Respiratory Failure
Normally, human beings breathe air into the lungs and breathe our carbon (IV) Oxide as the major waste gas from the body. The air taken in is full of oxygen, and it is essential to life itself. Oxygen must pass via the lungs and into the blood before being taken to other tissues and organs for their functionality to be effective. The aspect indicates that lack of oxygen deprives the body's major organs, such as the heart, the brain, and the lungs, one of the most important factors for their functionality. Therefore, respiratory failure is a serious condition that develops when the lungs fail to get enough oxygen for the entire body (Shebl & Burns, 2018). In such cases, the condition causes the buildup of carbon (IV) oxide in the tissues causing damages and impairing the transportation of important minerals in the body. It is worth noting that acute respiratory failure occurs quickly without much warning. It is often associated with acute conditions such as pneumonia, opioid overdose, lung or spinal injury, or even stroke. Respiratory failure can also develop slowly with symptoms of shortness of breath or feeling like one can get enough air, fatigue, and inability to perform normal duties. Therefore, the condition can be determined based on the level of carbon (IV) oxide in a person's blood.
Etiology of Respiratory Failure
Respiratory failure has been associated with pulmonary or extra-pulmonary causes that include the CNS causes that occur due to depression of the neutral drive to breathe. In most cases, the condition is caused by an overdose of a narcotic or a sedative. Disorders of the peripheral nervous system may also cause respiratory failure. In most cases, the respiratory muscles and the chest walls weakness like myasthenia gravis and Guillain-Barre syndrome. The disorders affect the rate at which oxygen is inhaled in the body. Also, the obstruction of the upper and the lower airways. The obstruction mostly occurs due to various causes such as asthma, pulmonary diseases, and other chronic obstructive diseases that affect an individual's breathing rate. Also, there are abnormities of the alveoli that cause hypoxemia or acute respiratory failures, like pneumonia and pulmonary edema.
Pathophysiology
The main pathophysiologic mechanism includes hypoventilation, where the difference between the calculated oxygen pressure available in the alveolus and the arterial oxygen tension is normal (Stukas et al 2020). The aspect causes the depression of the CNS, like in the case of opioid use disorder. Hypoxemia is the major cause of respiratory failure. In cases where the ratio between the oxygen that reaches the alveoli and the amount of blood that reaches the alveoli is abnormal, the amount of oxygen that reaches the tissues tends to be lowered, causing respiratory failure. There are cases where shunts occur where the alveoli are perfused but not ventilated. In such cases, despite a100 % O2 inhalation, the hypoxemia state tends to be persistent. In a shunt, the deoxygenated blood mixed with venous blood bypasses the alveoli without being oxygenated and mixes with oxygenated blood (Stukas et al 2020). The aspect cases hypoxemia or respiratory failure as most tissues are deprived of access to enough oxygen. The condition is common in atelectasis and pneumonia.
Clinical Manifestations
The clinical presentation of the condition depends on the underlying causes. Common presentations include restlessness, confusion, anxiety, loss of consciousness, and tachycardia. Other clinical manifestations of the condition include dyspnea and cyanosis of the central nervous systems (Vuillard et al. 2018). The respiratory failure victim may experience some warmth in the extremities, papilledema, headaches, and behavioral change. Other symptoms of the condition include fever, cough, and sputum production. Chest pains are also common in case the failure is due to pneumonia. One may also experience wheezing that suggests the obstruction of the airway. Elevated jugular venous pressure is also common among victims of respiratory failure.
At least all the body organs depend on oxygen to perform properly. For instance, the lungs depend on oxygen to be effective in its role of enhancing gaseous exchange. The heart must be well ventilated to pump blood to the lowest extremities (Shebl & Burns, 2018). Also, the brain cannot function for more than four minutes without proper ventilation. The aspect indicates that respiratory failure affects the entire body as one organ's functionality depends on the effectiveness of the other. If the lungs fail, the heart fails to pump blood to major body organs such as the brain and the liver, toxic accumulate in the body, and in the long run, the victim may succumb to hypoxia.
Respiratory Diagnostic Tests
Evaluation of arterial blood gases is critical in measuring the oxygen and carbon (IV) oxide in the blood. Renal function and liver function tests can be utilized to explore respiratory failure's etiology or identify complications associated with it. The pulmonary function test is critical in identifying obstruction, gas diffusion abnormalities, and restriction. It is worth noting that the normal values for forced expiratory volume and forced vital capacity suggest a respiratory control disturbance. Electrocardiography is also critical in identifying the level of respiratory failure in a victim. Also, chest radiography is critical in detecting chest wall walls, lung parenchymal, and pleural lesions. Other critical investigations include complete blood count, sputum examination, blood and urine culture, echocardiography, bronchoscopy, and blood electrolytes, let alone thyroid function tests.
Management
Supportive measures depend on airway management and correction of blood gas abnormalities. The major goal of management is to maintain adequate tissue oxygenation in the entire body. It is worth noting that un-controlled oxygen supplementation can result in oxygen toxicity and carbon (IV) oxide narcosis. Therefore, oxygen concentration should be adjusted at the lowest level, which is sufficient for tissue oxygenation (Rochwerg et al. 2019). In nursing care facilities, oxygen can be delivered by several routes that include a nasal cannula, simple face mask, or high flow nasal cannula. Respiratory acidosis may be achieved through ventilator support or treating the underlying cause. There are extreme cases that require ICU stays for extended periods. Physiotherapy intervention is critical in maximizing the ventilator system and improve the quality of life. Mechanically ventilated patients have been shown to improve the quality of life and prevent ICU-associated complications such as ventilator dependency and respiratory conditions. It is worth noting that timely physical therapy interventions may improve gaseous exchange and reverse pathological progression, thereby avoiding ventilation dependency.
Positioning is critical in improving the ventilation of a victim of respiratory failure. Studies have indicated that the right positioning results in oxygenation for 50-90% of patients with severe acute respiratory failure. Side-lying is critical in improving the aeration through increased volumes of gases among patients with unilateral diseases. The art of putting the head at a 45 degrees upward position serves to prevent the risk of gastro esophageal reflux and aspiration. Up-right positioning is critical in improving the lung's volumes and decrease the work of breathing in patients who are being weaned from any form of a mechanical ventilator. There are cases where postural drainage uses gravitational effects in facilitating mucociliary clearance. Suctions may also be used to clear airways. The active cycle of breathing is also critical in clearing the mucus membrane causing airways blockage. There are cases where patients are advised to have limb exercises to optimize the oxygen support and reduce the effects of immobility on respiration. Also, inspiratory muscle training is key in improving the muscle strength required to support mechanical ventilation. Early mobilization is also critical in improving the function and the mobility of quality of life.
Conclusions
Respiratory failure is among the conditions that cause sudden death. The aspect is linked to the fact that respiratory obstruction prevents effective gaseous exchange hence causing the accumulation of toxins that depends on oxygen to be eliminated. Also, organs such as the heart and the brain depend on oxygen to be effective. Therefore, any condition that deprives these organs of oxygen strikes their failure. Physicians suggest a regular check-up among potential victims to evaluate the level of gases in the blood. Effective management of respiratory failure aims to improve the respiratory aspects and remedy any intervening cause of the failure. Positioning is also critical in clearing airway blockages and improving the respiratory strength required in leading a healthy life.
References
Rochwerg, B., Granton, D., Wang, D. X., Helviz, Y., Einav, S., Frat, J. P., ... & Burns, K. (2019). High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive care medicine, 45(5), 563-572.
Shebl, E., & Burns, B. (2018). Respiratory failure.
Stukas, S., Hoiland, R. L., Cooper, J., Thiara, S., Griesdale, D. E., Thomas, A. D., ... & Sekhon, M. S. (2020). The association of inflammatory cytokines in the pulmonary pathophysiology of respiratory failure in critically ill patients with coronavirus disease 2019. Critical care explorations, 2(9).
Vuillard, C., de Chambrun, M. P., De Prost, N., Guérin, C., Schmidt, M., Dargent, A., ... & Contou, D. (2018). Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrospective study. Annals of intensive care, 8(1), 1-12.
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