Respiratory Failure

Respiratory failure is the inability of the respiratory system to maintain normal blood oxygenation (PaO2), elimination of carbon dioxide (PaCO2) and pH Adequate ventilation problem caused by diffusion or perfusion.
Respiratory failure is inadequate gas exchange to hypoxia, hypercapnia (increased arterial carbon dioxide concentration), and acidosis.
Respiratory failure occurs when the exchange of O2 to CO2 in the lungs can not maintain the rate of O2 consumption and CO2 formation in the body's cells causing pO2 <> 2> 45 mmHg (hypercapnia) (Smeltzer, C Susane, 2001)


Causes / Etiology
1. The central nervous system depression

Resulting in respiratory failure due to inadequate ventilation. Respiratory centers that control breathing, located below the brain stem (pons and medulla) so slow and shallow breathing.

2. Primary neurological disorder

May hamper respiratory function. Impulses arising in the respiratory center spreads through the nerves that extend from the brainstem to the spinal nerves continue to receptors on the respiratory muscles. Diseases of the nervous disorders such as spinal cord, the muscles of respiration or neuromuslular meeting that occurs on breathing will greatly affect ventilation.

3. Pleural effusion, Pneumothorax and Hemothorax

It is a condition that interferes with ventilation through the inhibition of lung expansion. This condition is usually caused by defect underlying lung, pleural disease or trauma and injury and can cause respiratory failure.

4. Trauma

Caused by motor vehicles can be a cause of respiratory failure. Accidents resulting in head injuries, unconscious and bleeding from the nose and mouth can lead to upper airway obstruction and respiratory depression. Hemothorax, Pneumothorax and rib fractures may occur and possibly causing respiratory failure. Flail chest may occur and can lead to respiratory failure. The treatment is to correct the underlying pathology.

5. Acute pulmonary disease

Pneumonia caused by bacteria and viruses. Bronchial asthma, Atelectasis,Pulmonary embolism and pulmonary edema are some other conditions that cause respiratory failure.

Signs and Symptoms
Sign
a. Failed total breath

• The flow of air in the mouth, the nose is not heard / felt
• In spontaneous breathing movements supra visible retraction between the ribs and clavicles and no development of the chest on inspiration

b. Partial failure of breath

• The sound of gargling extra breathing, snoring, growing and wheezing
• There is a chest retraction

Symptoms
a. Hypercapnia is an increase in CO2 levels in the body more than 45 mmHg
b. Hypoxaemia occurs tachycardia, restlessness, sweating or cyanosis or decreased pO2

Pathophysiology
Breath failed there are two kinds of acute respiratory failure and chronic respiratory failure in which each individual has a sense of bebrbeda. Acute respiratory failure is failing breath that arise in patients whose lungs are structurally and functionally normal before disease arises. While chronic respiratory failure is occurring in patients with chronic lung diseases such as chronic bronchitis, emphysema and black lung disease (disease of coal miners.) Patients experiencing tolerance to hypoxemia and hypercapnia that worsens gradually. Acute respiratory failure after lung usually re origin stage. In chronic respiratory failure structure of natural lung damage is irreversible.
Indicators of respiratory failure has been the frequency of respiratory and vital capacity, normal respiratory frequency is 16-20 times/mnt. When more than 20x/mnt action taken to give a ventilator because of "breathing work" to be high so that the resulting fatigue. Vital capacity is a measure of ventilation (normal 10-20 ml / kg).
Failed breath is the most important causes of inadequate ventilation where there is upper airway obstruction. Respiratory centers that control breathing are located below the brain stem (pons and medulla). In the case of patients under anesthesia, head injury, stroke, brain tumors, encephalitis, meningitis, hypoxemia and hypercapnia have the ability to suppress the respiratory center. So that breathing becomes slow and shallow. In the postoperative period with anesthesia can occur breathing is inadequate because there are agents that suppress breathing to the effect issued or to enhance the analgesic effect of opiad. Pneumonia or lung disease can lead to acute respiratory failure.

Examination Supports
a. Examination of arterial blood gases

Hypoxemia
Lightweight: PaO2 <80 mmHg
Medium: PaO2 <60 mmHg
Weight: PaO2 <40 mmHg
Examination of arterial blood gases is important to determine the presence of respiratory acidosis and respiratory alkalosis, as well as to determine whether the client is experiencing metabolic acidosis and metabolic alkalosis or both on a client who had long suffered respiratory failure. In addition, this examination is also very important to know and evaluate the progress of oxygenation therapy or treatment given to the client.

b. Chest X-ray examination

Based on the photo thoracic PA / AP and lateral fluoroscopy as well as data obtained will be many such as the occurrence of hyperinflation, pneumothorax, pleural effusion, and lung tumors.

c. Measurement of lung function

The use of spirometers can make us determine if there is obstructive pulmonary disorder.
d. ECG

The existence of pulmonary hypertension can be seen on the ECG is characterized by elevated P wave changes in leads II, III, and aVF, as well as an experienced cardiac right ventricular hypertrophy. Ischemia and cardiac arrhythmias are common in disorders of ventilation and oxygenation.

e. Sputum examination

Noteworthy is the color, odor, and consistency. If it is necessary to culture and sensitivity test against germs that cause. If there is found the blood lines in sputum (blood strekaed), probably caused by bronchitis, bronchiectasis, pneumonia, pulmonary tuberculosis, and malignancy. Sputum pink and frothy may be due to pulmonary edema. For a lot of sputum containing blood, the more often a sign of pulmonary or lung malignancy.

 Treatment

• Oxygen therapy. Low velocity oxygen delivery: Venturi mask or nasal prong
• Mechanical ventilator with continuous positive airway pressure (CPAP) or PEEP
• Inhalation nebulizer
• Chest physiotherapy
• Monitoring of hemodynamic / cardiac
• Drugs: Brokhodilator and Steroids
• Nutritional support as needed

The principle of handling Respiratory Failure

1. Secretions are not detained (ineffective cough): adequate hydration, expectorant, aerosols, assisted cough, aspiration with a catheter, suction bronchoscopy, aspiration with endotracheal tubes.
2. Hypoxemia: is oxygen therapy gradually with frequent blood gas monitoring.
3. Hypercapnia: Respiratory stimulation (drug overdose), avoid sedation, artificial ventilation through the ET tube.
4. Respiratory tract infections: Antibiotics, given preferably after culture results are obtained and the test sensitivity to germs that cause.
5. Bronchospasm: bronchodilator drugs.

Tags : Respiratory Failure, Acute Respiratory Failure, Type Respiratory Failure, Respiratory Heart Failure, Chronic Respiratory Failure, Respiratory Failure Symptoms, Hypercapnic, Hypercapnic Respiratory Failure, Respiratory Distress