Definition

Types
Causes
Clinical features
Pathophysiology
Diagnosis
Nursing management

PHYSIOLOGY

RESPIRATORY FAILURE
inability

of the lung to meet the metabolic

demands of the body. This can be from failure of
tissue oxygenation and/or failure of CO 2
homeostasis.
Clinically:
Respiratory failure is defined as
PaO 2 <60 mmHg while breathing air, or a PaCO 2
>50 mmHg

TYPES OF RESPIRATORY
FAILURE
Type
1(Hypoxemic RF)

Pao2
<60mmhg

Type 2(Hypercapnic RF)

Paco2>50m
mhg

TYPE 1 RESPIRATORY FAILURE

(HYPOXEMIC)
The

failure of the lung and heart to provide adequate oxygen to

meet metabolic needs.

Known

as lung failure, oxygenation failure, respiratory

insufficiency.

PaO2

<60mmHg with normal or low PaCO2.

Most common form of respiratory failure.

Causes of hypoxemic respiratory

failure
Acute asthma
ARDS
Pulmonary fibrosis
Pulmonary edema
Pneumonia
COPD (most common cause)
Pulmonary embolism
Decreased cardiac output

PATHOPHYSIOLOGY
Ventilation/ perfusion mismatch(V/Q)
Shunting

Diffusion limitation
Alveolar hypoventilation

Hypercapnic Respiratory Failure

(Type II)
It

is known as pump failure

The

failure of lung to eliminate adequate CO2

PaCO2

>50 mmHg

Hypoxemia

is always present

Causes of Hypercapnic Respiratory failure

Upper airway obstructions: tumor, foreign body,
laryngeal edema.
Airway disorder: severe asthma, COPD
CNS: drug overdose, brainstem injury, severe head injury.
Chest wall: thoracic trauma, morbid obesity, pleural
effusion.
Neuromuscular disease: myasthenia gravis, poliomyelitis,
ALS (Amyotrophic lateral Sclerosis) Guillain Bare
syndrome, multiple sclerosis.

Pathophysiology of Hypercapnic
respiratory failure

Clinical and Laboratory Manifestation

Rstlesness, fatigue, headache (HA)
Dyspnea
Tachypnea(Hypoxemic)
Bradypnea (Hypercapnic)
Orthopnea / Tripod position
Mild hypertension
Paradoxical

breathing

Later: Confusion, somnolence, cyanosis and coma

Convulsions

Mnemonics for clinical feature

DIAGNOSIS
History

and physical examination

ABG
Chest x-ray (pneumonia, atelectasis)
CBC
CMP (comprehensive metabolic panel)
Sputum culture
Blood culture
Serum electrolytes
EKG

Management of Respiratory Failure

Principles
Hypoxemia

may cause death in RF

Primary objective is to reverse and prevent
hypoxemia
Secondary objective is to control PaCO2 and
respiratory acidosis
Treatment of underlying disease
Patients CNS and CVS must be monitored and
treated

Plan and interventions

Plan/ goal:
- To maintain adequate oxygenation and ventilation
Administer oxygen:
- delivery method (nasal, mask, mechanical ventilation)
Mobilize pulmonary secretions:
- effective coughing
- adequate hydration and humidification
- chest physical therapy
- Proper positioning (high fowlers)
- Tracheal suctioning

Contd
Medication Use:
- Bronchodilators
- Corticosteroids to decrease inflammation.
- Diuretics, nitroglycerine, opioids to decrease pulmonary
congestion
- Antibiotics
- Sedations and analgesic to decrease anxiety, agitation
and pain.
- Sodium bicarbonate for metabolic acidosis

Contd
If measure fails to improve oxygenation and
ventillation:
Positive pressure ventilation is necessary
Endotracheal intubation

Evaluation: Desired outcome

Clients has adequate oxygenation and ventilation
Decrease in work of breathing
ABG within normal
Breath sounds clear (absence of crackle or rhonchi)
Oxygen saturation >92%
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