Respiratory Failure - Clinical

Question 1

What are the clinical features of hypoxia and hypercapnia (respiratory failure) not including those of the underlying condition?

Answer 1

• Confusion
• Cyanosis
• Somnolence/drowsiness
• Dyspnoea (more common in hypercapnia)

Question 2

What underlying clinical conditions lead to respiratory failure?

Answer 2

• COPD
• Pneumonia
• Pulmonary oedema → cardiogenic and non-cardiogenic
• PE
• Pulmonary fibrosis
• Asthma

Question 3

How do you assess respiratory failure?

Answer 3

1) ABC
2) Assess vital signs (temp, RR, HR, BP)
3) Oxyhaemoglobin saturation
4) ABG analysis → to diagnose hypercapnia bc can’t pick this up from saturations

Question 4

How do you do an ABG?

Answer 4

With local anaesthetic/lidocaine bc it is quite painful

Question 5

Above what SpO2 is hypoxia excluded?

Answer 5

> 92%

Question 6

What is oxygen not?

Answer 6

Ventilation

Question 7

How do you treat manage respiratory failure?

Answer 7

• Treat underlying condition
• Give oxygen if hypoxic (hypoxia kills)
• Ventilation

Question 8

What are the targets when giving titrated oxygen?

Answer 8

SpO2 94-98% (88-92% if chronic respiratory failure)

Question 9

When can giving oxygen benefit the patient even if they are not hypoxic?

Answer 9

When the patient has CO poisoning or the bends

Question 10

What might happen if you give oxygen to someone who is hypercapnic?

Answer 10

It may worsen the hypercapnia

so ventilate instead

Question 11

What are the two types of ventilation?

Answer 11

1) Non-invasive ventilation (NIV)

2) Invasive mechanical ventilation (IMV) i.e. endotracheal intubation

Question 12

Describe non-invasive ventilation (NIV)

Answer 12

• Via a mask
• Supplies a fixed pressure or fixed volume to increase ventilation
• Improves patient outcomes → supplies supportive care without intubating the patient
• Doesn’t have the risks of infection and sedation

Question 13

Describe invasive ventilation

Answer 13

• Endotracheal tube is the method of ventilation
• Needs sedation, impairs the ability to remove secretions
• Control degree of harm with this method

Question 14

What are the benefits of NIV?

Answer 14

• Patient remains conscious
• Maintains structural host defence system
• Level 2 support → lower level of support in hospital
• Evidence based in COPD and immunosuppressed

Question 15

What are the benefits of IMV?

Answer 15

• Greater control of ventilation → applying pressure/volume directly to the lower respiratory tract
• Secure ventilatory delivery
• Gold standard treatment for patients with refractory respiratory failure

Question 16

What are the negatives of IMV?

Answer 16

• Need level 3 support (required critical care bed)

- Risks of infection and sedation

Question 17

When can’t you ventilate or oxygenate patients and why?

Answer 17

• If the lungs are filled with fluid
• If try to ventilate, the patient needs a v high amount of oxygen and high pressure which damages the lungs as oxygen produces free radicals

Question 18

What do you used to manage severe respiratory failure when you can’t ventilate or oxygenate?

Answer 18

ECMO (prevents iatrogenic harm)

Question 19

How does ECMO work?

Answer 19

Does the job of the lungs without using the lungs

• Removes blood from circulation
• Replaces oxygen and removes CO2
• Returns the blood to venous circulation

Question 20

What does ECMO require?

Answer 20

Anti-coagulation

Question 21

What is the benefit of ECMO?

Answer 21

Allows the lungs to be protected

Question 22

What do you need to consider when ventilating or oxygenating?

Answer 22

Need to titrate oxygen/ventilation to the level of hypoxia/hypercapnia

Question 23

How do you treat hypercapnia?

Answer 23

Ventilation

Question 24

How do you treat hypoxia?

Answer 24

Oxygen