Respiratory failure occurs when the respiratory system fails to oxygenate blood and eliminate carbon dioxide. It is defined by hypoxemia (PaO2 <60 mm Hg) or hypercapnia (PaCO2 >50 mm Hg) on arterial blood gas analysis. Respiratory failure is a common cause of death worldwide and a frequent problem in intensive care units. It can be acute or chronic and classified by blood gas levels, site of failure in the respiratory system, or onset. Causes include airway obstruction, lung disease, pulmonary vascular conditions, chest wall issues, and neuromuscular disorders. Treatment involves oxygen therapy, ventilation, secretion clearance, nutrition, and managing the underlying cause.

1. By:- kanchan sharma
M.Sc(N) Lecturer
Medical surgical department
Respiratory Failure

2. Introduction
 Respiratory failure is a syndrome in which
the respiratory system fails in one or both
of its gas exchange functions oxygenation
and carbon dioxide elimination.
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3. Definition
 Respiratory failure define as a Pao2 value
less than 60 mm Hg (hypoxemia) or
PaCO2 value more than50 mm Hg
(hypercapnia). As it is determine by ABG
analysis.
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4. Incidence
 Be a frequently encountered medical problem
 A major cause of death in China
 Mortality from COPD, which ends in death
from respiratory failure, continues to increase
 More than 70% of patients with pneumonia are
attributed to respiratory failure
 About 1/3 patients in ICU in the United States,
about 500 000 persons, receive mechanical
ventilation each year
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5. Classification
1. According to pathophysiology and
arterial blood gas analysis:
 Type I:- Hypoxemic respiratory failure
PaO2 of less than 60 mm Hg with a
normal or low PaCO2. It caused by
Edema, Vascular disease, Chest Wall
 Type II:- Hypercapnic (Group Ⅱ )
respiratory failure PaO2 low 60 mm Hg
and PaCO2 of more than 50 mm Hg.
Caused by Airway obstruction,
Neuromuscular disease.
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6. Cont….
2. According to the involved site:-
 Central respiratory failure:- Change of
respiratory rhythm and frequency
 Peripheral respiratory failure :-
Dyspnea
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7. 3. According to onset of respiratory failure:-
• Acute respiratory failure:- it develops in
seconds or hours characterized by
hypoxemia or hypercapnia and
acidemia(pH less than 7.35).
• Chronic respiratory failure:- Develops in
days or longer, which characterize by
hypoxemia and hypercapnia with normal
pH.
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8. Risk factor
• Sepsis
• Aspiration of gastric content
• Pneumonia
• drowning
• Smoke inhalation/burn
• Trauma
• Pancreatitis
• Pulmonary embolis
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9. Causes
1. Airway obstruction
2. Alveolar or interstitial lung
diseases
 Airway Inflammation,
 Tumor,
 Foreign Bodies,
 Fibrosis Scar COPD
 Asthma
 Pneumonia
 Emphysema
 Pulmonary Tuberculosis
 Diffuse Interstitial
Pulmonary Fibrosis
 Pulmonary Edema
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10. Cont……
3. Pulmonary
vascular diseases
 Pulmonary
Embolism
 Pulmonary
Vasculitis
 Cardiogenic
pulmonary edema
(left ventrical
failure, mitral
stenosis)
4. Chest wall or
pleural diseases:-
 Flail Chest Caused
By Trauma
 Pneumothorax
 Severe Spinal
Deformity
 Massive Pleural
Effusion
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11. Cont…..
5.Neuromuscular Diseases:-
 Cerebrovascular Disease
 Poliomyelitis
 Polyneuritis
 Myasthenia gravis
 Gullian-Bare syndrome
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12. Pathophysiolgy.
 Four physiologic mechanisms may
cause hypoxemia and subsequent
hypoxemic failure.
1. Mismatch between ventilation and
perfusion commonly referred to as V/Q
mismatch.
2.Shunt.
3.Diffusion limitation.
4.Hypoventilation.
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13. 1.Mismatch between ventilation and perfusion/ V/Q
mismatch
 Due to disease condition COPD,
pneumonia, asthma
 Limited airflow alveoli no effect on
blood flow
 V/Q mismatch
 Hypoxia
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14. 2. Shunt.
 Shunt occurs when blood exits the
heart without having participated in
gas exchange.
 A shunt can be viewed as an extreme
form of V/Q mismatch.
 There are two types of shunt:
 1. Anatomic shunt.
 2. Intrapulmonary shunt.
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15. Shunt.
 An anatomic shunt occurs when blood
passes through an anatomic channel
in the heart (e.g. Ventricular septal
defect) and therefore does not pass
through the lungs.
 An intra pulmonary shunt occurs when
blood flows through the pulmonary
capillaries with out participating in gas
exchange.
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16. Shunt…
 Intra pulmonary shunt is seen in
conditions in which the alveoli is filled
with fluid (e.g., ARDS, Pneumonia,
Pulmonary edema).
 O2 therapy alone may be ineffective in
increasing PaO2 if hypoxemia is due
to shunt because :
 1. blood passes from the right to left
without passing through the lungs
(anatomic shunt).
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17. 3. Diffusion limitation..
Due to Fibrotic condition
Alveolar capillaries become thicker
Gas transport become slow but blood moves very fast
Decreased time of O2 diffusion in alveolar capillary
membrane
Hypoxemia
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18. 4. Alveolar Hypoventilation.
Due to restrictive lung disease/ chest wall
dysfunction
Decrease the ventilation
Increased PaCo2 and decreased PaO2
Hypoxia
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19. Clinical manifestations.
1.Early signs
 Restlessness,
 Fatigue,
 Headache,
 Dyspnea,
 Air Hunger,
 Tachycardia,
 Increased Blood
Pressure.
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2.As the hypoxemia
progresses
• Confusion,
•Lethargy,
• Tachycardia,
• Tachypnea,
• Central Cyanosis,
• Diaphoresis,
• Unable to speak without
pausing to breath.

20. Diagnostic studies.
 Physical assessment.
 Arterial blood gas analysis.
 Pulse oximetry.
 Chest X-ray,
 CBC, S.electrolytes, Urinalysis, ECG,
Sputum Culture, Blood Culture.
 Pulmonary angiography
 Hemodynamic Monitoring.
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21. Management
1.Oxygen therapy:
• If hypoxemia is secondary to V/Q mismatch,
supplemental oxygen is administered at 1 to 3
Lts/min by nasal cannula or 24% to 32% by
simple face mask or venturi mask.
• Hypoxemia secondary to intrapulmonary
shunt is usually not responsive to high O2
concentration and patient will require positive
pressure ventilation (PPV).
•PPV offers a means of providing O2 therapy
and humidification, decreasing the work of
breathing, and respiratory muscle fatigue.
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22. 2. Mobilization of secretions
 Augmented coughing or Quad
coughing
 Therapeutic cough technique
 Positioning
 Hydration and humidification
 Chest physiotherapy
 Suctioning
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23. 3. Positive pressure ventilation:-
 Positive pressure ventilation may be
provided:-
 Invasively- through endotracheal or
nasotracheal intubation
 Noninvasively- through nasal or face
mask.
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24. 4. Drug therapy
 Short - acting bronchodilators:- such
as metaproterenol are frequently
administered to reverse
bronchospasm using a hand held
nebulizer or metered-dose inhaler with
spacer.
 Corticosteroids:-
 methyl predonisolone 25 mg iv may
be used in conjunction with
bronchodilating effect when
bronchospasm and inflammation
occur. 7/31/2020 24

25. Diuretic:-
 FUROSEMIDE 40mg/IV are used to decrease the
pulmonary congestion caused by heart failure.
 Antibiotics:-
 Vancomycin or Ceftriaxone, are frequently
administered to inhibit bacterial growth and reduce
pulmonary infection.
 Sedation and analgesia:- with drug therapy such as
benzodiazepines (e.g., Lorazapam
[Ativan],Medazolam [Versed]), and narcotics (e.g.,
Morphine) may be used to decrease anxiety,
agitation and pain.
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26. 5. Nutritional therapy
 Maintenance of protein energy stores is
especially important in patients who experience
acute respiratory failure because nutritional
depletion causes loss of muscle mass, including
the respiratory muscle, and may prolong recovery.
 During the acute manifestations of respiratory
failure, the risk of aspiration typically prevents
oral nutritional intake. Therefore enteric or
parenteral nutrition may be administered.
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27.  A high carbohydrate diet may be
avoided in the patient who retains
Co2, because carbohydrates
metabolize into Co2 and increase Co2
load of the patient.
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28. 6. Nursing management
 Nursing assessment:-
 Assess respiratory rate, depth, and effort,
including use of accessory muscles, nasal flaring.
 Assess the lungs for areas of decreased ventilation
and auscultate presence of adventitious sounds.
 Monitor the patient behavior and mental status .
 Observe for nail beds, cyanosis in skin.
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29.  Nursing diagnosis:-
1. Ineffective airway clearance related to excessive
secretions, decreased level of consciousness,
presence of an artificial airway, neuromuscular
dysfunction, and pain as manifested by difficulty in
expectorating sputum presence of rhonchi, or
crackles, ineffective or absence cough.
2. Ineffective breathing pattern related to
neuromuscular impairment of respirations, pain,
anxiety, decreased level of consciousness,
respiratory muscle fatigue, and bronchospasm, as
manifested by respiratory rate < 12 or >14
breaths/minute
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30. 3. Risk for imbalanced fluid volume
related to increased peripheral or
pulmonary fluid
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