Respiratory failure: an overview.
ABSTRACT Respiratory failure is defined as a failure in gas exchange due to an impaired respiratory system--either pump or lung failure, or both. The hallmark of respiratory failure is impairment in arterial blood gases. This review describes the mechanisms leading to respiratory failure, the indices that can be used to better describe gas exchange abnormalities and the physiologic and clinical consequences of these abnormalities. The possible causes of respiratory failure are then briefly mentioned and a quick reference to the clinical evaluation of such patients is made. Finally treatment options are briefly outlined for both acute and chronic respiratory failure.
SourceAvailable from: Siavash Ahmadi-Noorbakhsh[Show abstract] [Hide abstract]
ABSTRACT: Oxygen is an essential part of the most important metabolic pathways in aerobic organisms. Oxygen delivery is merely dependent on blood, rendering blood loss a devastating event. Traumatic pre-hospital liver bleeding is a major cause of early trauma deaths in human and animals, with no established therapeutic method yet. Increasing intra-abdominal pressure (IAP) has been shown to reduce liver bleeding by half. Although reduction of blood loss could be in favor of blood oxygen delivery, however, the complex interaction between increased IAP and respiratory mechanics during severe hemorrhagic shock remained unclear. We used a novel model of liver trauma in 16 rabbits and randomly assigned them to either normotensive abdomen group or increased IAP by fluid infusion (HA) groups (n=8 each). Liver size and the amount of liver injury were evaluated. Various blood oxygenation parameters were recorded. Both groups were identical in terms of the liver size and injury. The HA group had significantly lower shock index. Arterial oxygen capacity and oxygen content were higher in the HA group. No significant statistical difference was seen between groups in terms of abdominal perfusion pressure; alveolar pressure of oxygen; dissolved oxygen in blood plasma; alveolar to arterial oxygen tension gradient; arterial to alveolar oxygen pressure ratio; the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen; and respiratory index. In conclusion, the novel therapeutic method of increasing IAP by fluid infusion in a rabbit model of liver hemorrhage preserved blood oxygenation better than the classic therapeutic method.
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ABSTRACT: Background Mechanical ventilation offers essential ventilatory support, while the respiratory system recovers from acute respiratory failure. Yet, invasive mechanical ventilation is associated with risks and complications that prolong the duration of mechanical ventilation and increase the risk of death. Neuromuscular dysfunctions acquired during intensive care unit (ICU) stay are considered to be one of the important factors that impair the weaning process.The aim of this workTo evaluate the role of the neuromuscular factors responsible for difficult weaning from mechanical ventilation.Methods The study included 19 patients with difficult weaning from mechanical ventilation from the Alexandria medical respiratory intensive care unit (ICU) during the period from May 2009 till May 2010. The selected patients included patients who need mechanical ventilation for medical reasons, Patient fulfilling the parameters for weaning, (59) with failed spontaneous breathing trial. In the present study EMG and sensory–motor nerve conduction study was done.Results26% show normal study, 63% showed moderate to severe axonal sensory–motor peripheral neuropathy and 11% showed a picture of myopathy. The study revealed that 33% of the patients with peripheral neuropathy failed weaning trials and finally died. It is also found that drugs taken during ICU stay as corticosteroids and electrolyte disturbances (hypocalcaemia, hypophosphatemia, and hypomagnesaemia) may be related to the occurrence of neuromuscular dysfunctions. The present work also revealed a significant relationship between hypoalbuminemia and neuromuscular dysfunction.Conclusions The present study stresses on the importance of neuromuscular assessment in all cases with difficult weaning as this may be an important contributing factor for difficult weaning and prolonged mechanical ventilation (neuropathic or myopathic in origin). EMG and nerve conduction study may be of help for the detection of such disturbances. So, proper assessment of the neuromuscular apparatus and the management of any disorder may be a great step toward successful weaning.09/2012; 48(3):223–232. DOI:10.1016/j.ajme.2012.02.004
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ABSTRACT: The Food and Drug Administration's (FDA) Mini-Sentinel pilot program initially aims to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest (HOIs) from administrative and claims data. This paper summarizes the process and findings of the algorithm review of acute respiratory failure (ARF). PubMed and Iowa Drug Information Service searches were conducted to identify citations applicable to the anaphylaxis HOI. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles using administrative and claims data to identify ARF, including validation estimates of the coding algorithms. Our search revealed a deficiency of literature focusing on ARF algorithms and validation estimates. Only two studies provided codes for ARF, each using related yet different ICD-9 codes (i.e., ICD-9 codes 518.8, "other diseases of lung," and 518.81, "acute respiratory failure"). Neither study provided validation estimates. Research needs to be conducted on designing validation studies to test ARF algorithms and estimating their predictive power, sensitivity, and specificity.Pharmacoepidemiology and Drug Safety 01/2012; 21 Suppl 1:261-4. DOI:10.1002/pds.2326 · 3.17 Impact Factor