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Acute respiratory failure

Respiratory failure is a life-threatening condition in which respiratory system is unable to ensure adequate gas exchange which results in hypercapnia (insufficient elimination of carbon dioxide from the blood), hypoxaemia (insufficient oxygen supply to arterial blood) or both. In acute respiratory failure compensatory mechanisms occur − hyperventilation, tachypnoea and tachycardia. The algorithm presents possibilities of oxygen therapy and ventilatory support in a patient with severe respiratory failure. Regarding patient's clinical condition (vital signs, laboratory, physical examination) you will be able to recognize the (in)effectiveness of therapy and understand ventilation parameters such as PEEP, FiO2 and oxygen flow. Knowledge of individual methods, their limitations and settings is crucial for correct indication in a given patient.

Author: Jozef Klučka, Lucienne Michnáčová

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: respiratory failure | oxygen therapy | PEEP | lung-protective ventilation | HFNC | HFOV | ECMO

Educational evel: Undergraduate level | Graduate

Respiratory failure is a life-threatening condition in which respiratory system is unable to ensure adequate gas exchange which results in hypercapnia (insufficient elimination of carbon dioxide from the blood), hypoxaemia (insufficient oxygen supply to arterial blood) or both. In acute respiratory failure compensatory mechanisms occur − hyperventilation, tachypnoea and tachycardia. The algorithm presents possibilities of oxygen therapy and ventilatory support in a patient with severe respiratory failure. Regarding patient's clinical condition (vital signs, laboratory, physical examination) you will be able to recognize the (in)effectiveness of therapy and understand ventilation parameters such as PEEP, FiO2 and oxygen flow. Knowledge of individual methods, their limitations and settings is crucial for correct indication in a given patient.


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Review

Severe form of acute respiratory failure (ARF) together with the most severe form acute respiratory distress syndrome (ARDS) is heterogeneous and potentially life-threatening pathological conditions. Rapid diagnosis and causal resolution of the triggering factor is inevitable when influencing the prognosis of the patient. Other vital elements in the patient´s care with ARF are correctly indicated and used supportive and rescuing interventions which enable to span the most severe phase of the disease. The view of professional public on respiratory insufficiency management has been developing dynamically in recent decades. This is in virtue not only of increase in new diagnostic methods, but also of the rapid development of interventions (technologies and indications), some of which currently belong to the standard patient´s care in critical care medicine (mechanical lung ventilation, pronation), and others are aiming for it (extracorporeal membrane oxygenation). The occurrence of various ARF forms is and will continue to be on the leading position among pathological conditions in intensive care medicine. The presented algorithm is a necessary guide to the care of the patient with ARF symptoms. It logically covers all of the phases of health care from pre-hospital to hospital. It emphasizes the need for a rapid identification of the diagnosis and an early initiation of the whole spectrum of adequate supportive and causal therapy.

publikováno: 8.5.2020 | last modified on: 1.7.2020