Respiratory failure medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
There is no treatment for respiratory failure; however, medication may be used to allow for easier intubation and to ease anxiety in the patient. Recently, studies have demonstrated a strong recommendation against the use of sedatives or analgesics. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms. | There is no treatment for respiratory failure; however, medication may be used to allow for easier [[intubation]] and to ease [[anxiety]] in the patient. Recently, studies have demonstrated a strong recommendation against the use of [[Sedative|sedatives]] or [[Analgesic|analgesics]]. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy includes:<ref name="pmid23424950">{{cite journal |vauthors=Stoica RT, Macri A |title=[Sedation of patients with respiratory failure in ICU] |language=Romanian |journal=Pneumologia |volume=61 |issue=4 |pages=240–4 |date=2012 |pmid=23424950 |doi= |url=}}</ref<ref name="pmid28828366">{{cite journal |vauthors=Bourenne J, Hraiech S, Roch A, Gainnier M, Papazian L, Forel JM |title=Sedation and neuromuscular blocking agents in acute respiratory distress syndrome |journal=Ann Transl Med |volume=5 |issue=14 |pages=291 |date=July 2017 |pmid=28828366 |pmc=5537113 |doi=10.21037/atm.2017.07.19 |url=}}</ref | Medical therapy includes:<ref name="pmid23424950">{{cite journal |vauthors=Stoica RT, Macri A |title=[Sedation of patients with respiratory failure in ICU] |language=Romanian |journal=Pneumologia |volume=61 |issue=4 |pages=240–4 |date=2012 |pmid=23424950 |doi= |url=}}</ref><ref name="pmid28828366">{{cite journal |vauthors=Bourenne J, Hraiech S, Roch A, Gainnier M, Papazian L, Forel JM |title=Sedation and neuromuscular blocking agents in acute respiratory distress syndrome |journal=Ann Transl Med |volume=5 |issue=14 |pages=291 |date=July 2017 |pmid=28828366 |pmc=5537113 |doi=10.21037/atm.2017.07.19 |url=}}</ref> | ||
*Naloxone: | *[[Naloxone]]: | ||
**Naloxone is used as an antidote to opioid overdose - induced respiratory depression. | **[[Naloxone]] is used as an antidote to [[opioid]] overdose - induced [[Hypoventilation|respiratory depression]]. | ||
*Flumazenil: | *[[Flumazenil]]: | ||
**Flumazenil is used as an antidote in benzodiazepine overdose - induced respiratory depression. | **[[Flumazenil]] is used as an antidote in [[benzodiazepine]] overdose - induced [[Hypoventilation|respiratory depression]]. | ||
*Sedatives, activated charcoal and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive respiratory acidosis with: | *[[Sedative|Sedatives]], [[Activated carbon|activated charcoal]] and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive [[respiratory acidosis]] with: | ||
**Anxiety | **[[Anxiety]] | ||
**Rapid shallow breathing | **Rapid shallow breathing | ||
**Respiratory arrest | **[[Respiratory arrest]] | ||
**Moderate to severe expiratory airway resistance | **Moderate to severe expiratory airway resistance | ||
**Dynamic hyperinflation | **Dynamic hyperinflation | ||
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** 1.1 '''Naloxone''' | ** 1.1 '''Naloxone''' | ||
*** 1.1.1 '''Adult''' | *** 1.1.1 '''Adult''' | ||
**** Preferred regimen (1): Naloxone 0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater | **** Preferred regimen (1): [[Naloxone]] 0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater | ||
**: '''Note (1):''' Apneic patients with suspected opiate overdose should receive higher first doses of naloxone between 0.2 - 1 mg | **: '''Note (1):''' [[Apnea|Apneic]] patients with suspected [[opiate]] overdose should receive higher first doses of [[naloxone]] between 0.2 - 1 mg | ||
**: '''Note (2)''': Cardiorespiratory with suspected opiate overdose should receive a minimum of 2 mg of naloxone | **: '''Note (2)''': Cardiorespiratory with suspected [[opiate]] overdose should receive a minimum of 2 mg of [[naloxone]] | ||
* 2 '''Benzodiazepine overdose''' | * 2 '''Benzodiazepine overdose''' | ||
** 2.1 '''Flumazenil''' | ** 2.1 '''Flumazenil''' | ||
*** 2.1.1 '''Adult''' | *** 2.1.1 '''Adult''' | ||
****Preferred regimen (1): [[Flumazenil]] 0.2 mg IV over 30 seconds | |||
**: '''Note (1):''' Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved | **: '''Note (1):''' Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved | ||
**: '''Note (2)''': Maximum dose of 3mg is given within any hour | **: '''Note (2)''': Maximum dose of 3mg is given within any hour | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 23:58, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
There is no treatment for respiratory failure; however, medication may be used to allow for easier intubation and to ease anxiety in the patient. Recently, studies have demonstrated a strong recommendation against the use of sedatives or analgesics. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms.
Medical Therapy
Medical therapy includes:[1][2]
- Naloxone:
- Naloxone is used as an antidote to opioid overdose - induced respiratory depression.
- Flumazenil:
- Flumazenil is used as an antidote in benzodiazepine overdose - induced respiratory depression.
- Sedatives, activated charcoal and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive respiratory acidosis with:
- Anxiety
- Rapid shallow breathing
- Respiratory arrest
- Moderate to severe expiratory airway resistance
- Dynamic hyperinflation
Respiratory failure
- 1 Opiate overdose
- 1.1 Naloxone
- 1.1.1 Adult
- Preferred regimen (1): Naloxone 0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater
- 1.1.1 Adult
- 1.1 Naloxone
- 2 Benzodiazepine overdose
- 2.1 Flumazenil
- 2.1.1 Adult
- Preferred regimen (1): Flumazenil 0.2 mg IV over 30 seconds
- Note (1): Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved
- Note (2): Maximum dose of 3mg is given within any hour
- 2.1.1 Adult
- 2.1 Flumazenil
References
- ↑ Stoica RT, Macri A (2012). "[Sedation of patients with respiratory failure in ICU]". Pneumologia (in Romanian). 61 (4): 240–4. PMID 23424950.
- ↑ Bourenne J, Hraiech S, Roch A, Gainnier M, Papazian L, Forel JM (July 2017). "Sedation and neuromuscular blocking agents in acute respiratory distress syndrome". Ann Transl Med. 5 (14): 291. doi:10.21037/atm.2017.07.19. PMC 5537113. PMID 28828366.