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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Clinical manifestations of respiratory failure

Respiratory failure is one of the common critical illnesses. So, what are the clinical manifestations of respiratory failure? Firstly, there is difficulty breathing, which is the most common symptom of respiratory failure. Most patients experience noticeable difficulty breathing, and in severe cases, patients may sit upright to breathe, sweat profusely, and appear very distressed. Another symptom is cyanosis, a typical sign of oxygen deficiency. Mild cases may show cyanosis at the extremities and lips, while severe cases can exhibit cyanosis throughout the body. Additional symptoms can include neurological and psychological symptoms such as confusion, mania, convulsions, coma, and drowsiness. Due to the oxygen deficiency affecting various systems, other systems may also show corresponding symptoms, such as tachycardia and arrhythmia in the circulatory system, and potential upper gastrointestinal bleeding in the digestive system.

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Causes of Respiratory Failure

Respiratory failure is relatively common in clinical practice and is frequently seen in critical respiratory conditions. The causes of respiratory failure most often arise from diseases of the respiratory and circulatory systems, such as chronic obstructive pulmonary disease, acute exacerbation of asthma, severe pneumonia, severe pulmonary tuberculosis, diffuse pulmonary fibrosis, pulmonary edema, pneumoconiosis, pulmonary embolism, various causes of heart failure, pulmonary hypertension, severe pneumothorax, and substantial pleural effusion, among others. These can all lead to respiratory failure. Therefore, if respiratory distress occurs clinically and respiratory failure is suspected, it is crucial to conduct prompt examinations and actively manage the condition.

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Written by Han Shun Li
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Does respiratory failure spread?

Respiratory failure is a condition characterized by significant decline in respiratory function and is clinically very serious, being a common critical and acute illness. Respiratory failure itself is not contagious, but certain diseases that cause respiratory failure can be contagious. For example, if it is caused by infectious pulmonary tuberculosis, then the tuberculosis can be transmitted, but respiratory failure itself is not contagious.

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Written by Wei Shi Liang
Intensive Care Unit
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The earliest clinical symptoms of respiratory failure

The clinical symptoms of respiratory failure mainly manifest as hypoxemia and carbon dioxide retention. Looking at their clinical manifestations, mild hypoxia may not show any clinical symptoms. As the severity of the disease increases, there can be signs of increased respiratory drive, such as rapid breathing or difficulty breathing, along with symptoms of sympathetic nervous system activation, such as anxiety and sweating. Hypoxemia can cause dilation of peripheral arteries and constriction of veins, leading to an increased heart rate, or even severe arrhythmias. Furthermore, considering the clinical manifestations of carbon dioxide retention, they are directly related to the levels of carbon dioxide in the body, mainly depending on the rate of occurrence. Clinically, this primarily affects myocardial contractility, the contractile ability of respiratory muscles, and increases in intracranial blood flow. In mild to moderate cases, it can stimulate the respiratory center causing increased and shallow breathing, but in severe cases, it may suppress the respiratory center.

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Written by Han Shun Li
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Is respiratory failure serious?

Respiratory failure is a common and critical condition in the respiratory system, and it is very serious. Respiratory failure manifests as a severe decline in respiratory function, often with significant damage to the lungs' ventilation and gas exchange capabilities. Patients often experience severe chest tightness, difficulty breathing, obvious hypoxic cyanosis, and may even present with symptoms such as convulsions and coma, which can be fatal. Treatment usually requires oxygen therapy and often the assistance of a ventilator. Therefore, respiratory failure is considered a very serious condition clinically and requires proactive management to save the patient's life.