Respiratory Failure (Acute, Chronic, Failure to Wean)

Definition/Etiology:

• What is happening?
  • Patient not breathing (well)
• Causes
  • Respiratory distress
  • ARDS
  • Pneumonia

Pathophysiology:

• Depends on cause
• Inability of lungs to get oxygen to the blood

Noticing: Assessment & Recognizing Cues:

• S/S of respiratory failure
  • Increased RR
  • Increased work of breathing
  • Cessation of breathing
  • Declining SpO2
  • Delayed cap refill
  • change in LOC, panic
• Like respiratory distress: arterial blood gas
  • *Respiratory acidosis (most common)
  • Respiratory alkalosis
  • Metabolic acidosis
  • Metabolic alkalosis 

Interpreting: Analyzing & Planning:

• Intubation options – collaborative endeavor 
• Endotracheal tube
  • Sedation
  • End-tidal CO2 (placement)
  • *oral care*
• Tracheostomy tube
  • Less sedation
  • Cuff inflated on vent
  • *oral/trach care*

Responding: Patient Interventions & Taking Action:

• Mechanical ventilation management
  • RR
  • FiO2 (%)
  • Positive-End Expiratory Pressure (PEEP)
• Mode
  • Assist Control (AC)
  • Synchronized intermittent mandatory ventilation (SIMV)
  • Pressure-support ventilation (PSV)
• Complications
  • Infections 
  • Barotrauma
  • Pneumothorax
  • Increased Intrathoracic pressure

*Breath for the patient*-bag them!

Reflecting: Evaluating Patient Outcomes:

• Promote weaning (lungs get lazy!) collaborative with med team, RT, etc. Follow facility decision-making protocol
  • Get off AC mode
  • Decrease vent support
  • Decrease sedation
  • Downgrade to trach (long-term)
  • Breathing trials (trach collar)

Linchpins (Key Points):

• Don’t use it,  Lose it
• (Lungs get lazy fast)
  • Recognize = impending or actual resp failure
  • Intubate= with ET/trach
  • Ventilate = ventilator modes and settings
  • Wean quickly = lungs get lazy fast