ARDS & Respiratory Failure

• What are risk factors for acute respiratory failure?

  • Lung disease: COPD, CHF, pneumothorax  
  • Decreased respiratory drive: overdose, brain injury 
  • Decreased chest wall expansion: neuromuscular disorders or pain
• What are the risk factors for ARDS?

  • Sepsis* 
  • Pneumonia 
  • Severe Trauma 
  • Aspiration 
  • Massive blood transfusion 
  • Cigarette smoking 
  • Cardiopulmonary bypass** 
  • Pneumonectomy 
  • PE 
  • Drug/alcohol overdose 
  • Burns  
• What are early symptoms of respiratory failure?

  • Dyspnea/tachypnea 
  • Restlessness 
  • Anxiety 
  • Fatigue 
  • Increased BP 
  • Tachycardia  
• What are the intermediate symptoms of respiratory failure?

  • Confusion 
  • Lethargy 
  • Flushed skin 
• What are the severe symptoms of respiratory failure??

  • Cyanosis 
  • Coma 
  • Shallower/slower respiration 
  • Slowing of HR/arrhythmias  
• What are interventions for treating respiratory failure?

  • Provide oxygen support w/ NRB or non-invasive (bipap) or mechanical ventilation 
  • High fowlers; tripod if mental status ok ~ propping up increases A/P diameter for better lung expansion 
  • Airway management ~ secretions = suction; assist w/ coughing, chest PT, nebulizers, bronchodilators  
• How will you treat the underlying cause of respiratory failure?

  • Bronchoconstriction = bronchodilators to reverse  
  • Pulmonary congestion = diuretics  
  • Infection = ABX 
  • Airway edema = corticosteroids [administer bronchodilators 1st then steroids] 
  • Allows steroids to be inhaled easily 
  • Use benzos cautiously to decrease anxiety bc it can also decrease work of breathing and O2 consumption  
• What are some nursing actions for a patient in respiratory failure experiencing an ineffective breathing pattern?

  • Stimulate ~ sternal rub 
  • BVM assist ~ if needed likely to intubate  
  • Reversal agent for overdose 
  • Narcan for heroine, oxytocin, opioids 
  • Romazicon for benzos [valium, versed, xanax] 
• What are the symptoms of ARDS?

  • Sudden onset of severe dyspnea  
  • Crackles 
  • Tachycardia 
  • Refractory hypoxemia (P/F ratio) 
  • Restlessness/Anxiety  
  • Decreased lung compliance
• What are some diagnostic findings for a patient with ARDS?

  • Bilateral infiltrates  
  • Respiratory hypoxemia on SPO2/ABGs 
  • P/F rate < 300  [P/F ratio = PaO2/FiO2]
  • 200 – 300 = mild ARDS 
  • 100 – 200 = moderate 
  • <100 = severe  
  • Vitals 
• What is the main treatment for ARDS?

  • Treat underlying cause --> reverse inflammatory response  
  • Goal: SPO2 > 90% on lowest possible FiO2 
• What nursing actions will maintain oxygenation in a patient with ARDS?

  • Maintain oxygenation (PaO2 >/= 60) 
  • Intubation with mechanical ventilation 
  • Primary Tx = need pressure from mechanical ventilation to push air into alveoli to open  
  • Position to increase oxygen  
  • Continuous lateral rotation therapy  
  • Prone position  
  • High Fowler’s  
• What other nursing actions are needed to manage a patient with ARDS?

  • Conservative fluid management  
  • Keep balanced I&O ~ hydrate w/o complicating pulmonary edema; fluids maintain circulatory volume and loosen secretions, so they aren't plugging the airways  
  • Support other organ systems ~ this is a systemic response! 
  • Adequate organ function prevents conversion to MODS 
  • Monitor Urine output, mental status, BP & HR  
  • Nutrition  
  • Should be initiated within 48 – 72 H 
  • Without proper nutrition = malnutrition, loss of body mass & reduced respiratory strength can result w/o nutrition support 
• A patient arrives to the ER dyspneic, restless, anxious, and tachypneic. They state they have been feeling fatigued for the past few days. What could these symptoms be indicatory of?

  early signs of respiratory failure