Acute Hypoxic Respiratory Failure (Ahrf Ards)

Under acute hypoxic respiratory failure (AHRF) refers to a high degree of arterial hypoxemia, which can not be terminated by the mere O2 administration. The reason is an extended intrapulmonary shunt due to airway obstruction or collapse. It can be found clinically dyspnea and tachypnea. Diagnosis is by arterial blood gas analysis and chest x-ray absorption. Treatment involves regular way in mechanical ventilation.

Under acute hypoxic respiratory failure (AHRF) refers to a high degree of arterial hypoxemia, which can not be terminated by the mere O2 administration. The reason is an extended intrapulmonary shunt due to airway obstruction or collapse. It can be found clinically dyspnea and tachypnea. Diagnosis is by arterial blood gas analysis and chest x-ray absorption. Treatment involves regular way in mechanical ventilation. Clinical calculator: PaO2 / FiO2 ratio (for the calculation of MODS) etiology airway obstruction in AHRF may arise through increased alveolar capillary hydrostatic pressure, as with left heart failure or hypervolemia Elevated alveolar capillary permeability, such as at an inclination to Acute Respiratory Distress Syndrome (ARDS) blood (as occurs with diffuse alveolar hemorrhage) or inflammatory exudates (such as occur in pneumonia or other inflammatory lung diseases) pathophysiology ARDS ARDS is divided into three levels of severity: mild, moderate and heavy, based (on Oxygenierungsdefekten and clinical criteria Berlin-definition vo n ARDS). The mild severity equivalent to the previous category of acute lung injury (ALI). Berlin definition of ARDS ARDS Category oxygenation severity Mild 200 mm Hg 15 units) inhalation of toxic gas Neuro Genes pulmonary edema due to stroke, seizure, head trauma, anoxia – pancreatitis – X-ray contrast agents (rarely) ARDS = acute respiratory syndrome Refractory hypoxemia Liquid-filled or collapsed airways make a gas inlet impossible in both forms. Thus, the remains these Alveolarregionen perfused blood independently of the inspiratory O2 fraction (FIO2) at the level of gemischtvenösen O2 saturation. This constant mixing of deoxygenated blood into the pulmonary veins provides the arterial hypoxemia. In contrast, hypoxemia resulting from ventilated alveoli, which have less ventilation as perfusion (ie, a low ventilation-perfusion rate as asthma or COPD or, to a certain degree to ARDS) are controlled with additional O2 , Symptoms and signs Acute hypoxemia (drop in oxygen saturation) can cause dyspnea, restlessness and anxiety. To this end, confusion may, with the change in the level of consciousness. Other side effects are cyanosis, tachypnea, tachycardia, and increased sweating. Cardiac arrhythmias and coma can follow eventually. The closure of the airways leads to auskultierbaren moist rales, which are typically dispersed diffusely, but also occasionally occur basal increased. Engorgement of the jugular veins results in cases high PEEP values ??or severe ventricular pump failure. Diagnostic chest X-ray and ABGA Clinical Definition (Berlin definition of ARDS) hypoxemia is often initially realized by pulse oximetry. In patients with a low O2 saturation of arterial blood gas analysis should be made and a chest X-ray can be made. They should then be treated with O2 delivery until the investigation results are available. O2 this administration does not lead to an increase in arterial O2 saturation> 90%, a right-left shunt is suspected. A previously unnoticed alveolar infiltrate, however, when the radiograph is evidence of fluid accumulation in the Alveolarregionen and is to be assumed rather than cause as one of intracardiac shunt. But at the beginning of the disease, hypoxemia often occurs before any changes can be seen on x-ray. Is a AHRF diagnosed, the cause must be clarified. Here, pulmonary and cardiac causes must be considered. In some cases, present known disturbance (such as acute myocardial infarction, pancreatitis or sepsis) obviously the reason this clinical situation. In other cases, history is groundbreaking. So Pneumonia may be more likely reason in immunocompromised patients. Similarly, an acute alveolar hemorrhage in state after bone marrow transplantation or in collagen is possible. Frequently reanimation requiring intensive care patients have received large amounts of liquid. Consequences of ventricular pumping weaknesses and fluid overload with the then-emerging picture of a AHRF must be distinguished from those cases where a “Low-Pressure AHRF” is based (such as sepsis or pneumonia). A high-pressure pulmonary edema must always be assumed when a third heart sound can be auscultated, a Jugularvenenstauung arises, peripheral edema can be identified and that there are diffuse central infiltrates. Cardiomegaly and an unusually extended vascular pedicle in the chest X-ray image are other characters. The diffuse bilateral infiltrates in the course of ARDS can be found in principle more peripheral. Focal infiltrations contrast, are usually caused by lobar pneumonia, atelectasis or pulmonary contusion. Even if the left heart failure can be demonstrated by echocardiography, which is close is a cardiac cause, these findings are still not specific, because sepsis can also affect the myocardial contractility. Pulmonary edema (Courtesy of Wada T: Basic and Advanced Visual Cardiology Illustrated Case Report Multi-Media Approach Philadelphia, Lea & Febiger, 1991; with permission..). With permission of the publisher. For O’Connor C., Tuman K. In Atlas of Anesthesia: Cardiothoracic Anesthesia. Edited by R. Miller (Series Editor) and J.G. Reeves. Philadelphia, Current Medicine, 1999. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/pulmonary_edema_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / ? images / pulmonary_edema_high_de.jpg lang = en & thn = 0 ‘, title:’ pulmonary edema ‘, description:’ u003Ca id = “v38395629 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDieser taken while standing chest x-ray shows some characteristic features of acute pulmonary edema

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