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1

Acute Respiratory Failure (ARF) Definition

Inadequate oxygenation and ventilation

2

Hypoxemic Respiratory Failure

PaO2 < 60 mm Hg when receiving inspired O2 concentration of 60% of more,
Main problem: inadequate exchange of O2.

3

Hypercapnic Respiratory Failure

PaCO2 > 50mm Hg with acidemia
Main problem: insufficient CO2 removal

4

When do you need urgent intervention

hemodynamic instability
increased respiratory effort
Decreased LOC.

5

Early s&s of ARF

Change in mental status: restlessness, agitation, confusion (inadequate o2), morning headache and slow RR (inadequate CO2 removal).
Tachycardia
Tachypnea
Slight diaphoresis
Mild HTN

6

S&s of ARF

WOB: lying down, sitting upright, or tripod position.
Decreased ability to speak due to dyspnea
Pursed-lip breathing
Retraction of intercostal space or supraclavicular area
Use of accessory muscles
Paradoxical breathing
Auscultate breath sounds for abnormalities.

7

Most common diagnostic studies

Chest X-ray - identify possible causes
ABGs - evaluate oxygenation and ventilation status and acid-base balance.

8

ARF management

O2 therapy
Mobilize secretions
Positive pressure ventilation (PPV)
Drug therapy
Supportive Therapy

9

O2 therapy:

Administer O2 at lowest possible FIO2
Use appropriate O2 delivery device (maintain PaO2 at 60 mmHg or higher, and SaO2 at 90% higher).
O2 toxicity and absorption atelectasis can occur with high FIO2 and long exposure.

10

How to mobilize secretions

Proper positioning
Effective cough
Chest physiotherapy
Suctioning
Humidification
Hydration
Early ambulation

11

Proper positioning

Position pt. upright with HOB at least 30 degrees
Risk for aspiration or one-sided lung disorders, use side-lying position or good lung down.

12

Effective coughs

Augmented cough (quad cough)
Huff cough
Staged cough

13

Augmented cough (quad cough)

Place hands in anterolateral base of pt.'s lungs and move hand upwards during deep breathing.

14

Huff cough

Pt takes a deep breath, hold breath for 2-3 sec, exhales.
Coughs while saying huff

15

Stage cough

sitting position, breathes in and out 3-4 times through mouth, cough when bending fwd, and press pillow against diaphragm.

16

Positive pressure ventilation and 2 forms

Most useful in pts with neuromuscular problems.
CPAP and BiPAP

17

Difference btwn CPAP and BIPAP

CPAP delivers 1 level of pressure
BiPAP delivers 2 levels of pressure, must be awake, alert, stable v/s, and support spontaneous ventilation. BiPAP is most often used because it opens collapse airways and decrease shunts.

18

Drug therapy:

Corticosteroids - reduce inflammation
Bronchodilators (albuterol) - reduce bronchospasm, short acting can be given in 15-30 min intervals.
Lasix, morphine & nitroglycerin - reduce pulmonary congestion
Anti-bx- tx infection, do cultures before administering
Benzodiazepine (lorazepam) fentanyl and morphine - reduce anxiety, pain and restlessness

19

What do you need to monitor for IV corticosteroids?

Potassium levels and adrenal insufficiency

20

What do you need to monitor for drug tx of anxiety, pain and restlessness?

Monitor pain, hypoxemia, electrolyte imbalance, TBI, & drug reactions
Monitor pts for CNS, cardiac and respiratory depression, esp. non-intubated pts.