How to administer oxygen for respiratory failure.

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 28, 2024
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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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What are the symptoms of respiratory failure?

Respiratory failure is a common critical illness in clinical settings, characterized by serious impairments in the lung's ventilation and gas exchange functions. What are the symptoms after respiratory failure? First and foremost, the earliest and most obvious symptom is difficulty breathing. Many patients experience significant difficulty breathing; severe cases may even involve orthopnea, profuse sweating, and inability to speak. Another important symptom is cyanosis, which is a typical manifestation of hypoxia. Additionally, there can be neuropsychiatric symptoms such as mental confusion, agitation, convulsions, and even coma. Other systems may also exhibit symptoms, such as tachycardia, arrhythmias, and decreased gastrointestinal function.

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Precursors of respiratory failure

Respiratory failure can be a very acute condition, or it may evolve gradually due to chronic diseases. The basic precursors of respiratory failure generally include hypoxia or hypercapnia. In the early stages of hypoxia, patients may experience excitement or irritability, characterized by rapid breathing and possibly sweating due to the effort of breathing. Symptoms include accelerated breathing and hypoxia; the patient’s lips may also turn blue. If the level of carbon dioxide increases, once past the initial period of excitement and as the hypoxia worsens, the person may become listless. Gradually, their consciousness may become unclear, manifesting as drowsiness or possibly even coma.

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Is respiratory failure serious?

Respiratory failure is a relatively severe disease, with the most common causes being chronic obstructive pulmonary disease (COPD) or heart failure, which are frequently seen in clinical settings. Respiratory failure can be definitively diagnosed by performing blood gas analysis. Clinically, patients will exhibit symptoms of breathing difficulty, such as orthopnea or wheezing. In blood gas analysis, oxygen saturation is often below 90%, and the partial pressure of oxygen is less than 60 mmHg. These indicators can diagnose respiratory failure. Although respiratory failure is a serious condition, it can be recoverable through active symptomatic treatment, identifying the underlying cause, and eliminating aggravating factors.

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Can respiratory failure be cured?

Whether respiratory failure can be cured depends on the causes of the respiratory failure and the severity of the condition. Respiratory failure can potentially be cured. For example, acute left heart failure can lead to pulmonary congestion and subsequent respiratory failure. This condition primarily manifests as a decrease in oxygen tension, and by conducting a blood gas analysis, if the oxygen tension is found to be less than 60 mmHg, it can be diagnosed as respiratory failure. However, with symptomatic treatments such as vasodilation and diuretics, once the left heart failure is alleviated, the respiratory failure will also improve. On the other hand, for diseases intrinsic to the lungs, such as chronic obstructive pulmonary disease or severe pulmonary infections, these chronic conditions cannot be completely cured. The symptoms of respiratory failure can only be managed with medication or ventilators.

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Is respiratory failure uncomfortable?

Respiratory failure is quite uncomfortable, and clinically, the symptoms feel severe, and the patient's own state is also very affected. Respiratory failure is mainly caused by a decrease in oxygen partial pressure, during which time the patient may experience wheezing, chest tightness, and even a feeling of being near death. There are many causes of respiratory failure, with severe infections being common, such as severe pneumonia or sepsis. A systemic inflammatory response can lead to respiratory failure. Another situation is when heart failure occurs, which can also accompany pulmonary congestion, causing pulmonary ventilation dysfunction that can also lead to respiratory failure. The treatment of respiratory failure focuses on removing the causative factors and selectively choosing different treatment plans, which can start with oxygen therapy or the use of a ventilator in severe cases to correct hypoxemia and sustain life.