الفشل التنفسي الحاد

Definition

Acute respiratory failure is the inability of the respiratory system to maintain gas exchange.

Two types

• Type 1 (hypoxaemic): PaO2 below 60 with normal or low CO2, as in pneumonia, pulmonary oedema, ARDS and PE
• Type 2 (hypercapnic): PaCO2 above 50 with acidosis, as in COPD, opioid overdose, neuromuscular weakness and chest trauma

Symptoms

• Dyspnoea, tachypnoea and accessory-muscle use
• Restlessness and confusion, then drowsiness with CO2 retention
• Cyanosis, tachycardia, then bradycardia late

Diagnosis

Arterial blood gas, imaging and a search for the cause.

Treatment

• Oxygen to target (usually 94–98%, or 88–92% if at risk of CO2 retention)
• BiPAP for type 2 in an alert, cooperative client
• Intubation and ventilation if failing or consciousness falls
• Treat the cause (antibiotics, diuretics, naloxone…)

Nursing care

• Sit upright; continuous SpO2, respiratory rate and consciousness
• Blood gases after interventions
• Airway equipment ready

Exam point

New drowsiness in a COPD client on high oxygen may mean rising CO2, not rest.