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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,UTHSCSA Pediatric Resident Curriculum for the PICU,RESPIRATORY FAILURE,&ARDS,UTHSCSA Pediatric Resident Cur,RESPIRATORY FAILURE,Inability of the pulmonary system to meet the metabolic demands of the body through adequate gas exchange.,Two types of respiratory failure:,Hypoxemic,Hypercarbic,Each can be further divided into acute and chronic.,Both types of respiratory failure can be present in the same patient.,RESPIRATORY FAILUREInability o,2,CENTRAL ETIOLOGIES,Trauma:head injury,asphyxiation,hemorrhage,Infection:meningitis,encephalitis,Tumors,Drugs:narcotics,sedatives,Neonatal apnea,Severe hypoxemia or hypercarbia,Increased ICP from any of the above causes,CENTRAL ETIOLOGIESTrauma:head,3,OBSTRUCTIVE ETIOLOGIES,Upper Airway,Anatomic:choanal atresia,tracheomalacia,tonsillar hypertrophy,laryngeal web,vascular rings,vocal cord paralysis,macroglossia,Aspiration:mucus,foreign body,vomitus,Infection:epiglottitis,abscesses,laryngotracheitis,Tumors:hemangioma,cystic hygroma,papilloma,Laryngpospasm,Lower Airway,Anatomic:bronchomalacia,lobar emphysema,Aspiration:FB,mucus,meconium,vomitus,Infection:pneumonia,pertussis,bronchiolitis,CF,Tumors:teratoma,bronchogenic cyst,Bronchospasm,OBSTRUCTIVE ETIOLOGIESUpper Ai,4,RESTRICTIVE ETIOLOGIES,Lung Parenchyma,Anatomic:agenesis,cyst,pulmonary sequestration,Atelectasis,Hyaline membrane disease,ARDS,Infection:pneumonia,bronchiectasis,pleural effusion,Pneumocystis carinii,Air leak:pneumothorax,Misc:hemorrhage,edema,pneumonitis,fibrosis,Chest Wall,Muscular:diaphragmatic hernia,myasthenia gravis,muscular dystrophy,botulism,Skeletal:hemivertebrae,absent ribs,fused ribs,scoliosis,Misc:distended abdomen,flail chest,obesity,RESTRICTIVE ETIOLOGIESLung Par,5,HYPOXEMIA,V/Q mismatch,Most common reason.Blood perfuses non-ventilated lung.Seen in atelectasis,pneumonia,bronchiectasis,Global hypoventilation,:,apnea,Right-to-left shunt,Intracardiac lesions,e.g.,tetralogy of Fallot,Incomplete diffusion,Oxygen must diffuse across increased distance secondary to interstitial edema,fibrosis,or hyaline membrane.,Low inspired FiO,2,:,high altitude,HYPOXEMIAV/Q mismatch,6,HYPERCARBIA,Pump Failure,Reduced central drive:apnea,metabolic alkalosis,drugs,brainstem injury,hypoxia,Muscle fatigue:muscular dystrophy,Increased pulmonary workload:decreased compliance,increased obstruction,Increased CO,2,production,:,fever,seizure,malignant hyperthermia,Increased dead space,:,V/Q mismatch(ventilation of non-perfused lung),HYPERCARBIAPump Failure,7,PHYSICAL EXAM,Tachypnea,Dyspnea,Retractions,Nasal flaring,Grunting,Diaphoresis,Tachycardia,Hypertension,Altered mental status,Confusion,Agitation,Restlessness,Somnolence,Cyanosis(need 5mg/dl of unoxygenated blood),PHYSICAL EXAMTachypneaAltered,8,CXR FINDINGS,CXR may be normal if problem is with upper airway,Can see hyperinflation,atelectasis,infiltrate,cardiomegaly,Additional studies may be needed,e.g.,chest CT,barium swallow,echocardiogram,CXR FINDINGSCXR may be normal,9,BLOOD GAS,For any age patient,breathing room air,respiratory failure is defined as arterial pCO,2,50mm Hg or arterial pO,2,60mm Hg.,If the patient is hyperventilating,a normal pCO,2,is disturbing.,The above definition assumes the absence of an anatomic shunt.,Chronic hypercarbic respiratory failure will often have a normal pH because of compensatory metabolic alkalosis.,BLOOD GASFor any age patient,10,MANAGEMENT,REMEMBER PALS,A,irway,B,reathing,C,irculation,MANAGEMENTREMEMBER PALS,11,AIRWAY,Repositioning,Position of comfort,Jaw thrust/chin lift,Oral airway,Unconscious patients only,Nasal trumpet,Nasal or mask CPAP,Bag-mask ventilation,Use during preparation for intubation,Tracheal intubation,AIRWAYRepositioning,12,BREATHING,Decrease respiratory workload,-agonists,Decadron or steroids,Antibiotics,CPAP,Supplemental O,2,Nasal cannula,Closed face mask,Non-rebreather,Counteract drug effects,Bag-mask ventilation,Mechanical ventilation,BREATHINGDecrease respiratory,13,CIRCULATION,Suppress anaerobic metabolism and acidosis,Correct anemia to improve oxygen delivery,Ensure adequate cardiac output,Inotropes:oxygen,vasopressors,Fluid boluses,CIRCULATIONSuppress anaerobic,14,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,15,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,16,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,17,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,18,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,19,ARDS,A patient must meet all of the following:,Acute onset of respiratory symptoms,CXR with bilateral infiltrates,No evidence of left heart failure,PaO,2,/FiO,2,200mm Hg(regardless of PEEP),American-European Consensus Conference on ARDS(Am J Resp Crit Care Med 149:818,1994),The following are implied:,Previously normal lungs,Decreased lung compliance,Increased shunting,Hypoxemic respiratory failure,ARDSA patient must meet all of,20,呼吸衰竭和急性呼吸窘迫综合征-英文ppt课件,21,ETIOLOGY,ARDS represents about 3%of PICU admissions.,Numerous precipitating events:,Trauma,Pneumonia,Burns,Sepsis,Drowning,Shock,ETIOLOGYARDS represent
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