# Acute Respiratory Failure --- **Acute respiratory failure** or **ARF** is a life-threatening condition that can arise from a number of different [[lungs|pulmonary]] diseases. Essentially when the lungs fail to provide enough oxygen to meet the needs of the body's systems. ARF (acute respiratory failure) is the inability of the lungs to maintain arterial oxygenation or to eliminate carbon dioxide from the body (or both), resulting in [tissue hypoxia](https://leveluprn.com/blogs/medical-surgical-nursing/respiratory-3-oxygen-delivery-devices-hypoxemia-hypoxia-sleep-apnea#hypoxia), that is, the tissues are not getting sufficient oxygen. ## Causes There are essentially two different ways the respiratory system can fail: - Hypoxemic Respiratory Failure: failure of oxygenation - Low oxygen in the blood - PaO2 less than 60 mm/Hg (O2 sat less than 80%) - pH higher - pulmonary manifestations: - dyspnea - tachypnea - retractions - increased WOB - agitation/ALOC - cyanosis (late) - cardiovascular manifestations: increased BP/HR, dysrhythmias, cyanosis, weak/thread pulse - CNS manifestations: altered LOC, restlessness, confusion - Caused by either respiratory or cardiac issues - respiratory issues - [[acute respiratory distress syndrome|ARDS]] - [[pneumonia]] if it's bad enough - smoke inhalations - massive [[embolus|pulmonary embolism]] - blocks blood flow to the lungs - laceration of the pulmonary artery or hemorrhage - cardiac issues - anatomic shunt - [[shock]] - [[pulmonary edema]] - alveoli are just drowning in fluid - Hypercapnic Respiratory Failure: Failure of ventilation - Failure of the air to move in and out of the chest - retaining CO2! - PaCO2 greater than 50 mm/Hg and [[acidosis|pH less than 7.30]] - pulmonary manifestations: tachypnea - cardiovascular manifestations: bounding pulse, increased BP/HR - CNS manifestations: lethargy, drowsiness, coma - CO2 has anesthetic effects - Can be caused by respiratory issues - respiratory causes - [[COPD]] - you're retaining all the dead air - [[asthma]] - can also be [[pneumonia]] and the like - CNS causes - overdose - [[spinal cord injury]] - [[brainstem]]/severe head injury - Causes from the chest wall - trauma ([[flail chest]]) - severe [[obesity]] - neuromuscular - [[myasthenia gravis]] - [[amyotrophic lateral sclerosis]] - [[Guillain-Barré syndrome]] - [[polio]] - [[multiple sclerosis]] ## Complications ## Diagnostic Tests ## Treatment Treatment for acute respiratory failure applies for both hypoxemic maintain O2 sats! Over 90% try to mobilize secretions if there are any - meds - steroids - reduce conjection (diuretics) - maybe antibiotics - maybe antianxiety [[mechanical ventilation]] ## Nursing Considerations ___