CAUSES
impaired function of the central nervous system
(drug overdose, head trauma, infection,
hemorrhage, sleep apnea)
neuromuscular dysfunction (myasthenia gravis,
Guillain-Barré syndrome, spinal cord trauma),
musculoskeletal dysfunction (chest trauma,
malnutrition),
pulmonary dysfunction (COPD, asthma, cystic
fibrosis).
CLINICAL MANIFESTATIONS
- sudden ↓in PaO2 or rapid rise in PaCo2 implies
serious condition
-bronchospasm
- impaired oxygenation: restless, headache,
dyspnea, air hunger, tachycardia, ↑BP
Progression: signs are more obvious: confusion,
lethargy, tachycardia, tachypnea, central cyanosis,
diaphoresis, respiratory arrest
- use of accessory muscle,↓breath sound if the pt
cannot adequately ventilate
- paradoxical breathing: abdomen & chest moves
in opposite manner
ACUTE RESPIRATORY
FAILURE
PATHOPHYSIOLOGY
ARF: a decrease in arterial oxygen tension (PaO2) to less than 50
mm Hg (hypoxemia) and an increase in arterial carbon dioxide
tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an
arterial pH of less than 7.35.
- V/Q mechanisms are impaired
-Oxygenation failure mechanisms leading to acute respiratory
failure include pneumonia, acute respiratory distress syndrome,
heart failure, COPD, pulmonary embolism, and restrictive lung
diseases.
-During postoperative period, acute respiratory failure may be
caused by the effects of anesthetic, analgesic, and sedative
agents, which may depress respiration or enhance the effects of
opioids and lead to hypoventilation.
- Pain may interfere with deep breathing and coughing. A
ventilation–perfusion mismatch is the usual cause of respiratory
failure after major abdominal, cardiac, or thoracic surgery.
MEDICAL MANAGEMENT
OBJECTIVE: correct underlying cause, restore
adequate gas exchange
- intubation, mechanical ventilation are needed to
maintain adequate ventilation & oxygenation while
underlying cause is corrected
DIAGNOSTICS
ABG analysis
CXR: may identify the cause
CBC, serum electroytes, UA,
electocardiography
NURSING MANAGEMENT:
- assist w/ intubation & maintain mechanical
ventilation
Pt are usually manage in the ICU
- monitor lvl of responsiveness, ABG, pulse oximetry &
VS
- assess the entire respitaroy system & implements
strategies (turning schedule, mouth care, skin care,
ROM of extremities) to prevent complications
- assesses the patient’s understanding of the
management strategies that are used and initiates
some form of communication to enable the patient to
express concerns and needs to the health care team.
- addresses the problems that led to the acute
respiratory failure. As the patient’s status improves,
the nurse assesses the patient’s knowledge of the
underlying disorder and provides teaching as
appropriate to address the disorder
H y p ox e m i a -a s t a t e o f l o w O 2 t e n s i o n o f t h e b l o o d ( p a r ti a l p r e s s u r e o f O 2 i n
arterial blood (PaO2)<6 0 m m Hg ), characterize d by non sp eci fi c clinical sig ns &
symptoms, a decrease in SaO2 is determined by measuring ABGs
H y p o x e m i c r e s p i r a t o r Py a fOa2i l ou fr e6; 0 m m H g o r l e s s w h e n t h e p t i s
receiving inspired O2 at a fracti onal [] FiO2 of 60% or more
1) The PaO2 lvl indicates inadequate O2 sat of Hbg
2) T h i s P a O 2 l v l e x i s t s d e s p i t e a d m i . O f s u p p l e m e n t a l O 2 a t a p e r c e n t a g e o f
60% that is 3X that in rm air (31 %)
F o u r c a: u m s ei ss t m a t c h b / w v e n ti l a ti o n & p e r f u s i o n
shunti ng, diff usion limitati on, hypoventi lati on

1) Venti lati on-Perfusion Mismatch V/Q mistmatch

- n o rm a l ly, 4 - 5 L of b l oo d p e r f u s e t h e lu n g s q m i n * e a c h p or ti o n o f t h e lu n g
would receive abt 1mL of air for each 1 mL of BF, resulti ng VQ 1:1 ( 1 mL of
a i r p e r 1 m L o f b l o o d ) , i n d i c a ti n g v e n ti l a ti o n v o l . i s i d e n ti c a l t o p e r f u s i o n
vol
- at apex of the lung, VQ rati os >1 ( more venti lati on than perfusion)
- at the base of the lung, VQ rati o is < 1

2) Shunti ng
- b l o o d l e av e s t h e h e a r t w /o h av i n g t o p a r ti c i p a t e i n ga s e xc h a n ge , c a n l e a d
to extreme VQ mismatch
a) anatomical s b phunt: t a oos
a assess
c i t hru h n natomica
( ventricular spetal defect), bypassing the lungs
b) i n t r a p u l m o n a r y s h u n t : b l o o d fl o w s t h r t h e p u l m o n a r y c a p i l l
parti cipati ng i g e n o as w xchange, a fi w fl ccurs( hen lve
pneumonia, oulmonary edema)
 c) d i ff u s i o n l i m i t a ti o n : d e c r e a s e i n g a s e x c h a n g e a c r
capillary mebrane by the process that thicken/ destroy the membrane
cause: emphysema, recurrent emboli, pulmonary fi brosis
- more likely to cause hypoxemia during exercise than at rest

H y p e r c a p n: i ap r e s e n c e o f e x c e s s C O 2 i n b l o o d , m a n i f e s t e d i n a n i n c r e a s e i n
parti al pressure of CO2 in arterial blood (PaCO2)
- when (pulse oximetry) Sp O2 is 90 %, the PaO2 is abt 60 mm Hg, if temp,
PaCO2 & pH are normal
H y p e r c a p n i c r e s p i r a t o r Py a fCaoi 2l u> 4r e5 : m m H g + a c i d e m i a ( a r t e r i a l p H
<7.35)
1) PaCO2 is > normal
2) body is inable to compensate for this increase (acidemia)
3) further decrease of pH can lead to severe acid-base imbalance
SPECIFIC NONSPECIFIC
HYPOXEMIA
Respiratory Cerebral
↓SpO2 (<80%) Agitation
Dyspnea Coma (late)
Intercostal muscle retraction Confusion
P r o l o n g e d e x p i r a t i o n ( r a tDelirium
i o l e n g t h o f
inspiration to the expiration: 1:3, 1:4)
Ta c h y p n e a , u s e o f a c c e s s p r y m u s c l e oDisorientation
n
respiration
Cyanosis (Late) ↓LOC
P a r a d o x i c a l c h e Restlessness,
s t / a combativeness
b d o m i n a l w a l l
movement w/ respiratory cycle (late)

CARDIAC
Dysrhythmias (late)
HTN
Hypotension (late)
Skin, cool, clammy, diaphoretic
Tachycardia
Fatigue
Inability to speak w/o pausing to breathe
HYPERCAPNIA
Respiratory Cerebral
Dyspnea C o m a ( l a t e ) , d i s o r i e n t a t i o n ,
headache, progressive somnolence
↓ M i n u t e v e n t i l a t i o Cardiac
n , ↓ R R / ↑ s h a l l o w
respiration
↓ tidal vol B o u n d i n g p u l s e , d y s r h y t h m i a s ,
tachycardia
Neuromuscular
↓deep tendon reflexes
Muscle weakness
T r e m o r , s e i z u r e ( l a t e )
breathing
 NURSIGN INTERVENTIONS
- Mobilize secretions
OXYGEN THERAPY -Effective coughing & positioning
GOAL: correct hypoxemia - Huffing cough: series of cough performed while saying the word “ huff”,
- supplemental O2 1-3 L/min by nasal cannula or at 24-34 % by prevents glottis from closing during cough , effective only clearing the
simplace face mask or venturi mask should improve Pa O2 & central airway, assist moving secretion upward
SaO2 if problem is V/Q mistmatch - Hydration & humidification ( adequate fuid intake (2-3L/day) is needed
- if hypoxemia is RT intrapulmonary shunt, pt usually does not to keep secretions thin & easy to expel
respond to high O2, pt usually require positive-pressure ventilation - Chest PT
(PPV), because provides therapy & humidification, ↓wrok of - airway suctioning
breathing, ↓ respiratory muscle fatigue, positive pressure assist in - Positive Pressure ventilation
opening collapse airways & ↓shunting Drug Therapy
-Relief of bronchospasm w/ bronchiodilator
- Reduce airway inflammation w/ ICS
- reduce pulmonary congestion
- Tx for pulmonary infections
- reduce anxiety, pain, agitation

MEDICAL SUPPORT
- treat underlying cause
- maintain adequate cardiac output
- maintain adequate Hgb []