Principles of oxygen therapy for respiratory failure

Written by Peng Miao Yun
Internal Medicine
Updated on September 30, 2024
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Patients with respiratory failure undergoing oxygen therapy should be treated differently depending on the type of respiratory failure. If it is Type I respiratory failure, it is simply hypoxia without accompanying carbon dioxide retention. Our oxygenation principle can provide slightly higher oxygen flow, with an oxygen flow rate exceeding 5 liters per minute. However, if it is Type II respiratory failure, which comes with severe carbon dioxide retention, it requires continuous low-flow oxygenation. This type of respiratory failure is often caused by chronic pulmonary diseases. Because if high-flow oxygen is provided, the peripheral chemoreceptors' response to hypoxia will decrease in the short term, which will exacerbate respiratory suppression, leading to increased carbon dioxide retention and worsening the condition. Therefore, for Type II respiratory failure, low-flow continuous oxygen should be provided, with an oxygen flow rate controlled below 3 liters per minute.

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Written by Han Shun Li
Pulmonology
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What are the symptoms of respiratory failure?

Respiratory failure is a common and serious condition in clinical settings, often categorized as an acute and critical illness. Simply put, respiratory failure occurs when respiratory function is extremely poor. It is caused by severe impairment of pulmonary ventilation and gas exchange due to various reasons. Even at rest, sufficient gas exchange cannot be maintained, leading to serious hypoxemia or concurrent hypercapnia. Clinically, this often presents with severe breathing difficulties, hypoxia, cyanosis, and requires immediate intervention to prevent potentially life-threatening complications.

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Written by Wang Li Bing
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How to administer oxygen for respiratory failure.

First, we should evaluate whether the patient has type I or type II respiratory failure based on arterial blood gas analysis. Type I respiratory failure is primarily characterized by low oxygen tension, indicating a state of hypoxia, with normal carbon dioxide tension, in which case high-flow oxygen therapy can be administered. In type II respiratory failure, both the oxygen tension is low and the carbon dioxide tension is high. In this case, only low-flow oxygen therapy should be given, or non-invasive ventilation, or endotracheal intubation connected to mechanical ventilation may be employed.

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Written by Li Qiang
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How to grade respiratory failure

Respiratory failure is generally not graded; instead, it is classified into types. There are two types, Type I and Type II. Type I is characterized by an oxygen tension lower than 60 mmHg, at which point, there is no increase in carbon dioxide, and the carbon dioxide level is normal. Type II respiratory failure is when the oxygen tension is below 60 mmHg, accompanied by an increase in carbon dioxide, which is then termed Type II respiratory failure. Regarding respiratory failure, it is classified by type and not by severity grade. This means that once it meets these criteria, it is referred to as respiratory failure, and at this point, some emergency treatments to improve low oxygen levels are necessary. Therefore, respiratory failure is generally not graded into mild, moderate, or severe degrees. It is only differentiated into different types. Of course, there are different severity levels in respiratory failure, but we generally do not apply a specific degree of severity.

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Can respiratory failure be cured?

Respiratory failure can potentially be cured, and the key lies in identifying the cause of the respiratory failure. For instance, acute inflammatory infections, such as severe pneumonia and other infectious diseases, can lead to dysfunction in lung ventilation and gas exchange, manifesting as respiratory failure. With the aggressive use of antibiotics and anti-infection drugs, once the infection is controlled, respiratory failure can also be corrected accordingly. Furthermore, if it is a complication of other diseases, such as acute left heart failure, respiratory failure can also occur. This type of respiratory failure will quickly improve once heart function is corrected. However, in the case of chronic diseases such as chronic obstructive pulmonary disease, bronchiectasis, asthma, and other causes, respiratory failure can only be managed with medication to alleviate symptoms, and it cannot be completely cured.

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Care for patients with respiratory failure

Patients with respiratory failure are always emergency and critically ill patients in clinical settings. For patients with respiratory failure, we need to pay close attention in nursing: first, strictly monitor the patient's vital signs, observe the frequency of respiration, blood pressure, and consciousness state; take good care of the skin and oral cavity to prevent dependent pneumonia and bedsores; and timely remove the patient’s sputum. Encourage conscious patients to cough more and expectorate sputum. For those with weak coughs, assist regularly with turning and patting the back to facilitate the removal of sputum. For comatose patients, mechanical suction or tracheostomy for mechanical ventilation can be performed. At the same time, avoid factors that can induce respiratory difficulty such as cold air and poor air circulation. Patients with respiratory failure consume a lot of energy, especially those on mechanical ventilation, who are in a stress state with increased catabolism. Therefore, daily protein intake should be increased, encourage the patient to eat more to enhance nutrition, and provide a diet high in protein, high in fat, and low in carbohydrates.