呼吸衰竭和急性呼吸窘迫综合征-英文课件.ppt

UTHSCSA Pediatric Resident Curriculum for the PICU RESPIRATORY FAILURE ARDS 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. 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 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 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 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 FiO2: high altitude HYP