Acute Respiratory Failure Causes, Types and Management

Write short note on Acute Respiratory Failure.

Answer. Respiratory failure is defied as failure of respiratory system to maintain normal partial pressure of oxygen and carbon dioxide in the blood.

Types Of Acute Respiratory Failure

1. Type I acute respiratory failure: In this, there is acute alteration in blood gases concentration with hypoxemia and normo­ or hypocapnia because of tachypnoea or hyperventilation.
2. Type IIacute respiratory failure: It is also known as asphyxia.
   In this, there is hypercapnia and acute respiratory acidosis.

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Causes Acute Respiratory Failure

1. Type I acute respiratory failure:

1. Acute asthma
2. Pulmonary embolism
3. Pulmonary edema.
4. Acute respiratory distress syndrome
5. Pneumothorax
6. Pneumonia

2. Type II acute respiratory failure:

1. An inhaled foreign body
2. Status asthmaticus
3. Paralysis of respiratory muscles
4. Fractured ribs
5. Brainstem ischemia
6. Overdose of narcotic drugs

Management Acute Respiratory Failure

1. Removal of underlying cause is mandatory.
2. Hospitalize the patient and treat in the respiratory intensive care unit.
3. Supervise coughing in a conscious patient and change the patient’s position from side to side which helps in clearing airway.
4. By using a rolled gauze piece clear the thick secretions in oral cavity by holding in an artery forcep.
   Secretions at back of throat or in trachea are removed by frequent secretion.
5. High concentration of oxygen is given to the patients via ventimasks to improve hypoxemia and ventilation.
   For small children oxygen tents are used.
   Oxygen therapy should be continued till patient achieve normal level of blood gases.
6. In Type II, acute respiratory failure immediate reversal of precipitating factor should be done. In cases where reversal cannot occur temporary ventilator support is required.
7. If patient get worse even after taking above­mentioned treatment, tracheostomy and endotracheal intubation is done and now the patient should be supported with intermittnt positive pressure ventilation.
8. Mucolytic agents such as bromohexine liquefy secretion.
   Acetylcystine, i.e. 1–2 mL of 20% solution is instilled via tracheostomy tube.
9. Patients suffring from acute respiratory distress syndrome can be on positive end expiratory pressure.
10. Intravenous flids and electrolyte therapy is given.
11. Underlying infection should be treated by proper antibiotics.
12. H2 blockers are given via IV drip
13. Patient should be slowly weaned from respirator as voluntary effrt is gained from ventilation as etiology is corrected.

Chronic Respiratory Failure

1. Nebulized solution of salbutamol, i.e. 2.5–5 mg 4 hourly or turbutaline 5–10 mg can also be given.
2. Bronchodilator such aminophylline is given in dose of 0.25 gm IV diluted in 10 mL of 10–25% dextrose and is injected slowly.
3. Short course of antibiotics should be given.
   Secretions should be removed by asking the patient to cough or by intermittnt endotracheal catheter suction.
4. If patient develops pulmonary edema or cor pulmonale.
5. Oxygen therapy and assisted ventilation should be given to acute on chronic Type II respiratory failure patients till patient have acceptable levels of PaO2 and PaCO2.
6. If condition of patient worsen mechanical ventilation by fied volume, ventilators is given to deliver fi volume of oxygen.
7. Ventilatory assistance is slowly withdrawn as patient returns to voluntary effort.