Respiratory Failure PDF

RESPIRATORY FAILURE MINDA B. BAHUG, RN, MAN ASSISTANT PROFESSOR  RESPIRATORY FAILURE Clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which Pa)2 is lower than 60mmHg and or PaCO2 higher than 50mmHg...

RESPIRATORY FAILURE MINDA B. BAHUG, RN, MAN ASSISTANT PROFESSOR  RESPIRATORY FAILURE Clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which Pa)2 is lower than 60mmHg and or PaCO2 higher than 50mmHg It starts with swelling of tissue in the lungs and build up of fluid in the tiny air sacs that transfer oxygen to the bloodstream. This leads to low blood oxygen levels. 2  Classification of Respiratory Failure 1. Acute Respiratory Failure ( Type 1) Characterized by hypoxemia ( PaO2 less than 60mmHg) or hypercapnia with a normal pH (7.35 to 7.45 ); normal or low CO2 The gas exchange is impaired at the level of alveolocapillary membrane Example: cardiogenic, noncardiogenic pulmonary edema, ARDS, COVID 19, severe pneumonia 3  Classification of Respiratory Failure 2. Chronic Respiratory Failure ( Type 2) Characterized by hypoxemia and/or hypercapnia with a normal pH (7.35 - 7.45); high CO2. Occurs over a period of days, months, or years, allowing activation of compensatory mechanisms, including renal bicarbonate retention (normal, approximately 22 to 26 mEq/ L) with normalization of pH(or only slightly decreased, approximately 7.30 - 7.34) 4  Classification of Respiratory Failure 3. Combined Respiratory Failure Characterized by an abrupt increase in the degree of hypoxemia and/or hypercapnia in patients with preexisting chronic respiratory failure. Extent of deterioration is best assessed by comparing the patient’s present ABG levels with previous ABG levels (patient baseline). 5  Causes of Respiratory Failure 1. CNS causes due to depression of the neural drive to breath as in cases of overdose of a narcotic and sedative. 2. Disorders of the peripheral nervous system: Respiratory muscle and chest wall weakness as in cases of Guillian-Barre syndrome and myasthenia gravis. 6  Causes of Respiratory Failure 3. Upper and lower airways obstruction: due to various causes as in cases of exacerbation of chronic obstructive pulmonary diseases and acute severe bronchial asthma. 4. Abnormities of the alveoli that result in type 1 (hypoxemic) respiratory failure as in cases of pulmonary oedema and severe pneumonia 7  Common S/S of Respiratory Failure Dyspnoea Tachycardia Tachypnoea Pulmonary Restlessness hypertension Confusion Loss of Anxiety consciousness Cyanosis- central 8  S/S of Type 1 Respiratory Failure Dyspnea, irritability Confusion, fits, somnolence Tachycardia, arrhythmia Tachypnea Cyanosis 9  S/S of Type 2 Respiratory Failure Change of behavior headache Coma Warm extremities Astrexis ( sudden relaxation of muscles or lose of muscle tension) Papilloedema ( swelling of the optic disc due to elevated ICP) 10  Complications of Respiratory Failure Pulmonary Complications: pulmonary embolism, pulmonary fibrosis, complications secondary to the use of mechanical ventilator Cardiovascular Complications: hypotension, reduced cardiac output, cor pulmonale, arrhythmias, pericarditis and acute myocardial infarction) 11  Complications of Respiratory Failure Gastrointestinal Complications: haemorrhage, gastric distention, ileus, diarrhoea, pneumoperitoneum and duodenal ulceration- caused by stress is common in patients with acute respiratory failure Infectious Complications: nosocomial- pneumonia, urinary tract infection and catheter-related sepsis. Usually occurs with use of mechanical devices.) 12  Complications of Respiratory Failure Renal Complications: acute renal failure, abnormalities of electrolytes and acid-base balance. Nutritional Complications malnutrition and complications relating to parenteral or enteral nutrition and complications associated with NG tube- abdominal distention and diarrhea) 13  DIAGNOSTIC EVALUATIONS 1. ABG analysis: shows changes in PaO2, PaCO2, pH, and possibly HCO3 from patient’s normal levels or PaO2 less than 60 mm Hg, PaCO2 greater than 50 mm Hg, and pH less than 7.35. 2. Pulse oximetry decreasing SpO2 (less than 90%). 14  DIAGNOSTIC EVALUATIONS 3. End-tidal CO2 monitoring elevated (greater than 40 mm Hg or greater than 5 mm Hg above PaCO2 4. Complete blood count, serum electrolytes, chest x- ray, urinalysis, electrocardiogram (ECG), and blood and sputum culture to aid in determination of underlying cause and patient’s condition) 15  MANAGEMENT OF RESPIRATORY FAILURE  MEDICAL MANAGEMENT Hypoxemia is the major acute concern impacting organ function. Once corrected with stable ventilation and hemodynamics, identification and correction of underlying causes is essential and used to direct treatment 17  MEDICAL MANAGEMENT 1. Oxygen therapy to correct hypoxemia. 2. Turn patient regularly and mobilize when clinically stable to improve ventilation and oxygenation. When appropriate, early ambulation of the patient. 3. Diuretics for pulmonary vascular congestion or pulmonary edema. 18  MEDICAL MANAGEMENT 4. Bronchodilators and possibly corticosteroids to reduce bronchospasm and inflammation. 5. Ventilatory support using mechanical ventilation or noninvasive positive pressure ventilation using a face mask 19  MEDICAL MANAGEMENT Continuous Positive Airway Pressure (CPAP) uses machine specifically designed to deliver a flow of air at a constant pressure. CPAP machines possess a motor that pressurizes room temperature air and delivers it through a hose connected to a mask or Nasopharyneal tube worn by the patient 20 21  NURSING MANAGEMENT 1. Correction of Hypoxemia Controlled Oxygen therapy/ supplementation. Uncontrolled oxygen supplementation can result to oxygen toxicity and CO2 narcosis. Inspired oxygen should be adjusted at the lowest level which is sufficient for tissue oxygenation 22  NURSING MANAGEMENT 2. Correction of Hypercapnia respiratory acidosis Treat the underlying causes 3. Ventilatory support for the patient with respiratory failure a. Non-invasive respiratory support : Noninvasive Positive Pressure Ventilation (NIPPV) reduces complications no use of ET intubation 23  NURSING MANAGEMENT b. Invasive respiratory support : Intubation is indicated in persistent hypoxemia despite receiving maximum oxygen therapy, hypercapnia with impairment of conscious level. Intubation is associated with complications such as aspiration of gastric content, trauma to the teeth, barotraumas, trauma to the trachea 24  PHYSIOTHERAPY MANAGEMENT POSITIONING proper positioning aimed at improving ventilation/ perfusion (V/Q) matching, promoting mucociliary clearance, improving aeration via increased lung volumes and reducing the work of breathing. 25  PHYSIOTHERAPY MANAGEMENT Prone Position helps to improve V/Q matching, redistribute oedema and increase functional residual capacity(FRC) in patients with acute respiratory distress syndrome Side lying position with affected lungs uppermost to improve aeration through increased lung volumes in patients with unilateral lung disease. 26  PHYSIOTHERAPY MANAGEMENT Semi-recumbent position 450 head-up position serves to prevent the risk of gastroesophageal reflux and aspiration. Upright Position helps to improve lung volumes and decrease work of breathing in patients that are being weaned from mechanical ventilator. 27  PHYSIOTHERAPY MANAGEMENT Postural drainage and Percussion: uses gravitational effects to facilitate mucociliary clearance. Suction: used for clearing secretions when the patient cannot do so independently Manual hyperinflation to re-inflate atelectatic areas of the lungs and facilitate clearance of pulmonary secretions. 28  PHYSIOTHERAPY MANAGEMENT Active cycle of breathing technique and manual techniques such as shaking and vibration to facilitate mucus clearance Limb exercises: passive, active-assisted, active exercises may optimize oxygen transport and reduce the effects of immobility. 29  PHYSIOTHERAPY MANAGEMENT Inspiratory muscle training: aims to improve inspiratory muscle strength and it facilitates weaning from mechanical ventilation. It has be shown to improve whole body exercise performance, particularly in less fit subjects. Early mobilization: improves function, mobility and quality of life 30