Respiratory Muscle Dysfunction

First Things First (assess & treat for the following)

  • Is pt able to adequately ventilate?
    • Spontaneously breathing pt should be intubated if
      • New or worsening respiratory acidosis
      • Unable to handle respiratory secretions
      • Increased & unsustainable work of breathing: rapid shallow breathing, tachycardia, accessory muscle use, abdominal paradox
    • Mechanically ventilated pt should have weaning trial interrupted or ventilatory support otherwise increased if
      • Tachypnea
      • Diminishing tidal volume on spontaneous breaths
      • Tachycardia otherwise unexplained
      • Hypoxia & respiratory acidosis late signs
  • Is there a reversible explanation for apparent weakness?
    • Receiving narcotics, benzodiazepines, other sedatives
    • Presence of any focal neuro abnormalities warrants urgent evaluation for new CNS injury or insult.
    • Electrolyte, calcium, magnesium, or phosphorus deficiency
    • Rule out causes of increased minute ventilation due to increased CO2 production (sepsis, fever, overfeeding carbohydrates) or increased dead space.

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: April 30, 2010