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    Acute Respiratory Failure

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    Yala Yoon
    There are two types of acute respiratory failure: type 1 is characterized by hypoxemia without hypercapnia due to problems with oxygenation, while type 2 involves both hypoxemia and hypercapnia due to ventilation issues. Treatment of acute respiratory failure focuses on maintaining airway patency, correcting the underlying cause, optimizing oxygen delivery, minimizing oxygen demand, and preventing complications. This involves interventions like chest physiotherapy, bronchodilators, mechanical ventilation, treating infections, positioning, oxygen supplementation, and monitoring for issues like respiratory distress, fluid imbalances, and ventilator-associated pneumonia.

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    Acute Respiratory Failure

    Uploaded by

    Yala Yoon
    95 views2 pages
    There are two types of acute respiratory failure: type 1 is characterized by hypoxemia without hypercapnia due to problems with oxygenation, while type 2 involves both hypoxemia and hypercapnia due to ventilation issues. Treatment of acute respiratory failure focuses on maintaining airway patency, correcting the underlying cause, optimizing oxygen delivery, minimizing oxygen demand, and preventing complications. This involves interventions like chest physiotherapy, bronchodilators, mechanical ventilation, treating infections, positioning, oxygen supplementation, and monitoring for issues like respiratory distress, fluid imbalances, and ventilator-associated pneumonia.

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    There are two types of acute respiratory failure: type 1 is characterized by hypoxemia without hypercapnia due to problems with oxygenation, while type 2 involves both hypoxemia and hypercapnia due to ventilation issues. Treatment of acute respiratory failure focuses on maintaining airway patency, correcting the underlying cause, optimizing oxygen delivery, minimizing oxygen demand, and preventing complications. This involves interventions like chest physiotherapy, bronchodilators, mechanical ventilation, treating infections, positioning, oxygen supplementation, and monitoring for issues like respiratory distress, fluid imbalances, and ventilator-associated pneumonia.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    95 views2 pages

    Acute Respiratory Failure

    Uploaded by

    Yala Yoon
    There are two types of acute respiratory failure: type 1 is characterized by hypoxemia without hypercapnia due to problems with oxygenation, while type 2 involves both hypoxemia and hypercapnia due to ventilation issues. Treatment of acute respiratory failure focuses on maintaining airway patency, correcting the underlying cause, optimizing oxygen delivery, minimizing oxygen demand, and preventing complications. This involves interventions like chest physiotherapy, bronchodilators, mechanical ventilation, treating infections, positioning, oxygen supplementation, and monitoring for issues like respiratory distress, fluid imbalances, and ventilator-associated pneumonia.

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    Acute Respiratory Failure

    Type 1 Respiratory Failure Type 2 Respiratory Failure


    1. Failure of oxygenation 1. Failure of Ventilation
    2. PaO2 < 60mmHg 2. PaO2 < 60mmHg, PaCO2 > 50mmHg
    3. Hypoxemia w/o hypercapnia 3. Hypoxemia with Hypercapnia
    4. Common causes: 4. Common causes:
     Low ambient O2  Increase airway resistance
     V/Q mismatch (COPD, asthma)
     Alveolar hypotension  Reduced WOB
     Diffusion problems  Decreased area of the lung for
     Shunt gas exchange (Bronchitis)
     Neuromuscular problems
     Depressed CNS
    Clinical Manifestations
    Early Signs:
    1. Restlessness
    2. Fatigue
    3. Headache
    4. Increased BP
    5. Tachycardia
    6. Tachypnoea
    7. Dyspnoea
    8. Use of respiratory muscles
    9. Nasal flaring
    10. Paradoxical breathing
    Late Signs:
    1. Confusion
    2. Central cyanosis
    3. Tachycardia
    4. Tachypnea
    5. Diaphoresis
    6. Respiratory arrest
    Goals for treatment of ARF
    1. Maintain adequate airway patency
    2. Correct underlying cause/issues
    3. Optimise oxygen delivery
    4. Minimize oxygen demand
    5. Prevent complications
    Maintain Airway Patency
    1. Perform chest physiotherapy to remove trapped secretions
    2. Administer bronchodilators to increase airway patency
    3. Non-invasive Mechanical Ventilation  Face Mask
    4. Invasive Mechanical Ventilation  ETT, if patient is unable to maintain airway
    Correct Underlying Cause
    1. Investigations & medical interventions is necessary to identify cause of ARF
    Optimise Oxygen Delivery
    1. Monitor for respiratory distress & auscultate for adventitious lung sounds
    2. Provide supplement oxygen
    3. Positioning for comfort & to enhance V/Q matching
    Acute Respiratory Failure

    4. Blood transfusion to ensure optimal Hb for oxygen transportation


    Minimize Oxygen Demand
    1. Provide adequate bed rest
    2. Timing of ADLs
    3. To address sepsis, restlessness & patient-ventilator desynchrony
    Prevent Complication
    Monitor for complications of ARF:
    1. Immobility-related complications
    2. Fluid & electrolytes imbalance
    3. Nutritional imbalances
    4. Medication side effects
    5. Ventilator associated complications  pneumonia, infection
    Acute Respiratory Distress Syndrome
    1. Subset of Acute Lung Injury (ALI)
    2. 3 Criteria to differentiate ARDS from ALI
     PaO2/FiO2 ratio <200 (ARDS), <300 (ALI)
     Chest x-ray  bilateral infiltrates
     Pulmonary Artery Occlusion Pressure (PAOP) <18 mmHg OR
     No evidence of left atrial hypertension
    Stages of ARDS
    Stage 1: Injury Stage 1. Increased Dyspnea & RR
    (within 24 hours) 2. Coarse bilateral crackles
    3. CXR – Patchy bilateral infiltrates
    Stage 2: Exudative Stage (1 1. Marked by mediator-induced interstitial & alveola edema
    – 7 days) 2. Increase permeability to proteins
    3. Hypoxia resistant to supplement O2  Mechanical
    Ventilation
    Stage 3: Proliferative Stage 1. Characterised by hemodynamic instability
    (1-2 weeks after initial 2. Evidence of SIRS (Temp >38 or <35, RR > 20, HR > 90, PaCO2
    injury) <32 mmHg)
    3. Thickened alveolar membrane
    4. Generalised edema – lungs is become more dense
    Stage 4: Fibrotic Stage 1. Lung is completely remodelled by fibrous tissues
    (2-3 weeks after injury) 2. Increase dead space  Poor ventilation
    Treatment of ARDS
    Mainly supportive while waiting for the lungs to heal
    1. Oxygenation
    2. Sedation/Comfort
    3. Prone positioning
    4. Fluids & Electrolytes + Nutrition
    5. Pharmacological

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