Respiratory Failure after Surgery or Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Respiratory failure is defined as the failure of the respiratory system to oxygenate blood or remove carbon dioxide at levels that are commensurate with the metabolic requirements of the tissues. The development of acute severe hypoxemia in the presence of bilateral lung infiltrates and in the absence of evidence of cardiac dysfunction constitutes a severe form of acute respiratory failure. This condition is further characterized on the basis of the ratio of partial pressure of arterial oxygen (PaO) to the fraction of inspired oxygen (FiO) (the PF ratio). Accordingly, a PF ratio of <300 indicates acute lung injury (ALI), whereas a PF ratio of <200 indicates ARDS (Table 5.1) [1].
Individual conditions grouped according to the international nosology and classification of genetic skeletal disorders*
Christine M Hall, Amaka C Offiah, Francesca Forzano, Mario Lituania, Michelle Fink, Deborah Krakow in Fetal and Perinatal Skeletal Dysplasias, 2012
The ends of the metaphyses show sclerosis. They are sometimes irregular or domed and the short tubular bones are cupped. There is irregular ossification of the calcanea and tali. In the pelvis the ilia are short, the sacrosciatic notches wide and the acetabula horizontal (‘halberd’ shaped). There is progressive kyphoscoliosis throughout childhood resulting in significant truncal shortening. There is delayed ossification of the carpal bones. Bone histopathology:
abnormal endochondral ossification, predominant circumferential growth
abnormal, irregular metaphyseal invasion
islands of dysplastic chondrocytes in metaphyses and epiphyses.
Prognosis: lethal in the most severely affected patients because of respiratory failure. In the surviving cases, the phenotype changes over time (the Greek ‘meta-tropos’ means ‘changing pattern’), with an inversion of proportions, developing a short, kyphoscoliotic trunk with relatively longer limbs. Intellect is normal; final stature is around 120 cm. Differential diagnosis:Other TRPV4 mutations: spondylometaphyseal dysplasia Kozlowski type: similar spine abnormalities, milder limb involvement. Narrow chest and short limbs: short rib-polydactyly syndromes including asphyxiating thoracic dystrophy (Jeune) (p. 198) and chondroectodermal dysplasia (Ellis-van Creveld syndrome) (p. 167); thanatophoric dysplasia (pp. 52–46). Short, dumbbell long bones and platyspondyly: fibrochondrogenesis (p. 97); Kniest dysplasia (p. 86); Stickler syndrome (p. 92); otospondylomegaepiphyseal dysplasia, Weissenbacher-Zweymüller syndrome (p. 100).
The patient with acute respiratory problems
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
Acute cardiac and respiratory problems can result in a failure to maintain effective gaseous exchange across the alveolar capillary membrane. Acute respiratory failure is the outcome of one of the following.
Use of body positioning in the mechanically ventilated patient with acute respiratory failure: Application of Sackett's rules of evidence
Published in Physiotherapy Theory and Practice, 1999
The aim of this paper is to review the evidence for the use of body positioning to improve oxygenation in the mechanically ventilated patient with acute respiratory failure. The emphasis is placed on research evidence for both benefits and risks associated with the use of common body positions in this patient population. Increased regional ventilation under the influence of gravity with an overall improvement in the ventilation/perfusion ratio appears to be the main mechanism of position-induced improvement in oxygenation. Strong evidence exists for positioning with the affected lung superior in acute respiratory failure due to unilateral lung disease. Haemodynamic risks, however, have been shown to be associated with side lying position. Weak but consistent evidence supports prone positioning for improving oxygenation in patients with acute respiratory failure. No major complications arising from the prone position have been reported. Randomised clinical trials on the effects of upright and semi-recumbent positions are needed. Physical therapists prescribe body positioning in patients with acute respiratory failure based on knowledge derived from physiological studies in the laboratory. The application of Sackett's rules of evidence in clinical studies has supported some of these physiological bases, identified areas for further research and highlighted their utility in distinguishing the relative strengths of scientific evidence.
Fulminant tuberculous bronchopneumonia in a young Hong Kong chinese woman
Published in Pathology, 1991
A 24-yr-old, previously healthy Chinese woman presented with symptoms of acute bronchopneumonia which led to acute respiratory failure and death 6 days after admission to hospital despite intensive antibiotic treatment. Autopsy showed acute tuberculous bronchopneumonia of the acinar type. This is a rare presentation and outcome of tuberculous infection in Hong Kong, where 124 cases per 100,000 population were notified in 1988, and indicates that tuberculosis can mimic acute bronchopneumonia and should be considered in cases so presenting, particularly when there is no growth on routine culture and no response to conventional antibiotics. Acute respiratory failure developing in such cases can cause a delay in the diagnosis of tuberculosis.
Use of extracorporeal life support in adults with severe acute respiratory failure
Published in Expert Review of Respiratory Medicine, 2011
Kyle J Rehder, David A Turner, Ira M Cheifetz
Extracorporeal membrane oxygenation (ECMO) is a recognized and accepted therapeutic option in the treatment of neonatal and pediatric respiratory failure. However, early studies in adults did not demonstrate a survival benefit associated with the utilization of ECMO for severe acute respiratory failure. Despite this historical lack of benefit, use of ECMO in adult patients has seen a recent resurgence. Local successes and a recently published randomized trial have both demonstrated promising results in an adult population with high baseline mortality and limited therapeutic options. This article will review the history of ECMO use for respiratory failure; investigate the driving forces behind the latest surge in interest in ECMO for adults with refractory severe acute respiratory failure; and describe potential applications of ECMO that will likely increase in the near future.
Related Knowledge Centers
- Respiratory System
- Hypercapnia
- Partial Pressure
- Oxygen
- Hypoxemia
- Gas Exchange