Acute Respiratory Failure

ACUTE RESPIRATORY
FAILURE
CONTENTS
 1.DEFINITION
 2.CLASSIFICATION
 3.PATHOGENESIS
 4.CLINICAL CRITERIA
 5.DIAGNOSTIC CRITERIA
 6.DIFFERENTIAL DIAGNOSTIC
 7.PRINCIPLES OF THERAPY
DEFINITION
 Respiratory failure is defined as a PaO2 value of
less than 60 mm Hg while breathing air or a PaCO2
of more than 50 mm Hg.
 Acute respiratory failure occurs when fluid builds
up in the air sacs in your lungs. When that happens,
your lungs can’t release oxygen into your blood. In
turn, your organs can’t get enough oxygen-rich
blood to function. You can also develop acute
respiratory failure if your lungs can’t remove
carbon dioxide from your blood.
CLASSIFICATION
 Acute respiratory failure may be classified as:
1. Hypoxemic Respiratory Failure –
-PaO2 low (< 60 mmHg (8.0 kPa))
- PaCO2 normal or low
-PA-aO2 increased
2. Acute Ventilatory Failure –
-PaO2 decreased
-PaCO2 increased
-PA-aO2 normal
-pH decreased
HYPOXEMIC RESPIRATORY
FAILURE
-Hypoxemic respiratory failure (type I) is characterized by a
PaO2 of less than 60 mm Hg with a normal or low PaCO2 .
-This is the most common form of respiratory failure, and it can
be associated with virtually all acute diseases of the lung,
which generally involve fluid filling or collapse of alveolar
units.
ETIOLOGY
 Chronic bronchitis and emphysema (COPD)
 Pneumonia
 Pulmonary edema
 Pulmonary fibrosis
 Asthma
 Pneumothorax
 Pulmonary embolism
 Pulmonary arterial hypertension
 Pneumoconiosis
 Granulomatous lung diseases
 Cyanotic congenital heart disease
 Bronchiectasis
 Adult respiratory distress syndrome
 Fat embolism syndrome
 Kyphoscoliosis
 Obesity
PATHOGENESIS
 ↑increased hydrostatic pressures in the pulmonary
vessels Creates Imbalance in Starling Forces.
 Increase in fluid filtration into interstitial spaces of
lungs that exceeds the lymphatis capacity to drain the
fluid away.
 Increasing volumes of fluids leak into the alveolar
space.
 The lymphatic system attempts to compensate by
draining excess interstitial fluid into the vascular
system through the Hilary lymph nodes.
 If the pathway becomes overwhelmed, fluid
moves from pleural interstitial to into the alveolar
walls.
 If the alveolar epithelium is damaged, the fluid
begins to accumulate in the alveoli.
 Alveolar edema is serious late manifestation in
the progression of fluid imbalance.
CLINICAL MANIFESTATION
 Hypoxemia as alveolar membrane is thickened by fluid that
impaired the gas exchange
 Dyspnea
 Tachypnea
 Weak and thread tachycardia
 Hypertension(if cardiogenic)
 Orthopnea at less than 90 degrees
 Coughing as to attempt to rid the fluid of chest
 Sputum is thin and frothy because it is combined with water
 Pink tinged sputum if small capillaries break
 Patient may be anxious and restless from hypoxemia
 Chest auscultation reveals crackles, wheezes, and presence
of S3 sound
 SPO2 is less than 85%
 Arterial PaO2 revels less than 50%
 Respiratory alkalosis because of Tachypnea
 Pressure in Pulmonary artery and Pulmonary wedge
Pressure(PAWP) will Increase 
 Chest X-Rays shows Areas of “white-out” where fluid has
replaced air filled lung tissues
 Right ventricular failure may be noted
DIAGNOSTIC CRITERIA
 Diagnostic tests:-
-ABG
-X-Ray
-SpO2
 Management:-
1. Emergency management
2. Medical Management
3. Nursing Management
EMERGENCY
MANAGEMENT
MEDICAL MANAGEMENT
 Correct hypoxemia:
 non invasive positive pressure ventilation (NPPV)
 Reduce preload:
-upright position
-Diuretics
-nitroglycerin
-treating the underlying cause
 Reduce after load:
 Antihypertensive such as nitroprusside
 Morphine
 Support perfusion:
 The left ventricle is supported by using isotropic medication such as
dobutamine.
 Monitor --Urine output
 An intra aortic balloon pump (IABP)
NURSING MANAGEMENT
 1.Diagnosis: Impaired gas exchange related to

capillary membrane obstruction from fluid
evidence by decreased PaO2 and SiO2
 2. Diagnosis: Excessive fluid volume related to
excess preload evidence by weight gain,
peripheral edema, and wheezes and crackles
sounds in the lung
VENTILATORY/HYPERCAPNIA
RESPIRATORY FAILURE
 This is characterized by a PaCO2 of more than
50 mm Hg. Hypoxemia is common in patients
with hypercapnic respiratory failure who are
breathing room air. The pH depends on the level
of bicarbonate, which, in turn, is dependent on
the duration of hypercapnia.
ETIOLOGY
 In acute Ventilatory failure, the respiratory load
placed on the lungs to exchange CO2 is impaired by;
 1. Problem of resistance to moving air in and out of
the lung
 2. The ability of lung to expand and contact(elastic
recoil)
 3. Conditions that increase the productions of CO2
or decrease the surface available for exchange of
gases.
PATHOGENESIS
 In obstructive type respiratory failure, the

residual pressure in the chest impairs inhalation
and increase the workload of breathing.
 When end expiratory alveolar volume remains
above their critical closing point, the alveoli
remain open and functioning.
 Allowing oxygen to diffuse in bloodstream
 If alveolar volume falls below the closing point,
the alveoli tends to collapse.
 No oxygenation or blood flow to the alveoli
occurs.
 Leads to true intra pulmonary shunt (perfusion
without oxygenation) and decreased lung
compliance.
 Leads to hypoxia.
CLINICAL MANIFESTATION
 Altered respiratory rate and patterns.

 Breaths are shallow due to spasm of the airway.
 Client become confused, less conversant, and are
difficult to arouse.
 Pulsus paradoxes.
 Pulse oxymetry shows steadily decrease in SpO2.
 ABG analysis shows falling PaO2 and rising
PaCO2.
DIAGNOSTIC CRITERIA
 ABG
 X-Ray
 SpO2
MEDICAL MANAGEMENT
 Reverse Bronchospasms.
 Several forms of bronchodilators are used to
treat obstructions to airflow in client with COPD
and asthma. These agents include beta2 selective
agonists (albuterol), ipratropium, theophyllin,
and corticosteroids. If infection is cause then
broad spectrum antibiotics are used.
 Maintain oxygenation.
 Oxygen by mask may be adequate to support
oxygenation. Using forms of NPPV such as
CPAP reduces the workload of breathing by
decreasing the force needed to overcome the
pressure in the chest.
 Manage the underlying problem.
 Maintain ventilation:
NURSHING MANAGEMENT
 1. Nursing diagnosis: Impaired spontaneous ventilation
related to imbalance between Ventilatory capacity and
Ventilatory demand evidence by SPO2 and ABG findings.
 2. Nursing diagnosis: Impaired gas exchange and
ineffective breathing pattern related to underlying diseases
process and artificial airway and ventilator system
abnormal ABG findings and respiratory rate .
 3. Nursing diagnosis: Ineffective airway clearance related
to increased mucus production associated with continuous
positive-pressure mechanical ventilation evidence by
wheezes and crackles sounds in lungs.
 4. Nursing diagnosis: Risk for trauma and
infection related to endotracheal intubation or
tracheotomy.
 5. Nursing diagnosis: Impaired physical mobility
related to ventilator dependency.
 6. Nursing diagnosis: Impaired verbal
communication related to endotracheal tube and
attachment to ventilator
 7. Nursing diagnosis: Defensive coping and
powerlessness related to ventilator Dependency

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ACUTE RESPIRATORY

 1.Diagnosis: Impaired gas exchange related to

 In obstructive type respiratory failure, the

 Altered respiratory rate and patterns.

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