Category: Critical Care Nursing Securing airway patency is the first step in the management of acute respiratory failure. This usually requires interventions such as positioning, suctioning of secretions, treatment with bronchodilators and/or placement of an oral airway.
Category: Critical Care Nursing Arterial blood gas (ABG) analysis should be obtained in all patients with suspected acute respiratory failure. The ABG helps determine the chronicity of the respiratory failure and more importantly, the extent and severity of the acute respiratory failure.
Category: Critical Care Nursing High-demand respiratory failure is related to an inability of normal or relatively normal lungs to keep up with increased ventilatory demands associated with systemic hypermetabolism (e.g., secondary to sepsis).
Category: Critical Care Nursing Perioperative respiratory failure is related to atelectasis of the lung. It is often a consequence of abnormal abdominal and chest wall mechanics in the setting of surgery or trauma, especially by intrapleural or subdiaphragmatic pathologies.
Category: Critical Care Nursing Hypercarbic respiratory failure (PaCO2 >45 mm Hg) represents the failure of the lungs to remove a sufficient amount of CO2 in a given time interval and is characterized by decreased alveolar minute ventilation.
Category: Critical Care Nursing Acute respiratory failure can originate in one of three dysfunctions: (1) inadequately oxygenated alveoli; (2) compromised transition of oxygen from the alveoli to the blood or (3) compromised ability of the blood to oxygenate.
Category: Critical Care Nursing Respiratory failure can be classified as acute or chronic. Acute on chronic respiratory failure represents an acute deterioration in the presence of preexisting chronic pulmonary disease and chronic respiratory dysfunction.
Category: Critical Care Nursing Acute respiratory failure is defined by severe impairment of pulmonary gas exchange and is characterized by the inability of the lungs to meet the body’s metabolic needs for the transport of oxygen and/or removal of carbon dioxide.
Category: Critical Care Nursing The first action to increase PaO2 is to increase the FiO2. If the response is unsatisfactory, one can consider increasing the flow rate of supplemental oxygen or using a mask with an oxygen reservoir (i.e., nonrebreather mask).
Category: Critical Care Nursing A decrease in the oxygen saturation of mixed venous blood (SvO2) can contribute to the severity of hypoxemia. This is usually because of inadequate cardiac output, anemia or increased oxygen consumption by body tissues.
Category: Critical Care Nursing Ventilation/perfusion (V/Q) mismatch is the most common cause of hypoxemia and arises when perfusion is maintained in regions that are no longer participating effectively in gas exchange: for example, atelectasis, pneumonia or lung edema.
Category: Critical Care Nursing One issue with pulse oximetry, notably in critically ill patients, is that it takes many seconds for the SpO2 to reflect acute changes in PaO2, including those occurring due to alterations of oxygen administration and/or positive end-expiratory pressure.
Category: Critical Care Nursing Although PaO2 reflects pulmonary function, it must be related to FiO2 when judging oxygenating efficiency. The PaO2/FiO2 ratio is one indicator commonly employed for that purpose and is used to assess lung function.
Category: Critical Care Nursing Moderate hypoxemia must be compensated for by an increase in cardiac output. When that compensatory mechanism is exhausted or when there is concurrent anemia, hypoxia can develop and result in multiple organ failure and cardiac arrest.
Category: Critical Care Nursing Hypoxemia is almost always the result of respiratory failure, but it can also be the result of cardiac abnormalities. A low cardiac output can aggravate hypoxemia via a reduction in oxygen saturation of the mixed venous blood (SvO2).
