| 1 - Definition: |
| Acute Respiratory Failure (ARF) is characterized as an acute
functional disorder caused by the inability of the respiratory system
to maintain the need for ventilation/oxygenation, with severe problems
in the hematosis process. |
| |
| 2 - Classification: |
| |
| 2.1 - Acute Hypoxemic Respiratory Failure: |
| Condition that can strongly reduce the arterial oxygen tension.
Results from disorders in the relation between alveolar ventilation
and perfusion, characterized in gasometric terms as hypoxemia without
retention of CO2. |
| |
| 2.2 - Acute Hypercapnic-Hypoxic Respiratory Failure/Acute Ventilatory
Failure: |
| Condition in which the elimination of CO2 is
inappropriate. Results from alveolar hypoventilation, characterized in
gasometric terms as hypoxemia associated with increased
PaCO2. |
| |
| 3 - Causes of acute respiratory failure: |
| |
| 3.1 - Acute Hypoxemic Respiratory Failure: |
| • Acute lung injury. |
| • Acute respiratory distress syndrome
(ARDS). |
| • Cardiogenic pulmonary edema. |
| • Pneumonias. |
| • Pulmonary embolism. |
| |
| 3.2 - Acute Ventilatory Failure: |
| a) Disorders affecting the
respiratory stimulus: |
| •
Overdose. |
| •
Brain stem stroke. |
| b) Commitment of respiratory muscle
function: |
| •
Amyotrophic lateral sclerosis. |
| •
Guillain-Barré syndrome. |
| •
Myasthenia gravis. |
| c) Increased respiratory effort: |
| •
Asthma. |
| •
Chronic Obstructive Pulmonary Disease (COPD). |
| |
| 4 - Bases for the diagnosis: |
| The observed clinical signs and symptoms can derive from a wide range
of illnesses that can cause the ARD. |
| The clinical manifestations originate in the hypoxia and hypercapnia,
without any specific role in the acute respiratory failure diagnosis.
Therefore, for the sake of an early and precise diagnosis of ARD,
gasometric analysis of the arterial blood is needed. |
| |
| 4.1 - Guiding symptom: |
| Is a sign/symptom that allows the nurse to recompose the history of
the current disease more easily and precisely. Changes in the
respiratory frequency and/or rhythm are considered a basic finding of
acute respiratory failure and are compulsorily present in these
disorders. |
| Dyspnea: habitually observed and more relevant in Acute Respiratory
Failure. |
| |
| 4.2 - Signs of alert: |
| Together with the dyspnea, the manifestation of two or more
signs/symptoms determines the presence of acute respiratory
disorder. |
| |
| 4.3 - Sign of gravity: |
| Indicates worsening of the ARD: |
| Cyanosis: late manifestation, considered important in the assessment
of the ARD, can indicate increased hypoxemia (PaO2 < 50
mmHg). |
| |
| 5 - Objectives of the intervention in cases of ARD: |
| Correct the underlying cause and restore appropriate gas exchange
through four methods: |
| |
| 6 - Nursing interventions in cases of ARD: |
| The treatment can include pharmacological measures, physical and
psychosocial techniques and oxygen therapy. |
| Some tasks require the intervention of other professionals, demanding
joint monitoring by the health team involved in care delivery to ARD
clients. |
| • Airway maintenance and
permeability. |
| • Mobilization of secretions. |
| • Promotion of chest
expandability. |
| • Oxygen therapy. |
| |
| 6.1 - Maintenance of airway permeability and clearance: |
| • Coughing technique - maintenance of
airway permeability. |
| • Oropharyngeal/nasopharyngeal and/or
orotracheal/nasotracheal aspiration. |
| • Invasive ventilatory support to
correct ARD if necessary. |
| |
| 6.2 - Mobilization of secretions: |
| • Hydration - maintain normal
mucociliary transport. |
| • Humidification - fluidize and
mobilize pulmonary secretions. |
| • Nebulization - improve the cleaning
of pulmonary secretions. |
| • Postural drainage. |
| |
| 6.3 - Promotion of chest expandability: |
| • Position change - reduce
respiratory difficulty, facilitate chest expandability and
mobilization of pulmonary secretions. |
| • Appropriate ventilatory support -
promote alveolar recruitment, facilitate chest expandability. |
| |
| 6.4 - Maintenance and promotion of oxygenation: |
| • Oxygen therapy - use of facial
mask. |
| • Position change - reduces
ventilatory/respiratory difficulty. |
