Respiratory Failure

Question 1

What are the categories of respiratory failure?

Answer 1

Combo of:
Lung tissue problem: diffusion
Ventilatory problem: muscle weakness
Pleural space problem: fluid in space

Question 2

What is the goal of mechanical ventilation?

Answer 2

Support breathing by providing airway and adequate alveolar ventilation

• based on ABGs
• restores normal balance and increases respiratory function
• gives tidal volume and RR that provide satisfactory blood gases and pH
• gives muscles time to rest

Question 3

What are parameters for the MV machine?

Answer 3

Mode of ventilation: how much work it’s doing
FiO2: amount of inspired air
Positive end-expiratory pressure (PEEP): above atmosphere given at end of expiration to stop closing airways
Peak Inspiratory Pressure (PIP): pressure to lungs as breath in; helps inhalation and weak muscles
Respiratory Rate
Tidal Volume: avg 500mL
Minute Volume: volume moved insp/exp in one minute; avg 5-8 L/min

Alarm settings:
High pressures: secretions, blockage, biting tube
Low pressures: tube is dissconected

Question 4

What is critically ill polyneuropathy? (aka ICU acquired weakness)

Answer 4

Limb muscle weakness and paresis with unexplained difficulty to wean off ventilation

PT can revert weakness:

• faster return to function
• decrease wean time
• decrease length of hospitalization

Question 5

What is the implication for treating patients on MV?

Answer 5

Physio demand of weaning, daily ICU routines, and PT
Work of breathing could be 20-35% more than at rest

Coordinate treatment with meds
Use respiratory support before, during and 10 min after
Coordinate airway clearance before mobilization

Question 6

What are the PT implications for a patient on an artificial airway trach tube?

Answer 6

Emphasize airway clearance and mobilization
Pay attention to stability of airways prior to treatment
Check position of endotracheal tube at all times
Suction judiciously- try non-invasive first due to inflammation

Question 7

What are the goals of Body position intervention?

Answer 7

Move into upright position:

• increase CV, pulmonary, and gas exhange
• preferential ventilation position
• perform exercises in this position

Compare HR to resting: 20-30 increase
BP 10-20 drop= can’t keep up
PIP between 25-35
Minute ventilation: 5-8L/min avg

Question 8

How do you help wean from MV?

Answer 8

Decrease level of support from ventilator making patient do more work

Accomplish via:
decreasing machine use, rapid extubation, spontaneous breathing trials, decreased time on ventilatory support