Acute respiratory failure  Pursed-lip breathing

Overview  Nasal flaring

 Inadequate ventilation resulting from the inability of the lungs to  Ashen skin
adequately maintain arterial oxygenation or eliminate carbon  Rapid breathing
dioxide
 Cold, clammy skin
Pathophysiology
 Asymmetrical chest movement
 Primarily hypercapnic respiratory failure: Results from
inadequate alveolar  Decreased tactile fremitus over obstructed bronchi or a pleural
ventilation effusion
 Primarily hypoxemic respiratory failure: Results from inadequate  Increased tactile fremitus over consolidated lung tissue
exchange  Hyperresonance
of oxygen between the alveoli and capillaries
 Diminished or absent breath sounds
 Combined hypercapnic and hypoxemic respiratory failure
common  Wheezes (in asthma)
Causes  Rhonchi (in bronchitis)
 Accumulated secretions secondary to cough suppression  Crackles (in pulmonary edema)
 Airway irritants Diagnostic test results
 Any condition that increases the work of breathing and decreases Laboratory
the
respiratory drive of patients with chronic obstructive pulmonary
 ABG analysis reveals hypercapnia and hypoxemia.
disease  Serum white blood cell count is increased in bacterial infections.
 Bronchospasm  Serum hemoglobin and hematocrit show decreased oxygen-
carrying
 Central nervous system depression capacity.
 Endocrine or metabolic disorders  Serum electrolyte results reveal hypokalemia and hypochloremia.
 Gas exchange failure  Blood cultures, Gram stain, and sputum cultures show the
 Heart failure pathogen. (See
Identifying respiratory failure.)
 Myocardial infarction (MI)
Imaging
 Pulmonary emboli
 Chest X-rays may show underlying pulmonary diseases or
 Respiratory tract infection conditions, such
 Thoracic abnormalities as emphysema, atelectasis, lesions, pneumothorax, infiltrates, and
effusions.
 Ventilatory failure Diagnostic procedures
Incidence
 Electrocardiography may show arrhythmias, cor pulmonale, or
 Acute respiratory failure occurs in patients with hypercapnia or myocardial
hypoxemia. ischemia.
 The disorder occurs in patients who have an acute deterioration  Pulse oximetry may show decreased arterial oxygen saturation.
in arterial
blood gas (ABG) values.  Pulmonary artery catheterization may show pulmonary or
cardiovascular
Complications causes of acute respiratory failure.
 Tissue hypoxia Identifying respiratory failure
 Chronic respiratory acidosis Use these measurements to identify respiratory failure:
 Metabolic alkalosis  vital capacity less than 15 cc/kg
 Respiratory and cardiac arrest  tidal volume less than 3 cc/kg
Assessment  negative inspiratory force less than –25 cm H
History  respiratory rate more than twice the normal rate
2
Precipitating events O
 Infection  diminished partial pressure of arterial oxygen despite increased
 Accumulated pulmonary secretions secondary to cough fraction of
suppression inspired oxygen

 Trauma  elevated partial pressure of arterial carbon dioxide, with pH

lower than
 MI 7.25.
 Heart failure
 Pulmonary emboli
 Exposure to irritants (smoke or fumes)
 Myxedema
 Metabolic acidosis
Physical findings
 Cyanosis of the oral mucosa, lips, and nail beds
 Yawning and use of accessory muscles