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RELIANCE INSTITUTE OF
NURSING DHAMTARI
• ACUTE RESPIRATORY FAILURE
OM VERMA
LECTURER MEDICAL SURGICAL NURSING
ACUTE RESPIRATORY
FAILURE
高雄長庚醫院胸腔內科 王逸熙
Definition of respiratory failure
• Respiratory failure is a condition in
which the respiratory system fails in
its gas exchange function
• Respiratory failure is a syndrome
rather than a disease
• Respiratory failure may be acute or
chronic
• inability of the lung to meet the metabolic
demands of the body. This can be from
failure of tissue oxygenation and/or failure
of CO2 homeostasis.”
• Results from inadequate gas exchange
 Insufficient O2transferred to the blood
• Hypoxemia
 Inadequate CO2removal
• Hypercapnia
RESPIRATORY FAILURE
HYPERCAPNIA HYPOXEMIA
Two types of respiratory failure
HYPERCAPNIA
( “PUMP FAILURE” )
HYPOXEMIA
( “LUNG FAILURE” )
Central
Nerve
System
Component
Peripheral
Nerve
System/
Chest Bellows
component
Airways
Component
Alveolar
Component
HYPERCAPNIA
excessive carbon dioxide in the bloodstream, typically caused by
inadequate respiration.
HYPOXIMIA
An abnormal low concentration of oxygen in the blood.
Type 1 Acute Respiratory Failure
• Primary problem is impaired gas
exchange
• Primary gas exchange
abnormality seen in this setting
is hypoxemia
Causes of Acute Respiratory Failure
Type 1 respiratory failure Type 2 respiratory failure
Parenchymal process Increased load
Pneumonia Upper airway obstruction
Pulmonary edema Asthma
cadiogenic COPD
noncardiogenic
Pulmonary hemorrhage Neurological etiology
Progressive interstitial process Central respiratory depression
Pulmonary vascular Spinal cord injury
Pulmonary embolism Peripheral nerve
Pulmonary hypertension Neuromuscular junction
HYPOXMIA
• Caused by a disorder of heart, lung or blood.
Asthma, COPD
Pulmonary embolism
Atelectasis
Pneumonia
Cardiogenic Pulmonary Edema
• Interstitial pneumonitis interstitial pneumonia
is a form of lung disease characterized by
progressive scarring of both lungs.
• Infections
Hypercapnic
• Respiratory centre (medulla) dysfunction
• Drug over dose, CVA, tumor, hypothyroidism, central
hypoventilation
• Neuromuscular disease
Guillain-Barre, Myasthenia Gravis, polio,
spinal injuries
• Chest wall/Pleural diseases
pneumothorax, massive pleural effusion
• Upper airways obstruction
tumor, foreign body, laryngeal edema
• Peripheral airway disorder
asthma, COPD
• Guillain–Barré syndrome (GBS) is a
rapid-onset muscle weakness caused by
the immune system damaging the
peripheral nervous system.
• Myasthenia gravis is an autoimmune
disease which results from antibodies that
block or destroy nicotinic acetylcholine
receptors at the junction between the
nerve and muscle.
ETILOGY
Sepsis
Aspiration of gastric contents
Pulmonary contusion
Pneumonia
Near drowning
Smoke inhalation/burn
Trauma
Pancreatitis
Multiple transfusions
Pulmonary embolism
Disseminated intravascular coagulation
CLINICAL
MANIFESTRATION
• Cyanosis
- bluish color of mucous
membranes/skin indicate
hypoxemia
• - unoxygenated hemoglobin 50 mg/L
- not a sensitive indicator
• Dyspnea
- secondary to hypercapnia and
hypoxemia
• Paradoxical breathing
• Confusion, somnolence and coma
• difficulty breathing or shortness of breath,
especially when active.
• coughing up mucous.
• wheezing.
• bluish tint to the skin, lips, or fingernails.
• rapid breathing.
• fatigue.
• anxiety.
• confusion.
• Circulatory changes
- tachycardia, hypertension, hypotension
• Polycythemia
- chronic hypoxemia
- erythropoietin synthesis
• Pulmonary hypertension
• Cor-pulmonale or right ventricular failure
Management of Acute
Respiratory failure
• Airway Management
• Correction of Hypoxemia
and Hypercapnia
• Search for an Underlying
Cause
Airway Management
Assurance of an adequate
airway
Whether emergent intubation or
not?
• INFECTION
• Antimicrobial source control
• AIRWAY OBSTRUCTION
• Bronchodilator
• Glucocorticoide
• IMPROVE CARDIAC FUNCTION
• Diuretic ,vasodilators, morphine .
• Endotracheal tube (ETT) Endotracheal
tubes (ETT) are wide-bore plastic tubes
that are inserted into the trachea to
allow artificial ventilation.
• Tracheostomy – if upper airway is
obstructed if upper airway is obstruction
• A tracheostomy is an opening created
at the front of the neck so a tube can be
inserted into the windpipe (trachea) to
help you breathe. If necessary, the tube
can ...
COMPLICATION
• pulmonary embolism, pulmonary
fibrosis
• Shock

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Acute respiratory-failure-100330214226-phpapp01

  • 1. RELIANCE INSTITUTE OF NURSING DHAMTARI • ACUTE RESPIRATORY FAILURE OM VERMA LECTURER MEDICAL SURGICAL NURSING
  • 3. Definition of respiratory failure • Respiratory failure is a condition in which the respiratory system fails in its gas exchange function • Respiratory failure is a syndrome rather than a disease • Respiratory failure may be acute or chronic
  • 4. • inability of the lung to meet the metabolic demands of the body. This can be from failure of tissue oxygenation and/or failure of CO2 homeostasis.” • Results from inadequate gas exchange  Insufficient O2transferred to the blood • Hypoxemia  Inadequate CO2removal • Hypercapnia
  • 6. Two types of respiratory failure HYPERCAPNIA ( “PUMP FAILURE” ) HYPOXEMIA ( “LUNG FAILURE” ) Central Nerve System Component Peripheral Nerve System/ Chest Bellows component Airways Component Alveolar Component
  • 7. HYPERCAPNIA excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration. HYPOXIMIA An abnormal low concentration of oxygen in the blood.
  • 8. Type 1 Acute Respiratory Failure • Primary problem is impaired gas exchange • Primary gas exchange abnormality seen in this setting is hypoxemia
  • 9. Causes of Acute Respiratory Failure Type 1 respiratory failure Type 2 respiratory failure Parenchymal process Increased load Pneumonia Upper airway obstruction Pulmonary edema Asthma cadiogenic COPD noncardiogenic Pulmonary hemorrhage Neurological etiology Progressive interstitial process Central respiratory depression Pulmonary vascular Spinal cord injury Pulmonary embolism Peripheral nerve Pulmonary hypertension Neuromuscular junction
  • 10. HYPOXMIA • Caused by a disorder of heart, lung or blood. Asthma, COPD Pulmonary embolism Atelectasis Pneumonia Cardiogenic Pulmonary Edema • Interstitial pneumonitis interstitial pneumonia is a form of lung disease characterized by progressive scarring of both lungs. • Infections
  • 11. Hypercapnic • Respiratory centre (medulla) dysfunction • Drug over dose, CVA, tumor, hypothyroidism, central hypoventilation • Neuromuscular disease Guillain-Barre, Myasthenia Gravis, polio, spinal injuries • Chest wall/Pleural diseases pneumothorax, massive pleural effusion • Upper airways obstruction tumor, foreign body, laryngeal edema • Peripheral airway disorder asthma, COPD
  • 12. • Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. • Myasthenia gravis is an autoimmune disease which results from antibodies that block or destroy nicotinic acetylcholine receptors at the junction between the nerve and muscle.
  • 13. ETILOGY Sepsis Aspiration of gastric contents Pulmonary contusion Pneumonia Near drowning Smoke inhalation/burn Trauma Pancreatitis Multiple transfusions Pulmonary embolism Disseminated intravascular coagulation
  • 14. CLINICAL MANIFESTRATION • Cyanosis - bluish color of mucous membranes/skin indicate hypoxemia • - unoxygenated hemoglobin 50 mg/L - not a sensitive indicator • Dyspnea - secondary to hypercapnia and hypoxemia • Paradoxical breathing • Confusion, somnolence and coma
  • 15. • difficulty breathing or shortness of breath, especially when active. • coughing up mucous. • wheezing. • bluish tint to the skin, lips, or fingernails. • rapid breathing. • fatigue. • anxiety. • confusion.
  • 16. • Circulatory changes - tachycardia, hypertension, hypotension • Polycythemia - chronic hypoxemia - erythropoietin synthesis • Pulmonary hypertension • Cor-pulmonale or right ventricular failure
  • 17. Management of Acute Respiratory failure • Airway Management • Correction of Hypoxemia and Hypercapnia • Search for an Underlying Cause
  • 18. Airway Management Assurance of an adequate airway Whether emergent intubation or not?
  • 19. • INFECTION • Antimicrobial source control • AIRWAY OBSTRUCTION • Bronchodilator • Glucocorticoide • IMPROVE CARDIAC FUNCTION • Diuretic ,vasodilators, morphine .
  • 20.
  • 21. • Endotracheal tube (ETT) Endotracheal tubes (ETT) are wide-bore plastic tubes that are inserted into the trachea to allow artificial ventilation. • Tracheostomy – if upper airway is obstructed if upper airway is obstruction • A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe. If necessary, the tube can ...
  • 22. COMPLICATION • pulmonary embolism, pulmonary fibrosis • Shock