文档介绍:1 Respiratory failure 呼吸衰竭谢灿茂中山大学附属第一医院呼吸内科 Male, 32 Fever, cough 3 days No finding on physical examination Diagnosis: pneumonia X- ray: shadow in left lower lobe August 16, 2003 August 20, 2003 Acute shortness of breath Anxiety RR 40/min, Cyanosis BGA: PaO2 61mm Hg(FiO2 ) PaCO2 35 mmHg, pH Diagnosis : ARDS Acidosis X-ray: clouded glass Intubation via mouth tracheotomy Monitoring and ventilation 4 Introduction l Be a frequently encountered medical problem l A major cause of death in China l Mortality from COPD, which ends in death from respiratory failure, continues to increase l More than 70% of patients with pneumonia are attributed to respiratory failure 5 Introduction l About 1/3 patients in ICU in the United States, about 500 000 persons, receive mechanical ventilation each year l Short-term survival is more than 80% for acute respiratory failure not preceded by additional lung disease or systemic illness 6 Introduction l Multisystem organ failure or pre-existing renal 、 liver 、 or chronic gastrointestinal disease with malnutrition substantially worsens outlook l About 17% of patients placed on mechanical ventilation require assistance for more than 14 days l Among those requiring this amount of mechanical ventilation, elderly patients have a 9% survival and younger patients a 36% survival 7 Definition l Be a clinical syndrome of respiratory and metabolism dysfunction caused by any condition that severely affects the lung ’ s ability to maintain arterial oxygenation or carbon dioxide elimination l Both acute or chronic respiratory failure may be divided into two main categories ? A failure of gas exchange – hypoxemia ? A failure of ventilation – hypercapnia 8 Diagnostic criteria l Blood gas analysis ? PaO2 < 60 mmHg, or plus ? PaCO2 > 50 mmHg l Inhale air at sea level to get blood sample l Exclude intracardiac shunt, such as ventricular septal defect, and primary cardiac output decease