treatment of acute respiratory failure

Principles of treatment

Clearing the airways.

Oxygen therapy.

 

Endotracheal intubation, tracheostomy, respiratory support.

Infection control, multiple infections.

Plasma alkaline.

Specific Treatment

Treatment of support and liberation Respiratory:

Wipe clean suction mouth, throat, nose.

Put canuyn Mayo tongue to keep from falling.

Sucking the talks, substance discharge in vacuum.

Bronchoalveolar lavage, diluting the conversation by aerosol, pump de sodium bicarbonate solution or a solution of 14 ‰ chlorure de natrri 9 ‰, 2-5 ml each time and then suck out.

Enrichment of water and electrolytes and acidosis-alkaline balance.

Ensure a balance between the amount of fluid in and out every day, avoid dry thick phlegm, bronchitis discharge quality. If there is respiratory acidosis must infusion of sodium bicarbonate cum as 14 ‰.

Oxygen therapy:

Oxygen:

Oxygen must be moistened and warmed before use oxygen to the patient. Oxygen must pass a water tank and is warmed by ultrasound or by the plate is heated up.

The means of oxygen therapy.

Nasal inhalation is usually applied.

Most often the beginning of a multi-orifice catheters, placed nostrils not exceed the following (length is the distance between the nose and earlobes).

Steam tip can be used for the output from 1-6 liters / minute, often used in cases of mild or moderate respiratory distress.

Indications:

Breathing pure oxygen.

Apply in very limited circumstances, such as cardiac arrest, severe bleeding.

Enhanced oxygen breathing gas.

Patients with blood carbon dioxide levels to normal or reduced: All blood hypoxia, the PaO 2 decreased below 65 mm Hg, oxygen output with 4-6 liters / minute by nasal inhalation or in the case hypoxic heavier use of oxygen masks.

Patients with carbon dioxide concentrations in chronic high blood: these are the cases of chronic respiratory failure, oxygen supply used in patients with chronic respiratory failure is low about 1-3 liters / minute, breathing interruption and controlled gas concentrations in the blood.

Intubation:

Indications:

When there are obstacles such as upper airway edema, wound larynx, tongue slipped causing coma.

When you need to reduce the dead space to increase alveolar ventilation, respiratory support, need to breathe oxygen, ventilator.

When there is increased blood carbon dioxide.

When required respiratory protection, breathing the wrong room.

Methods:

There are two methods.

Nasal intubation:

Also known as intubation curious, is commonly used method, especially for newborns, infants and children, especially in tetanus and medical resuscitation. Patient improved posture Jackson: lie on your back shoulder Statistics 5-7 cm high to moderate pruritus or half-sitting posture, especially when the fear of blood, lung disease care ... from movement into the lungs other.

Oral intubation:

The patient is placed in position as above: Jackson or half sitting posture. Oxygen minutes before intubation.

Typically, the tube does not put more than 3 days.

Tracheostomy:

Indications:

As specified intubation or can not set the cannula tube or more than 3 days.

Methods:

Tracheostomy high: more conspicuous trachea.

Open the lower airways.

Complications may be encountered when intubation and tracheostomy:

Complications when placed:

Bleeding, swelling of the larynx, trachea perforation, glottis spasm, cardiac arrest.

Complications after setting:

Where infections, pneumonia, ulcers, necrosis of the trachea, esophagus air leakage, vocal cord lesions, atelectasis, pneumothorax, pneumomediastinum, subcutaneous emphysema.

Respiratory Support

Respiratory support tools by hand:

Breathing air is supplied to the patient is air.

Ball type: ambu, Canister.

Of a bag rated: Ranima, Drager.

Mechanical ventilation:

Indications:

Mechanical ventilation is used as the method of respiratory support usually ineffective.

Three major types of patients corresponding to three different levels of carbon dioxide in the blood. Each patient needs a way to adjust various artificial respiration:

The first type of patients are those with a lot of carbon dioxide increases include a reduction in blood oxygen, as the level of decompensation of chronic respiratory failure, breathing oxygen supply to start with low, then increase up but very slowly, the ability to supply oxygen (FiO2) is highest at the start.

Patients with type second kind is formed of carbon dioxide increases blood, patients can completely normal respiration with FiO2 50%.

Tuesday's disease: is there a type of blood carbon dioxide reduction. Increased respiratory phenomenon secondary to lack of oxygen to the blood. However due to lung disease below, should not increase respiratory entail an increase PaO2 was. So ill patients gradually, more and more oxygen debt becomes severe.

There are 5 types of ventilators:

Ventilator created based on frequency cycle.

Ventilator create cycle based on volume.

Ventilator created based on pressure cycle.

Ventilator create cycle based on airflow.

Ventilator create mixed cycle.

Infection Control:

The bacterial superinfection usually Strepxococcus pneumoniae, Haemophilus influenzae, Stapylococcus aureus, Klebsiella pneumoniae, etc .., should have the appropriate antibiotics.