所复旦呼研所13呼吸衰竭英文版第13页SaO2 of 90%(PaO2 about 60 mm Hg).Hypoxemia in patients with obstructive airway disease is usual easily corrected by using low-flow oxygen by nasal cannula(13 L/min)or Venturi mask(2428%).Higher concentrations of oxygen are necessary to correct hypoxemia in patients with ARDS,pneumonia,and other parenchymal lung diseases.Nonventilation复旦呼研所复旦呼研所14呼吸衰竭英文版第14页经鼻面罩机械通气治疗前后血气改变（经鼻面罩机械通气治疗前后血气改变（经鼻面罩机械通气治疗前后血气改变（经鼻面罩机械通气治疗前后血气改变（XSXS）白白春春学学,等等.应应用用国国产产呼呼吸吸器器经经鼻鼻面面罩罩治治疗疗慢慢性性阻阻塞塞性性肺肺病所致呼吸衰竭病所致呼吸衰竭9例汇报例汇报.上海医学上海医学 1993;16:102复旦呼研所复旦呼研所15呼吸衰竭英文版第15页Tracheal intubation Mechanical ventilation Ventilation复旦呼研所复旦呼研所16呼吸衰竭英文版第16页Hypoxemia which is not quickly reversed by supplemental oxygenAirway obstructionImpaired airway protectionInadequate handling of secretionsFacilitation of mechanical ventilation Tracheal intubationIndications17呼吸衰竭英文版第17页Tracheal intubation复旦呼研所复旦呼研所18呼吸衰竭英文版第18页ApneaAcute hypercapnia that is not quickly reversed by appropriate specific therapySevere hypoxemiaProgressive patient fatigue despite appropriate treatmentMechanical ventilationIndications19呼吸衰竭英文版第19页Assisted mechanical ventilation(AMV)or assist/control(A/C)Synchronized intermittent mandatory ventilation(SIMV)Pressure support ventilation(PSV)Mechanical ventilationModes20呼吸衰竭英文版第20页Pressure control ventilation(PCV)Continuous positive airway pressure(CPAP)Positive end-expiratory pressure(PEEP)Mechanical ventilationModes21呼吸衰竭英文版第21页Atelectasis of the centrolateral lung and overdistention of the intubated lung Barotrauma,manifested by subcutaneous emphysema,pneumomediastinum,subpleural air cysts,pneumothorax,or systemic gas embolismMechanical ventilationComplications22呼吸衰竭英文版第22页Subtle parenchymal lung injury Acute respiratory alkalosis Hypotension Ventilator-associated pneumonia,mortality rate of this disorder is about 5060%Mechanical ventilationComplications23呼吸衰竭英文版第23页Nutrition Psychological and emotional supportSkin care Meticulous avoidance of nosocomial infection and complications of tracheal tubesB.General Supportive Care复旦呼研所复旦呼研所24呼吸衰竭英文版第24页Course&Prognosis 复旦呼研所复旦呼研所25呼吸衰竭英文版第25页Prognosis 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复旦呼研所复旦呼研所26呼吸衰竭英文版第26页ARDS associated with sepsis has an extremely poor prognosis,with mortality rates of about 90%.Survival rates of 62%to weaning,43%to hospital discharge,and 30%to 1 year after hospital discharge.Course&Prognosis复旦呼研所复旦呼研所27呼吸衰竭英文版第27页-END-END-复旦呼研所复旦呼研所28呼吸衰竭英文版第28页