ACUTE RESPIRATORY FAILURE

BY : AAN NURAENI CRITICAL CARE NURSING FACULTY OF NURSING UNPAD 2013

Description
Clinical condition in which the pulmonary system

fails to maintain adequate gas exchange It usually occurs secondary to another disorder, in such a way as to decrease the ventilatory drive, decrease muscle strength, dec chest wall elasticity, dec lung capacity for gas exchange, increase airway resistance, or increase metabolic O2 requirements There are two types : hypoxemic normocapnic respiratory failure (Type I) and hypoxemic hypercapnic respiratory failure (Type II)

Etiology
Extrapulmonary
Brain : Drug overdose, central

Intrapulmonary

alveolar hypoventilation sindrome, Brain trauma, postop anesthesia deppression Spinal cord : GBS, Poliomyelitis etc Neuromuscular : Myasthenia gravis, MS, Organophosphate poisoning Thorax : Massive obesity, chest trauma Pleura : Pleural effusion, Pneumothorax

Upper airways : sleep

apnea, tracheal obstruction Lower airways alveoli : COPD Pulmonary emboli Inhalation of toxic gases etc

Pathophysiology
ARF Hipoxemia, the main causes of hypoxemia are : Alveolar hypoventilation

The O2 being brought into the alveoli is insufficient to meet metabolic needs of body Metabolic needs Ventilation Ventilation and blood flow mismatched Alveoli partially collapsed or partially filled with fluid Blood reaches the arterial system without participating in gas exchange

Ventilation / Perfusion mismatching

Intrapulmonary shunting

Assesment and Diagnosis

Hypoxemia : ABG analysis PaCO2 > 50 mmHg PaO2 < 50 mmHg Hipercapnia Acidosis pH < 7.35 Additional tests : Bronchoscopy, chest radiography,

thoracic ultrasound, CT scan

Manifestasi klinis : ..

Medical management
Oxygenation : To correct hypoxemia keeping the arterial Hb oxygen saturation > 90 % Supplemental oxygen administration and positive airway pressure Ventilation : non invasive and invassive ventilation Pharmacology : To facilitate dilation of airways, such as Bronchodilators (beta 2 agonist and anticholinergic agents). Aminophiline have negative side effects. Steroids to decrease airway inflamation and enhance the beta2agonists effect. Sedation (assist maintaining adequate ventilation), analgesics Acidosis :

Correction of hypoxemia and sodium bicarbonate Nutrition support Prevention of complications

Nursing Management
Nursing care is directed by the specific etiology of ARF. Common interventions : Positioning Preventing desaturation :

Performing procedures only as needed Hyperoxygenating the patient before suctioning Providing adequate rest and recovery time between various procedures Minimizing oxygen consumption Deep breathing after extubation Adequate systemic hydration Hummidifying supplemental oxygen Coughing and suctioning Chest physiotherapy

Promoting secretion clearance :

Patient Education