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Failure in one or both gas exchange functions: oxygenation and carbon dioxide elimination
In practice: PaO2<60mmHg or PaCO2>46mmHg Derangements in ABGs and acid-base status
Alveolar Hypoventilation
PI max Central Hypoventilation Neuromuscular Problem
V/Q abnormality
Nl VCO2 V/Q Abnormality VCO2 Hypermetabolism Overfeeding
Alveolar Hypoventilation
PI max Central Hypoventilation Neuromuscular Problem
V/Q abnormality
Nl VCO2 V/Q Abnormality VCO2 Hypermetabolism Overfeeding
Alveolar Hypoventilation
Alveolar Hypoventilation
PI max Central Hypoventilation Neuromuscular Disorder
V/Q abnormality
Nl VCO2 V/Q Abnormality VCO2 Hypermetabolism Overfeeding
VCO2
V/Q Abnormality
Hypermetabolism Overfeeding
VCO2
V/Q Abnormality Increased dead space ventilation advanced emphysema PaCO2 when Vd/Vt >0.5 Late feature of shunt-type edema, infiltrates
Hypermetabolism Overfeeding
VCO2
V/Q Abnormality
Hypermetabolism Overfeeding
VCO2 only an issue in pts with ltd ability to eliminate CO2 Overfeeding with carbohydrates generates more CO2
No
Hypoventilation
(PAO2 - PaO2) Hypovent plus another mechanism
(PAO2 - PaO2)?
Yes Is low PO2 correctable with O2? No Shunt Yes V/Q mismatch No Inspired PO2 High altitude FIO2
No
Hypoventilation
(PAO2 - PaO2) Hypovent plus another mechanism
(PAO2 - PaO2)?
Yes Is low PO2 correctable with O2? No Shunt Yes V/Q mismatch No Inspired PO2 High altitude FIO2
V/Q mismatch
SHUNT V/Q = 0
SHUNT V/Q = 0
Severe ALI B/L radiographic infiltrates PaO2/FiO2 <200mmHg (ALI 201-300mmHg) No e/o L Atrial P; PCWP<18
Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium
Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium Fluid in interstitium and alveoli
Neutrophils - ROIs and proteases damage capillary endothelium and alveolar epithelium Fluid in interstitium and alveoli
Impaired gas exchange Compliance PAP
Exudative phase
Diffuse alveolar damage
Proliferative phase
Fibrotic phase
MECHANICAL VENTILATION
Non invasive with a mask Invasive with an endobronchial tube MV can be volume or pressure cycled For hypercapnia: - MV increases alveolar ventilation and lowers PaCO2, corrects pH - rests fatigues respiratory muscles
For hypoxemia: - O2 therapy alone does not correct hypoxemia shunt - Most common cause of shunt is fluid filled or alveoli (Pulmonary edema)
caused by
collapsed