Mr. Husain Nadaf, Tutor

1. Acute
Respiratory
Failure

2. INTRODUCTION
When you breathe, air passes through your nose and mouth
into your windpipe. The air then travels to your lungs' air sacs.
These sacs are called alveoli
Small blood vessels called capillaries run through the walls of
the air sacs.
When air reaches the air sacs, the oxygen in the air passes
through the air sac walls into the blood in the capillaries. At the
same time, carbon dioxide moves from the capillaries into the
air sacs. This process is called gas exchange.
• In respiratory failure, gas exchange is impaired.

3. DEFINITION
Acute respiratory failure (ARF) is defined as a fall in arterial
oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia)
and a rise in arterial carbon dioxide tension (PaCO2) to greater
than50 mm Hg (hypercapnia), with an arterial pH of less than
7.35. leading to:-
• Alveolar hypoventilation
• Diffusion abnormalities
• Ventilation–perfusion mismatching
• Shunting

5. TYPES
• When respiratory failure causes a low level of oxygen in the
blood, it's called hypoxemic respiratory failure.
• When respiratory failure causes a high level of carbon
dioxide in the blood, it's called hypercapnic respiratory
failure.
• Acute & Chronic or both

6. ETIOLOGY
• Conditions that affect the nerves and muscles that control
breathing. Examples include muscular dystrophy,
amyotrophic lateral sclerosis (ALS), spinal cord injuries,
and stroke.
• Damage to the tissues and ribs around the lungs. An injury to
the chest can cause this damage.
• Problems with the spine, such as scoliosis (a curve in the
spine). This condition can affect the bones and muscles used
for breathing.
• Drug or alcohol overdose. An overdose affects the area of the
brain that controls breathing. During an overdose, breathing
becomes slow and shallow.

7. • Lung diseases and conditions, such as COPD (chronic
obstructive pulmonary disease), pneumonia, ARDS (acute
respiratory distress syndrome), pulmonary embolism,
and cystic fibrosis. These diseases and conditions can affect
the flow of air and blood into and out of your lungs. ARDS
and pneumonia affect gas exchange in the air sacs.
• Acute lung injuries. For example, inhaling harmful fumes or
smoke can injure your lungs.
• Dysfunction of lung parenchyma For eg pleural effsuion

8. RISK FACTORS
• Smoke tobacco products
• Drink alcohol excessively
• A family history of respiratory disease or conditions
• Sustain an injury to the spine, brain, or chest
• Patient having a compromised immune system
• Patient having a chronic (long-term) respiratory problems,
such as cancer of the lungs, chronic obstructive pulmonary
disease (COPD), or asthma

9. CLINICAL MANIFESTATIONS
Early signs are those associated with impaired oxygenation and
may include
• Restlessness, Fatigue, headache, Dyspnea, air hunger.
Tachycardia and increased blood pressure.
As hypoxemia progresses more signs may be present such as:
• Confusion, lethargy, tachycardia, tachypnea, central cyanosis,
diaphoresis and finally respiratory arrest.
• Physical findings are those of acute respiratory distress,
including use of accessory muscles, decreased breath sounds
if the patient cannot adequately ventilate, and other findings
related specifically to the underlying disease process are the
cause of ARF.

10. DIAGNOSTIC TESTS
• History Collection
• Physical Examination – On Auscultation crackles sound.
Irregular hearbeat
• Pulse Oxymetry
• ABG – To check CO2 & O2 levels
• Chest X-Ray shows air filled sacs
• ECG – To detect arrhythmias
• Pulmonary function test

11. PHARMACOLOGICAL ‘MX’
Nitric oxide
• Nitric oxide is a potent vasodilator that can be administered
via inhalation causing pulmonary vascular relaxation. Inhaled
nitric oxide reaches the alveolus where it enters into direct
contact with the pulmonary vasculature.

12. TREATMENT
Oxygen Therapy -
Oxygen is given
through a nasal
cannula (two small
plastic tubes, or
prongs, that are
placed in both
nostrils) or through a
mask that fits over
your nose and mouth.

13. Ventilator support –
If o2 levels doesn’t
increase, patient may
land up in complications
so put the patient of
ventilator with sedation,
a ventilator. A ventilator
is a machine that
supports breathing. It
blows air—or air with
increased amounts of
oxygen—into your
airways and then your
lungs.

14. Tracheostomy -
Oxygen also can be
given through
a tracheostomy This is
a surgically made hole
that goes through the
front of your neck and
into your windpipe. A
breathing tube, also
called a tracheostomy
or trach tube, is
placed in the hole to
help you breathe.

15. OTHERS
• Noninvasive positive pressure ventilation (NPPV) and a
rocking bed are two methods that can help you breathe
better while you sleep. These methods are very useful for
people who have chronic respiratory failure.
• NPPV is a treatment that uses mild air pressure to keep your
airways open while you sleep.

16. Rocking bed – A
mattress on a motorized
platform that gently
rocks back and forth.
When your head rocks
down, the organs in your
abdomen and your
diaphragm slide up,
helping you exhale.
When your head rocks
up, the organs in your
abdomen and your
diaphragm slide down,
helping you inhale.

17. NURSING CONSIDERATIONS
Postioning
• The use of prone positioning, associated with reports of
improvements in oxygenation in 60 to 70% of patients with
ARF has made this therapeutic method popular. A number of
different mechanisms have been suggested to explain this
effect in patients placed in the prone position, such as an
improvement in the ventilation-perfusion relationship

18. Prevention and early diagnosis of intercurrent infections
• As ARF patients require invasive technology, such as
vascular and urinary catheters, endotracheal intubation and
mechanical ventilation for prolonged periods of time, they are
often the target of secondary infections, especially pulmonary
infections. Early diagnosis and precise treatment of these
infections is extremely important

19. Nutritional Support
• Patients with ARF have an elevated daily caloric requirement as a
function of the stress of trauma, sepsis, surgery or the inflammatory
process that accompanies the lung injury in ARDS. These patients
require prompt institution of parenteral or enteral nutrition since a
caloric deficit can result in alterations of the defense mechanisms, as
well as delay lung healing
Psychological support
• Attention must be afforded to explain to the patient (whenever
possible) and the family all the diagnostic and therapeutic procedures
and also the natural course and prognosis of the condition.

20. Monitoring of patient
• Patients with ARF routinely require an arterial catheter for continuous
arterial pressure monitoring and for obtaining serial arterial blood gas
analysis.
• A central venous catheter with two or three lumens is used for the
administration of fluids and drugs and also for continuous
measurement of the central venous pressure.
• A urinary catheter permits the precise measurement of urinary output
and control of the fluid balance.
• Continuous pulse oximetry is used for real time assessment of
oxygenation.
• Analysis of exhaled carbon dioxide curves provides a continuous data
for inferring ventilation, pulmonary perfusion and dead space.