– The respiratory system can not adequately supply the blood with the O2 it needs or adequately remove the CO2.
– Inadequate gas exchange due to pulmonary or non-pulmonary causes leading to hypoxemia, hypercarbia or both.
– Respiratory failure is defined as:
– PaO2 < 60 mmHg,
– PaCO2 > 50 mmHg.
– with pH < 7.25
– Type I – Acute hypoxemic respiratory failure
– Type II – Acute hypercapnic respiratory failure
– Type III – Combined hypoxemic and hypercapnic failure
Respiratory system includes:
– Peripheral nervous system (phrenic nerve)
– Respiratory muscles
– Chest wall
– Upper airways
– Bronchial tree
– Pulmonary vasculature
1- Airways obstruction:
– Tracheitis & Epiglottitis
– Retropharyngeal / Peritonsillar abscess
– Acute hypertrophic tonsillitis
– Foreign body, trauma,
– Bronchiolitis, Asthma, Foreign body
2. Alveolar and pleural disease:
– Pneumonia, pulmonary edema, embolism,
– Empyma, pneumothorax, ARDS.
3. CNS causes:
– Infections, injury, trauma, seizures
– Drugs induce rspiratory depression
– CNS dysfunction (CVA)
– Phrenic nerve injury
– Myasthenia gravis
– Muscle dystrophies, Polymyositis
– Congenital myopathies, muscle fatigue
– Tetanus, Polio
– Difficult of breathing, shortness of breath, dyspnea, tachypnea, orthopnea, hyperventilation, use of accessory muscless and nasal flaring.
– Confusion, drowsiness, disorientation, and coma.
Tachycarida, cyanosis, diaphoresis, chest pain, peripheral vasodilatation with hypotension.
– ABGs levels show hypoxemia, acidosis, alkalosis, and hypercapnia.
– Chest x-ray shows pulmonary infiltration and atelectasis.
– Hematology reveals increased WBCs and ESR.
– Sputum study identifies organism.
– Hypoxemia may cause death in RF
– Primary objective is to reverse and prevent hypoxemia
– Secondary objective is to control PaCO2 and respiratory acidosis
– Treatment of underlying disease
– Patient’s CNS and CVS must be monitored and treated
Intervention and rational
– Maintain bed rest to reduce O2 requirement.
– Keep the patient in semi-folwers position to promote chest expansion and ventilation.
– Administer O2 to reduce hypoxemia and relieve respiratory distress.
– Assess respiratory status to detect early signs of hypoxemia.
– Monitor and record vital signs, tachycardia and tachypnea may indicate hypoxemia.
– Monitor pulse oximetry to detect a drop in SaO2.
– Provide suctioning, assist with turning, coughing, and deep breathing, and perform chest physiotherapy and postural drainage to facilitate removal of secretion.
– Report deteriorating: ABGS (PaO2 and PaCo2)
– CBC, and Chemistry to detect electrolyte imbalance result use of diuretics.
– Maintain diet restrictions, fluid restrictions and a low Na diet may be necessary to avoid fluid overload.
– M.V may indicated: monitor M.V. to prevent complication and optimize PaO2
– Bronchodilators: “Aminolphyllin, Aerosol”
– Analgesic: morphine sulfate.
– Diuretics “Lasix” if overload is the cause.
– Steroids: “hydrocortisone- Solu-medrol”
– Histamine blockers “Zantac, famotidine”