Definition of Respiratory Failure:
The term respiratory failure is used when pulmonary gas exchange fails to maintain normal arterial Oxygen and carbon dioxide levels.
Clinical Feature of Respiratory Failure:
1. Features of hypoxemia:
- Systemic Hypotension,
- Pulmonary HTN.
- Tachycardia, tachypnoea, polycythaemia
- Cerebral dysfunction ranging from confusion to coma.
2. Features of hypercapnoea:
- Confusion,
- Warm periphery,
- Flapping tremor,
- Bounding pulse.
Investigations:
1. Arterial blood gas analysis
Type-I: ↓ Pa02 and normal or low PaC02
Type-II: ↓ Pa02 and ↑ PaC02
2. X-ray chest P/A view.
Management of Respiratory Failure:
- Maintenance of airway.
- Treatment of specific precipitating cause.
- Frequent physiotherapy + pharyngeal suction.
- Nebulized bronchodilators.
- Oxygen therapy-
- Type-I respiratory failure : High concentration of 02, (40-60% 02 via a high flow mask)
- Type-II respiratory failure: Low concentration of 02 (venturi masks – 24% or 28% 02)
- Mechanical assisted ventilation.
- Lung transplantation.
Causes of Respiratory Failure:
Common causes of Type-I respiratory failure:
- 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 associated with HIV infection,
- Kyphoscoliosis,
- Obesity
Common causes of Type-II respiratory failure:
- COPD,
- Severe asthma,
- Drug overdose, poisoning,
- Myasthenia gravis,
- Polyneuropathy,
- Poliomyelitis,
- Muscle disorders,
- Head injuries and neck injuries,
- Obesity,
- Pulmonary oedema,
- Adult respiratory distress syndrome,
- Hypothyroidism.
Complication of Respiratory Failure:
A. Pulmonary complications, include-
- Pulmonary embolism,
- Barotrauma,
- Pulmonary fibrosis, and
- Complications secondary to the use of mechanical devices.
B. Cardiovascular complications include
- Hypotension,
- Reduced cardiac output,
- Arrhythmia,
- Pericarditis, and
- Acute myocardial infarction.
- These complications may be related to the underlying disease process, mechanical ventilation, or the use of pulmonary artery catheters.
C. Gastrointestinal complications, include
- Hemorrhage,
- Gastric distention,
- Ileus,
- Diarrhea, and
- Pneumoperitoneum.
D. Nutritional complications, include
Malnutrition and its effects on respiratory performance and complications related to administration of enteral or parenteral nutrition. (Hypoglycemia, electrolyte imbalance).
Nursing Management of Respiratory Failure in Critical Care Unit:
1. Investigate the causes of respiratory failure,
Rational- understanding of the important causes of respiratory failures to provide care.
2. Observations of breathing patterns and note the frequency of breathing, the distance between spontaneous breathing and breathing ventilator,
Rational- Patients with ventilator can experience hyperventilation / hypoventilation and Patients trying to improve the lack of oxygen to the breathing pattern of increasing the frequency increases.
3. Auscultation of the chest periodically, record sound when breathing disorders.
Rationale: Provides information on the obsturksi airway, chest simetrisitas changes do not precisely indicate the location of endotracheal tube.
4. Sum of Respiratory Patients for I full minute and compare it to construct the Desired frequency ventilator
Rationale: Respiratory Patients Quickly leads to respiratory alkalosis, respiratory acidosis cause slow sednagkan Patients (Increased PaCO2).
5. Develop appropriate balloon endotracheal ube using a technical barrier to a minimum, check the development of every 4 hours.
Rational: inflate balloons must be appropriate to assure adequate ventilation is not Desired corresponding volume
6. Check the hoses if there is a blockage / folds.
Rational: hose folds obstruct the flow of air volume inadequate. The presence of water Allows the bacteria grow so that the originator of the colonization of bacteria,
7. Check the ventilator alarm function.
Rational: ventilator alarms that have a variety of abnormalities can be detected early as a Decrease in gas pressure, oxygen saturation, the ratio of inspiration and expiration, etc.
8. Help Patients performance control breathing when weaning sought.
Rational: train the patient to breathe slowly premises ways abdominal breathing and use relaxation techniques so that respiratory function can be maximized.
9. Collaboration for the examination of blood gas analysis by order.
Rational: to know the success of breath relief.
10. See tidal volume.
The rationale for determining the amount of air inspiration and expiration.
11. Supervision den inspiration expiration ratio.
Rational: Usually expiratory phase is 2 times the length of the speed of inspiration.
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”