Respiratory failure oxygen therapy and endotracheal intubation
|
Respiratory failure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Respiratory failure oxygen therapy and endotracheal intubation On the Web |
|
American Roentgen Ray Society Images of Respiratory failure oxygen therapy and endotracheal intubation |
|
FDA on Respiratory failure oxygen therapy and endotracheal intubation |
|
CDC on Respiratory failure oxygen therapy and endotracheal intubation |
|
Respiratory failure oxygen therapy and endotracheal intubation in the news |
|
Blogs on Respiratory failure oxygen therapy and endotracheal intubation |
|
Risk calculators and risk factors for Respiratory failure oxygen therapy and endotracheal intubation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Oxygen therapy
- The aim of oxygen therapy is to correct hypoxia
- These therapies may include:
- Non-invasive ventilatory support
- Extracorporeal membrane oxygenation
Non-invasive ventilatory support (NIV)
- Non-invasive ventilatory support (NIV) uses positive pressure ventilation delivered through a face or nasal mask or nasal prongs as a non-invasive way of delivering oxygen.
- Non-invasive ventilatory support (NIV) is indicated for:
- Acute hypoxemic respiratory failure
- Chronic obstructive pulmonary disease (COPD) complicated by hypercapnic acidosis
- Use of (NIV) is contraindicated in cases of need of emergent intubation, such as:
- Myocardial arrest
- Respiratory arrest
- Inability to preserve a patent airways
- Severely altered consciousness
- Life threatening organ failiure of nonpulmonary origin
- Abnormalities of facial structure for any reason
- High risk of aspiration
- Expected long term treatment with mechanical ventilation
- Recent esophageal surgery with anastomoses
Mask selection
- Studies have demonstrated that a face mask confers the largest physiological improvement, whilst nasal masks and prongs are tolerated the best.
- Face masks are preferred in several studies and have the following advantages:
- Less air leaks compared to volumes lost with nasal masks through the oral cavity
- Nasal masks increase resistance to air flow and therefore, increase respiratory effort
- Face masks make it easier to assess aspiration risk in comparison to a nasal mask
Ventilatory modes
Will be discussed in the mechanical ventilation section of this chapter.
Monitoring NIV
- Success or failure of NIV therapy is established within an initial observation period of 8 hours.
- During this time adjustments should be made, whilst looking for signs of destabilization.
- An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV.
- Indications of failed NIV include:
- A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours
- Encephalopathy
- Agitation
- Unclearable secretions
- Intolerable mask interface
- Decreased oxygen saturation
- Hemodynamic instability
- Successful selection of patients with indications for NIV by physicians is poor and therefore, a third of patients that receive a trial of NIV fail.
- The use of sedatives and analgesics, for purposes of comfort and anxiety is not recommended as studies have demonstrated an increase in NIV failure rates with pretreatment of these agents.