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Recognition of Impending Respiratory Failure

Recognition of Impending Respiratory Failure is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following):

  • Definition
    • 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
  • Identification
    • 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

Citation

"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 April 20, 2019.
Recognition of Impending Respiratory Failure. (2010). In Pocket ICU Management. Available from 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 2019 April 20]. 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 -