Acute Respiratory Failure

Acute Respiratory Failure (ARF): - This disorder occurs when the lungs no longer meet the body's metabolic needs.  It isn't easily defined because it has many causes and variable clinical presentation.

Cause:  Acute respiratory failure may develop in patients with Chronic obstruction pulmonary disease (COPD ) from any condition that increases the work of breathing and decreases the respiratory drive.  Conditions includes:  respiratory tract infection, bronchospasm, or accumulating secretions secondary t cough suppression.   Other causes of ARF in COPD include:

Central nervous system (CNS) depression - head trauma or injudicious use of sedatives, narcotics, tranquilizers, or oxygen
Cardiovascular disorders - myocardial infarction (MI), congestive heart failure (CHF), or pulmonary emboli
Airway irritants - smoke or fumes
Endocrine and metabolic disorders - myxedema or metabolic alkalosis
Thoracic abnormalities - chest trauma, pneumothorax, or thoracic or abdominal surgery.

Symptoms:

In COPD patients with ARF: hypoxemia (deficient oxygenation of the blood) and acidemia affect all body organs.

Altered respirations. Rate may be increased, decreased, or normal; respirations may be shallow, deep, or alternate between the two. Cyanosis may or may not be present. Auscultation of the chest may reveal crackles, rhonchi, wheezes, or diminished breath sounds.

Altered mentation. The patient show evidence of restlessness, confusion, loss of concentration, irritability, tremulousness, diminished tendon reflexes, and papilledema.

Cardiac dysrhythmias. Tachycardia (rapid heart rate), with increased cardiac output and mildly elevated blood pressure secondary to adrenal release of catecholamine, occurs early in response to low PaO2 (oxygen level). With myocardial hypoxia, dysrhythmias may develop. Pulmonary hypertension also occurs.

Treatment:

Antibiotic for infection

Bronchodilators

Steroids

In COPD patients, ARF is an emergency that requires cautious oxygen therapy

In significant respiratory acidosis persists, mechanical ventilation through an endotracheal or a tracheostomy tube may be necessary

High - frequency ventilation may be used if the patient doesn't respond to conventional mechanical ventilation

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