呼吸衰竭典型课件.ppt

Respiratory failure呼吸衰竭 谢灿茂 中山大学附属第一医院呼吸内科 Introduction Be a frequently encountered medical problem A major cause of death in China Mortality from COPD, which ends in death from respiratory failure, continues to increase More than 70% of patients with pneumonia are attributed to respiratory failure Introduction About 1/3 patients in ICU in the United States, about 500 000 persons, receive mechanical ventilation each year Short-term survival is more than 80% for acute respiratory failure not preceded by additional lung disease or systemic illness Introduction Multisystem organ failure or pre-existing renal、liver、or chronic gastrointestinal disease with malnutrition substantially worsens outlook About 17% of patients placed on mechanical ventilation require assistance for more than 14 days Among those requiring this amount of mechanical ventilation, elderly patients have a 9% survival and younger patients a 36% survival Definition 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 Both acute or chronic respiratory failure may be divided into two main categories A failure of gas exchange – hypoxemia A failure of ventilation – hypercapnia Diagnostic criteria Blood gas analysis PaO2 60 mmHg, or plus PaCO2 50 mmHg Inhale air at sea level to get blood sample Exclude intracardiac shunt, such as ventricular septal defect, and primary cardiac output decease Classification According to pathophysiology and blood gas analysis Type I: A failure of gas exchange Hypoxemia, PaO2 60 mmHg Type II: A failure of ventilation PaO2 60 mmHg, PaCO2 50 mmHg PaO2 60 mmHg, PaCO2 50 mmHg Iatrogenic Classification According to the involve site Central respiratory failure Change of respiratory rhythm and frequency Peripheral respiratory failure Dyspnea According to onset of respiratory Acute, develops in seconds or hours Chronic, develops in d