acute respiratory failure


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acute respiratory failure (ARF)

Etymology: L, acutus + respirare, respiratory, fallere, to deceive
a sudden inability of the lungs to maintain normal respiratory function. The condition may be caused by an obstruction in the airways or by failure of the lungs to exchange gases in the alveoli. See respiratory failure.

a·cute res·pi·ra·to·ry fail·ure

(ARF) (ă-kyūt' res'pir-ă-tōr-ē fāl'yŭr)
Loss of pulmonary function, either acute or chronic, that results in hypoxemia or hypercarbia.

acute respiratory failure

Any impairment in oxygenation or ventilation in which the arterial oxygen tension falls below 60 mm Hg, and/or the carbon dioxide tension rises above 50 mm Hg, and the pH drops below 7.35.

Treatment

In most cases the patient will need supplemental oxygen therapy. Intubation and mechanical ventilation may be needed if the patient cannot oxygenate and ventilate adequately, i.e., if carbon dioxide retention occurs. Treatment depends on the underlying cause of the respiratory failure, e.g., bronchodilators for asthma, antibiotics for pneumonia, diuretics or vasodilators for congestive heart failure.

Patient care

Patients with acute respiratory failure are usually admitted to an acute care unit. The patient is positioned for optimal gas exchange, as well as for comfort. Supplemental oxygen is provided, but patients with chronic obstructive lung disease who retain carbon dioxide are closely monitored for adverse effects. A normothermic state is maintained to reduce the patient's oxygen demand. The patient is monitored closely for signs of respiratory arrest; lung sounds are auscultated and any deterioration in oxygen saturation immediately reported. The patient is also watched for adverse drug effects and treatment complications such as oxygen toxicity and acute respiratory distress syndrome. Vital signs are assessed frequently, and fever, tachycardia, tachypnea or bradypnea, and hypotension are reported. The electrocardiogram is monitored for arrhythmias. Serum electrolyte levels and fluid balance are monitored and steps are taken to correct and prevent imbalances. If mechanical ventilation or noninvasive support is needed, ventilator settings and inspired oxygen concentrations are adjusted based on arterial blood gas results. See: ventilation To maintain a patent airway, the trachea is suctioned after oxygenation as necessary, and humidification is provided to help loosen and liquefy secretions. Secretions are collected as needed for culture and sensitivity testing. Sterile technique during suctioning and change of ventilator tubing helps to prevent infection. Use of the minimal leak technique for endotracheal tube cuff inflation helps prevent tracheal erosion. Positioning the nasoendotracheal tube midline within the nostril, avoiding excessive tube movement, and providing adequate support for ventilator tubing all help to prevent nasal and endotracheal tissue necrosis. Periodically loosening the securing tapes and supports prevents skin irritation and breakdown. The patient is assessed for complications of mechanical ventilation, including reduced cardiac output, pneumothorax or other barotrauma, increased pulmonary vascular resistance, diminished urine output, increased intracranial pressure, and gastrointestinal bleeding.

All tests, procedures, and treatments should be explained to the patient and family to improve understanding and help reduce anxiety. Rationales for such measures should be presented, and concerns elicited and answered. If the patient is intubated (or has had a tracheostomy), the patient should be told why speech is not possible and should be taught how to use alternative methods to communicate needs, wishes, and concerns to health care staff and family members.

See also: failure
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