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Acute Respiratory Failure (Investigations (Bloods (Arterial Blood Gas…
Acute
Respiratory Failure
Type I Respiratory Failure
Common Causes
Chronic Obstructive Pulmonary Disease (COPD)
Pneumonia
Pulmonary Oedema
Pulmonary Fibrosis
Asthma
Pneumothorax
Pulmonary Embolism
Pulmonary Hypertension
Cyanotic Congenital Heart Disease
Bronchiectasis
Acute Respiratory Distress Syndrome
Respiratory Illness due to HIV
Obesity
Hypoxic/Hypoxaemic Respiratory Failure
Characterised by arterial oxygen tension (PaO2) of <8 kPa (60 mm Hg) with normal or low arterial carbon dioxide tension (PaCO2)
Type II Respiratory Failure
Common Causes
Chronic Obstructive Pulmonary Disease (COPD)
Severe Asthma
Myasthenia Gravis
Polyneuropathy
Poliomyelitis
Muscle Disorders
Head & Neck Injuries
Pulmonary Oedema
Adult Respiratory Distress Syndrome
Hypothyroidism
Hypercapnic Respiratory Failure
Characterised by the presence of a PaCO2 >6 kPa (45 mm Hg) and PaO2 <8 kPa.
Investigations
Bedside
ECG
Echocardiograph (Echo)
Bloods
Arterial Blood Gas Analysis (ABG)
Used to diagnose of RF
Full Blood Count (FBCs)
Liver Function Tests (LFTs) & Renal Function Tests
Serum Creatine Kinase (CK) & Troponin I
Thyroid Function Tests (TFTs)
Imaging
Chest X-Ray (CXR)
Special Tests
Spirometry
Management
Hypoxaemia
Ensure adequate oxygen delivery - Arterial Saturations >90%
Oxygenation Therapy
Prolonged use of high-concentration oxygen in chronic sufferers who have become reliant on their hypoxic drive to maintain an adequate ventilation rate. Elevating the PaO2 too much may reduce the respiratory rate so that the PaCO2 may rise to dangerously high levels.
Hudson Mask with Venturi Valve
Used in patients with COPD and Chronic Type II RF reducing risk of reducing hypoxic drive for breathing
At this stage, also consider
Mechanical Ventilation
in order to assist with the the removal of CO2 as well as oxygenation - controlling hypoxic dirve
Nasal Cannula
Can deliver 2-4L Oxygen per minute
Do not interfere with speaking or feeding
Can cause ulceration of nasal and pharyngeal mucosa
Hudson Face Mask
Non-Rebreather Mask
Used to deliver concentrations of oxygen higher than 40% oxygen up to 85% oxygen at a rate of 10-15l/min
Continuous Positive Airway Pressure (CPAP) mask/hood
Positive airway pressure applied re-expands underventilated alveoli (usually at the base of the lungs) allowing increased O2 diffusion within the lungs. This also reduces the work of breathing
Hypercapnia & Respiratory Acidosis
Mechanical Ventilation to allow the removal of CO2
Ventillation
(Respiratory Support)
Indications for Mechanical Ventilation
Invasive Ventilation
Ventilation Pressures
IPAP
EPAP/PEEP
ECMO
NIV
Management for this problem is to correct the underlying cause
History & Examination
Signs
Symptoms
