Acute Respiratory Failure Essay

Acute respiratory failure is described as a condition where the blood does not get enough oxygen. The blood may also contain too much carbon dioxide. Organs such as the heart and brain require enough oxygenated blood to function well. Also, breathing helps in removing too much carbon dioxide from the blood. Accumulation of carbon dioxide can harm the lungs of an individual. Various conditions can cause acute respiratory failure. These include the diseases that affect the lungs, such as pneumonia, cystic fibrosis, COVID-19 19 virus, and pulmonary embolism. Muscular dystrophy, spinal cord injury, and stroke can also affect the nerves that control breathing. Spine problems such as scoliosis. This can destroy the muscles and bones, which are crucial during the breathing process(Acute Respiratory Failure – an overview | ScienceDirect Topics, n.d.). Damage can also occur in the muscles and dribs around the lungs. Drug abuse and alcohol overdose can also cause acute respiratory failure. Also, injuries caused by inhalation can cause this condition. The symptoms of acute respiratory failure depend on oxygen levels in the patient’s body. If the oxygen level is low in the blood, one may experience shortness of breath. The skin and nails may turn bluish. People with this condition may feel tired and confused. One may also have an irregular heartbeat.

Pathophysiology

The alveolar injury and damage may cause acute respiratory failure. The injury activates the release of pro-inflammatory cytokines like the tumor necrosis factor. The cytokines bring the neutrophils into the lungs and become activated may release toxic mediators(Eman Shebl & Bracken Burns, 2019). These mediators cause damages to the endothelium and the alveolar epithelium. The injuries in the capillary endothelium cause the protein to escape into the vascular space. The fluid pours into the interstitium because the oncotic gradient gets lost. The lymphatics get overwhelmed. Regulation of the alveolar fluid is also lost. The damage in the alveolar epithelium and the high amounts of the interstitial fluid make the air spaces fill up with the edema fluid. There is also an accumulation of debris from the cells. This makes the alveolar collapse. This damage cause impairment in the gas exchange. There is also a decrease in lung compliance. This is because of the stiffness of the lungs. The air volumes exceed the lung’s capacity and cause an increase in the airway pressures.

The patients who may have a mild injury may only have interstitial edema. Severe damage may cause alveolar epithelial permeability and increase fluid filtration rates(Kaynar, 2019). This is called alveolar flooding. The alveolar flooding causes hypoxemia’s affected lung units that get flooded, contributing to the ventilation mismatch. Surfactant inactivation by alveolar fluid accumulation cause atelectasis of the alveolar units. The decrease in lung compliance is caused by alveolar edema and increased permeability. They also contribute to the workload in breathing. The accumulation of the edema fluid leads to the resistance of the airways, also contributing to the workload in breathing. Microvascular hydrostatic pressure is also another cause of fluid formation in the alveolar-capillary.

Assessment

Acute respiratory failure can be a very life-threatening condition. The accurate assessment of this condition should be critical. The general presentation of the patient suffering from this condition is vital. The patients may look anxious and very exhausted (Medline Plus, 2019). Hypoxia can change the mental state of the patient. They may seem to be confused. The skin color may look pale. The patients may look flushed from vasodilation. The airway patency should be assessed. The airway sounds are also important. Snoring may indicate that there is airway obstruction. Vibrating sounds during inhalation and exhalation may mean partial blocks. The measurement of the respiratory rate is recommended. This can be done through electronic devices, which can be unreliable. Any change in the respiratory rate should enable the nurses to know that the patient is deteriorating. Pulse oximetry is also crucial to patients suffering from respiratory failure. It involves measuring the amount of hemoglobin that is saturated with oxygen. The reliability of pulse oximeters can be questionable for cold or even shivering patients. The balance of acid-base and arterial blood can be crucial in managing patients with respiratory failure. It gives accurate information on the blood ph and oxygen and carbon dioxide levels. The assessment of the chest patters is also crucial. Recession may be an indication of rib breakage decrease in the movement of one side may be due to pneumothorax.

Management

Th management of acute respiratory failure includes the use of sedation. Sedation and analgesia are crucial in patients suffering from this condition. It improves the tolerance in mechanical ventilation and decreases the consumption of oxygen. Recent studies have proved that morphine reduced resting and energy by six and eight percent. These patients require sedation for several days. More studies suggest that dexmedetomidine may be an alternative. The use of sedatives has potential side effects. The use of sedation scales is essential because it helps clinicians decrease the likelihood of oversedation and undersedation. Most patients can be lightly sedated, while more severe lung injury patients need deep sedation (Summers et al., 2022). Paralysis(neuromuscular blockade)has sound effects such as the improvement of oxygenation. It also has undesirable effects, such as neuromuscular weakness in patients. Hemodynamic monitoring is also essential when guided by a central venous catheter. Nutritional support with patients with acute respiratory disease is not well understood. The patients may be highly catabolic, and the nutritional support may change the catabolic processes. Enteral feeding is preferred when the gastrointestinal tract is good., Overfeeding has no healthy advantage and should be avoided. This will prevent high levels of carbon dioxide production. After feeding the patients, their heads should be raised in order to avoid ventilator-associated pneumonia. The use of autocoids is also essential in managing patients with acute respiratory disease.

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In conclusion, acute respiratory failure is a severe condition that can be life-threatening. The major causes of this condition include pneumonia, COVID-19 19, and cystic fibrosis symptoms include breathlessness, irregular heartbeat, and the nails may turn bluish. The medical management of this condition include sedation which helps in tolerance of mechanical ventilation. The nutritional support of these patients include enteral feeding. It is also important to raise the heads of the patients after meals to avoid ventilator associated pneumonia

References

Acute Respiratory Failure – an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. Retrieved February 25, 2022, from https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-respiratory-failure

Eman Shebl, & Bracken Burns. (2019, May 6). Respiratory Failure. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526127/

Kaynar, A. M. (2019, November 10). Respiratory Failure: Background, Pathophysiology, Etiology. Medscape.com. https://emedicine.medscape.com/article/167981-overview

Medline Plus. (2019). Respiratory Failure. Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/respiratoryfailure.html

Summers, C., Todd, R. S., Vercruysse, G. A., & Moore, F. A. (2022). Acute Respiratory Failure. Perioperative Medicine, 576–586. https://doi.org/10.1016/b978-0-323-56724-4.00039-3