Acute Respiratory Failure

 A condition in which not enough oxygen passes from your lungs into your blood.  Can occur if your lungs can't properly remove carbon dioxide (a waste gas) from your blood. It is defined clinically as:  PaO2 less than 50mmHg  hypoxemia
 PaCO2 greater than 50mmHg   Arterial pH less than 7.35


 Both of these problems—a low oxygen level and a high carbon dioxide level in the blood—can occur at the same time.  Diseases and conditions that affect your breathing can cause respiratory failure. Examples include COPD (chronic obstructive pulmonary disease) and spinal cord injuries.  In respiratory failure, gas exchange is impaired.

Low oxygen Level:  Shortness of breath  Air hunger (feeling like you can’t breathe in enough air)  Cyanosis on your skin, lips & fingernails

High carbon dioxide Level:  Rapid breathing  Confusion Others:  Sleepiness  Arrhythmias

―One of the main goals of treating respiratory failure is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the underlying cause of the condition.‖

Pulse Oximetry – estimate how much oxygen is in your blood.  Arterial blood gas test – measures the oxygen and carbon dioxide levels in your blood.  Chest xray – to help find the underlying cause of respiratory failure.  ECG – records the heart’s electrical activity.

 Oxygen Therapy – given through a nasal cannula or through a mask that fits over the nose and mouth. Can also be given through a tracheostomy.

 Fluids - You may be given fluids to improve blood flow throughout your body and to provide nutrition. Your doctor will make sure you get the right amount of fluids. Fluids usually are given through an intravenous (IV) line inserted in one of your blood vessels.  Medications - Your doctor may prescribe medicines to relieve discomfort.

 Assess respiratory status by monitoring the level of responsiveness, ABG, pulse oximeter, and VS.  Assess the entire respiratory system and implement strategies to prevent complications.  Assist in intubation and maintaining mechanical ventilation.  Suction airways as required.  Administer care of patient on mechanical ventilation.

 Also called Respirator / Ventilator / Breathing Machine A machine that supports breathing. These machines mainly are used in hospitals. Ventilators: * Get oxygen into the lungs. * Remove carbon dioxide from the body. * Help people breathe easier. * Breathe for people who have lost all ability to breathe on their own.

A standard setup for a ventilator in a hospital room

Mechanical ventilation may be required for a variety of reasons: • Including the need to control the patient’s respirations during surgery or during treatment of severe head injury. • To oxygenate the blood when the patient’s ventilatory efforts are inadequate. • And to rest the respiratory muscles.

If you have general anesthesia during surgery, you'll likely be connected to a ventilator. The medicines used to induce anesthesia can disrupt normal breathing. A ventilator helps make sure that you continue breathing during surgery.

 It affects your ability to talk and eat.  A ventilator greatly restricts your activity and also limits your movement.  Instead of food, your health care team may give you nutrients through a tube inserted into a vein. If you're on a ventilator for a long time, you'll likely get food through a nasogastric, or feeding, tube.

A.Negative-Pressure Ventilators B.Positive-Pressure Ventilators

 Applies negative pressure around the chest wall, causing intra airway pressure to become negative, thus drawing air into the lungs through patient’s nose and mouth  No artificial airway  Patient must be able to control and protect own airway, done under weaning from PEEP.  3 types are: (1) IRON LUNG, (2) BODY WRAP and (3) CHEST CUIRASS VENTILATOR.

Body Wrap & Chest Cuirass
- A negative-pressure chamber used for ventilation. It was used extensively during polio epidemics in the past and currently is used by polio survivors and patients with other neuromuscular disorders.
- Both of these portable devices require a rigid cage or shell to create a negative-pressure chamber around the thorax and abdomen. Because of problems with proper fit and system leaks, these types of ventilators are used only with carefully selected patients.

Air is delivered under positive pressure to the lungs, expiration is passive, endotracheal intubation or tracheostomy is usually necessary.  3 types: (1) Pressure-Cycled Ventilators, (2) Time-Cycled Ventilators, (3) VolumeCycled Ventilators

Pressure-Cycled Ventilators
- The pressure-cycled ventilator ends inspiration when a preset pressure has been reached. - In adults, pressurecycled ventilators are intended only for shortterm use. - The most common type is the IPPB machine.

Time-Cycled Ventilators
- Time-cycled ventilators terminate or control inspiration after a preset time. - These ventilators are used in newborns and infants.

Volume-Cycled Ventilators
- By far the most commonly used positive-pressure ventilators today. - With this type of ventilator, the volume of air to be delivered with each inspiration is preset. Once this preset volume is delivered to the patient, the ventilator cycles off and exhalation occurs passively.

Non-invasive Positive-Pressure Ventilation (NIPPV)
- Pressure ventilation can be given via facemasks that cover the nose and mouth, nasal masks, or other nasal devices.

Ventilator Modes
    Controlled Ventilation CV Assist/Control A/C Intermittent Mandatory Ventilation IMV Synchronized Intermittent Mandatory Ventilation SIMV  Pressure Support  Positive End-Expiratory Pressure PEEP  Continuous Positive Airway Pressure CPAP

1. Controlled Ventilation – the ventilator completely controls the patient’s ventilation according to preset tidal volume and respiratory rate. 2. A/C  the patient’s breathing pattern may trigger the ventilator to deliver a preset tidal volume; in the absence of spontaneous breathing, the machine delivers a controlled breath at a preset minimum rate and tidal volume. 3. IMV  provides a combination of mechanically assisted breaths and spontaneous breaths. 4. SIMV  the ventilator allows the patient to breathe spontaneously while providing a preset number of breaths to ensure adequate ventilation; ventilated breaths are synchronized with spontaneous breathing.

5. PSV  Preset positive pressure is delivered with spontaneous breaths to decrease work of breathing. 6. APRV  a time-triggered, pressure-limited, time-cycled mode of mechanical ventilation that allows unrestricted, spontaneous breathing throughout the ventilatory cycle. 7. PAV  provides partial ventilatory support in which the ventilator generates pressure in proportion to the patient’s inspiratory efforts. 8. CPAP  provides positive pressure to the airways throughout the respiratory cycle. 9. PEEP  Positive pressure maintained by the ventilator at the end of exhalation (instead of a normal zero pressure) to increase functional residual capacity and open collapsed alveoli; improves oxygenation with lower fraction of inspired oxygen.

 Infections - One of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube that's put in your airway can allow bacteria to enter your lungs. As a result, you may develop ventilatorassociated pneumonia (VAP).  The breathing tube also makes it hard for you to cough.  Another risk of being on a ventilator is a sinus infection.

 Pneumothorax. This is a condition in which air leaks out of the lungs and into the space between the lungs and the chest wall. This can cause pain and shortness of breath, and it may cause one or both lungs to collapse.  Lung damage. Pushing air into the lungs with too much pressure can harm the lungs.  Oxygen toxicity. High levels of oxygen can damage the lungs.  Risk for blood clots and serious skin infections.  Damage to the vocal cords from the breathing tube.

"Weaning" is the process of taking you off of a ventilator so that you can start to breathe on your own. People usually are weaned after they've recovered enough from the problem that caused them to need the ventilator.
After you're weaned, the breathing tube is removed. You may cough while this is happening. Your voice may be hoarse for a short time after the tube is removed.

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