Recognition of Impending Respiratory Failure
First Things First (assess & treat for the following):
- Respiratory failure: inadequate oxygenation and/or ventilation OR failure to protect airway
- Respiratory failure can be physiologic or mechanical
- Physiologic: infection, mental status, systemic acid–base disturbance, acute coronary syndromes, etc.
- Mechanical failure: anatomic obstruction or disruption preventing adequate gas exchange (eg, angioedema, tracheal transection, neck hematoma) OR failure of respiratory musculature (eg, neuromuscular disease, spinal trauma)
- Oxygenation: measured by SaO2 or PaO2
- Ventilation: measured by PaCO2
- ABG is test of choice; VBG correlates, but higher PCO2 threshold value
- Airway protection: gag reflex is not helpful—clinical assessment is paramount; gag reflex does not accurately predict ability to protect airway
- Despite potential appearance otherwise, trauma patients with GCS < 8 should be considered to have impeding respiratory failure
- Treat hypoxemia aggressively and early
- Rule out acute cardiac failure as cause
- Rule out toxidrome by history
- Toxicology-focused labs generally not helpful in identifying life-threatening toxidrome with respiratory failure
- Recognition of impending respiratory failure is a CLINICAL assessment
- Not done on the basis of laboratory or radiographic findings
- Findings that mandate airway management
- Significant hypoxia that does not improve with non-invasive O2 supplementation
- Expanding neck mass
- GCS 8 or less in acute trauma
- Inability to protect airway
- Anticipated worsening of clinical condition
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Last updated: April 29, 2010
"Recognition of Impending Respiratory Failure." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534185/all/Recognition_of_Impending_Respiratory_Failure.
Recognition of Impending Respiratory Failure. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534185/all/Recognition_of_Impending_Respiratory_Failure. Accessed June 7, 2023.
Recognition of Impending Respiratory Failure. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534185/all/Recognition_of_Impending_Respiratory_Failure
Recognition of Impending Respiratory Failure [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2023 June 07]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534185/all/Recognition_of_Impending_Respiratory_Failure.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Recognition of Impending Respiratory Failure ID - 534185 Y1 - 2010/04/29/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534185/all/Recognition_of_Impending_Respiratory_Failure PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -