RESPIRATORY FAILURE AND BRONCHIECTASIS

 

Hey people today we will discuss about respiratory failure and Bronchiectasis.

MAIN TOPIC

RESPIRATORY DISEASES

SUB TOPIC

RESPIRATORY FAILURE

DEFINITION

Inadequate lung function for the metabolic requirements of O2 to the body is called respiratory failure. It occurs when gas exchange in inadequate and resulting in hypoxia.

TYPES OF RESPIRATORY FAILURE

According to PaO2 level, it is classified into two types.

A. Type I respiratory failure:

It is defined as hypoxia with a normal or low PaCO2. It is caused primarily by ventilation/ perfusion mismatch.

- Pneumonia

- Pulmonary Oedema

- Bronchial asthma

- Pulmonary embolism

- Emphysema

- Acute respiratory distress syndrome

- Fibrosing alveolitis

B. Type II respiratory failure:

It is defined as hypoxia with hypercapnia. This is caused by alveolar hypoventilation with or without V/Q mismatch.

CAUSES OF RESPIRATORY FAILURE:

A. Pulmonary diseases:

• Bronchial asthma

• COPD

• Pneumonia

• Pulmonary fibrosis

• Obstructive sleep apnea

B. Reduced respiratory drive:

• Sedative drugs

• CNS tumor

• Trauma

C. Neuromuscular diseases:

• Cervical cord lesion

• Diaphragmatic paralysis

• Poliomyelitis

• Myasthenia gravis

• Guillain – Barre syndrome

D. Thoracic wall diseases:

• Flail chest

• Kyphoscoliosis

CLINICAL FEATURES

Features depends upon underlying diseases condition and symptoms of Hypoxia and Hypercapnia.

HYPOXIA

 Symptoms

• Dyspnoea

• Restlessness

• Agitation

• Confusion

• Central cyanosis

• Polycythemia

• Pulmonary hypertension

• Cor- pulmonale

HYPERCAPNIA

 Symptoms

- Headache

- Papilloedema

- Confusion

- Coma

- Tremor

- Bounding pulse

- Tachycardia

- Peripheral vasodilation

- Drowsiness

INVESTIGATIONS

Aims: To determine the underlying causes and types.

Blood:

- Full blood count

- Urea , creatinine and electrolytes

- C- reactive protein

- Arterial blood gas analysis

Radiography: Chest x-Ray

Microbiology: Sputum and blood cultures

Spirometry

MANAGEMENT

Depends on the cause

Type I respiratory failure

- Treat underlying causes

- Give O2 by face mask to correct Hypoxia

- Assisted ventilation, if PaO2< 8kPa despite 60% O2 inhalation.

Type II respiratory failure

- Treat underlying causes

- Controlled O2 therapy start at 24% O2

- Recheck ABG after 20 minutes. If PaCO2 is steady or lower, increase O2 concentration to 28% , if PaCO2 has risen> 1 kPa and the patient is still hypoxic , consider a respiratory stimulant ( Doxapram 1.5 -4 mg/min) or assisted ventilation.

- If this fails , consider intubation and ventilation.

Assessment and management of Acute on chronic type II respiratory failure

Initial assessment:

 Patient may not appear distressed despite being critically ill.

a) Conscious level

• Response to commands

• Ability to cough

b) CO2 retention

• Warm periphery

• Bounding pulses

• Flapping tremor

c) Airways obstruction

• Wheeze,

- Intercostal indrawing

- Pursed lips

- Tracheal tug

d) Right heart failure

• Peripheral edema

• Raised JVP

• Hepatomegaly

• Ascites

e) Background functional status and quality of life .

f) Signs of precipitating factors:

• Retention of secretions

• Infection

• Bronchospasm

• Cardiac failure

• Rip fractures

• Pneumothorax

• Sedation

INVESTIGATIONS

• Arterial blood gases ( severity of Hypoxemia, hypercapnia and acidemia)

• Chest radiograph

MANAGEMENT

• Maintenance of airway

• Treatment of specific precipitated factors

• Nebulized with Bronchodilator

• Frequent physiotherapy pharyngeal suction

• Controlled O2 therapy

- Start with 24% controlled – flow mask

- Aim for a PaO2 > 7kPa

- Antibiotics

- Diuretics

SOME IMPORTANT QUESTIONS

1. What happens when you go into respiratory failure?

Ans: when a person has acute respiratory failure, the usual exchange between oxygen and carbon dioxide in the lungs does not occur. As a result, enough oxygen cannot reach the heart, brain, or the rest of the body. This can cause symptoms such as shortness of breath, a bluish tint in the face and lips, and confusion.

2. Does using oxygen make your lungs weaker?

Ans: Unfortunately,beathing 100% oxygen for long periods of time can cause changes in the lungs, which are potentially harmful. Researchers believe that by lowering the concentration of oxygen therapy to 40% patients can receive it for longer periods of time without the risk of side effects.

SUB TOPIC

BRONCHIECTASIS

DEFINITION

It is a chronic necrotizing infection of bronchi and bronchioles leading to or associated with abnormal permanent dilatation of these airways.

CAUSES OF BRONCHIECTASIS

A. Congenital:

a) Ciliary dysfunction syndromes:

- Primary Ciliary dyskinesia ( immotile cilia syndrome)

- Kartagener’s syndrome

- Young’s syndrome

b) Cystic fibrosis

c) Primary hypoalbuminemia

B. Acquired:

Children:

a) Pneumonia

- Post measles

- Whooping cough

b) Primary tuberculosis

c) Foreign body

Adult:

a) Suppurative pneumonia

b) Pulmonary tuberculosis

c) Bronchial tumors

d) Allergic bronchopulmonary aspergillosis

CLINICAL FEATURES

 Symptoms

- Fever

- Malaise

- Sputum often copious and persistently purulent

- Chronic productive cough

- Haemoptysis

- Recurrent pleurisy

- Weight loss

- Anorexia

- Failure to thrive in children

- Clubbing

INVESTIGATIONS

• Sputum

- Gram staining

- Culture and sensitivity

• Chest x-Ray

- Multiple ring like shadows

- Thickened bronchial walls ( tramline)

• CT scan of chest: to assess extent and haemoptysis or exclude obstruction.

• Spirometry: Obstructive pattern

• Bronchoscopy: To locate site of haemoptysis or exclude obstruction.

• Assessment of Ciliary function test

• Serum immunoglobulins

MANAGEMENT

a) Pistural drainage: To keep the dilated bronchi empty of secretion.

- Percussion of the chest wall with cupped hands for 5-10 minutes twice a day, aids dislodgement of sputum from respiratory tract.

b) Antibiotics therapy

- Amoxicillin 250mg -500mg × 8 hourly or

- Clarithromycin 250 – 500mg × 12 hourly or

- Co – amoxiclav 375mg × 8 hourly or

- Ciprofloxacin 250 – 750 × 12 hourly or

- Inj. Ceftazidime 100- 150mg/ Day in 3 divided doses.

c) Bronchodilator and O2 therapy

d) Surgical treatment: it is indicated in young patient with localized unilateral and confined to a single lobe or segment with adequate pulmonary function or in massive haemoptysis.

e) Chest physiotherapy

COMPLICATIONS

- Massive haemoptysis

- Metastatic abscess

- Pneumothorax

- Cor pulmonale

- Recurrent pneumonia, lung abscess, empyema.

PREVENTION

a) Avoidance of smoking

b) Early recognized amd Treatment of bronchial obstruction

c) Vaccination to child for DPT , Measles, BCG

SOME IMPORTANT QUESTIONS

1. How serious is bronchiectasis?

Ans: Bronchiectasis is a serious condition. Without treatment, it can lead to respiratory failure or heart failure. Early diagnosis and treatment, however, can help people to manage the symptoms and prevent the condition from worsening.

2. How did I get bronchiectasis?

Ans; Bronchiectasis is caused by the airways of the lungs becoming damaged and widened. This can be the result of an infection or another condition, but sometimes the cause is not known.

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