ACUTE

RESPIRATORY
FAILURE

PIYALI BISWAS
MSC NURSING,2ND YEAR
Rapid and significant
compromise in the system’s
ability to adequately exchange
carbon dioxide and /or oxygen
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
 incidence
In the US ,the number of hospitalisations increased
owing to acute respiratory failure increased from
1,007,549 in 2001 to 1,917,910 in 2009.
Acute respiratory failure is often associated with
pulmonary infections,the most common infection
being pneumonia.
The mortality rates for acute respiratory failure are
around 40%
 anatomy and physiology of the lungs
The lungs are the essential
organs of respiration; they are
two in number, placed one on
either side within the thorax,
and separated from each other
by the heart and other
contents of the mediastinum.
 Each lung is conical in shape,
and presents for examination
an apex, a base, three borders,
and two surfaces
The lungs are asymmetrically
paired. The right lung is divided
by major and minor fissures into
three lobes: the upper, lower, and
middle lobes. By contrast, the left
lung has a single fissure dividing
it into upper (superior) and lower
(inferior) lobes
Results from inadequate gas exchange
Insufficient O2 transferred to the
blood
Hypoxemia

Inadequate CO2 removal

Hypercapnia
Hypoxemic
respiratory failure
PaO2 <60 mm
Hg on inspired
O2 concentration
>60%
Hypercapnic
respiratory failure
PaCO2 above
normal ( >45 mm
Hg)
Acidemia (pH
<7.35)
 Two types of respiratory failure

HYPERCAPNIA HYPOXEMIA
( “PUMP FAILURE” ) ( “LUNG FAILURE” )

Central
Nerve Airways Alveolar
System Peripheral Component Component
Component Nerve
System
 causes of hypoxemic respiratory
failure
Alveolar hypoventilation
Restrictivelung disease
CNS disease

Chest wall dysfunction

Neuromuscular disease
 causes of hypercapnic respiratory
failure
Imbalance between ventilatory supply and demand
Airways and alveoli
Asthma
Emphysema
Chronic bronchitis

Central nervous system

Drug overdose
Brainstem infarction
Spinal cord injuries
Chest wall
Flail chest
Fractures
Mechanical restriction
Muscle spasm
Neuromuscular
conditions
Muscular dystrophy
Multiple sclerosis
Major threat
is the inability
of the lungs to
meet the
oxygen
demands of
the tissues
clinical manifestations
Sudden or gradual onset
A sudden decrease in PaO2 or rapid
increase in PaCO2 indicates a serious
condition
Severe morning headache
Cyanosis
Late sign
Tachycardia and mild hypertension
Early signs
 specific clinical manifestations
Rapid, shallow
breathing
pattern
Dyspnea
Pursed-lip
breathing
consequences
 collaborative care
Respiratory therapy
Oxygen therapy: Delivery system should
Be tolerated by the patient
Maintain PaO at 55 to 60 mm Hg or
2
more and SaO2 at 90% or more at the
lowest O2 concentration possible
Mobilization of secretions
Hydration and
humidification
Chest physical therapy

Airway suctioning
Effective coughing
and positioning
Augmented Cough

Fig. 68-6
Positive pressure
ventilation (PPV)
Noninvasive
PPV
BiPAP
CPAP
Drug Therapy
Relief of bronchospasm
 Bronchodilators
Reduction of airway inflammation
 Corticosteroids
Reduction of pulmonary congestion
 Diuretics, nitrates if heart failure
present
Treatment of pulmonary
infections
IV antibiotics
Reduction of severe anxiety,
pain, and agitation
Benzodiazepines
Narcotics
Nutritional Therapy
Maintain protein and
energy stores
Enteral or parenteral
nutrition
Nutritional supplements
 NURSING MANAGEMENT
Ineffective airway clearance related to expiratory airflow
obstruction
Ineffective cough as evidenced by absence of breath sounds.
Impaired gas exchange related to alveolar hypoventilation
as evidenced by Paco2 >45mmhg
Imbalanced nutrition less than body requirements related to
poor appetite lowered energy level as evidenced by weight
loss > 10% of ideal body wt.
Risk for infection related to decreased pulmonary function
possible corticosteroid therapy.
 bibliography
Smeltzer. Suzanne.C;Bare Brenda.G; “Medical surgical
Nursing” 10th edition , Lippincott Williams and Wilkins.
Page no=520-532.
Black. Joyce .M; Hawks.Jane.Hokansons;
“Medical Surgical Nursing” 7th edition. Page no= 1839-
1843.
o Grabowski.Tortora ; “principles of Anatomy and
Physiology” 10th edition John Wiley and Sons,
Inc.publishers. Page no=813-820.
www.austincc.edu/nursmods/online/.../Ch68
RespiratoryFailure.ppt
www.healthline.com/health/acute-respiratory-failure
www.nlm.nih.gov/medlineplus/respiratoryfailure.html
www.thoracic.org/education/...in.../chapter-20-
respiratory-failure.pdf
ATS journal-volume 160,page no-1079 to 1100.topic-
Corticosteroids in ARF-Michael.A.Jantz and Steven.A.Sahn.
The journal of american medical association.editorial of
27th jan 2015.page no-363-364- Sangeeta Mehta.