Treatment principles for respiratory failure

Written by Han Shun Li
Pulmonology
Updated on November 30, 2024
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Respiratory failure is a common emergency condition in the respiratory system, with patients often experiencing significant breathing difficulties, cyanosis, etc. So, what are the principles of treatment for respiratory failure? The overall principles of treatment are to enhance respiratory support, including maintaining airway patency, correcting hypoxia through oxygen therapy, and improving ventilation with the use of ventilators, among other measures. Additionally, it is important to intensify treatment of the causes and inducers of respiratory failure, such as controlling infections. Attention should also be paid to general supportive treatment, such as nutritional support, correcting electrolyte imbalances, etc., as well as protecting other vital organs, like the liver and kidneys.

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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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Is asthma considered respiratory failure?

Asthma and respiratory failure are two distinct concepts. Asthma is a disease, whereas respiratory failure is a clinical outcome resulting from a series of diseases. During an acute asthma attack, there is also a possibility of respiratory failure occurring, and in severe cases, it can lead to serious respiratory failure requiring interventions like tracheal intubation and mechanical ventilation. Therefore, acute asthma attacks require active intervention. Treatments often include nebulized inhalation of short-acting bronchodilators and even intravenous administration of corticosteroids to handle the acute episode. Short-term intravenous use of corticosteroids can also help in controlling the acute attack.

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Written by Han Shun Li
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Treatment of Respiratory Failure

Respiratory failure refers to the severe impairment of lung ventilation and gas exchange function caused by various reasons. The treatment of respiratory failure is comprehensive. Firstly, it is necessary to maintain the patency of the airway. Second, oxygen therapy is required. Oxygen therapy is mainly used to correct the patient's hypoxia. Third, a ventilator can be used to assist breathing. Fourth, the cause of the condition should be addressed. For example, if it is caused by a severe infection, aggressive anti-infection measures should be taken; if caused by a large amount of pleural effusion, aggressive drainage of the pleural fluid should be undertaken, etc. Additionally, general supportive therapy should be considered, such as maintaining electrolyte and acid-base balance. It is also important to protect the function of vital organs, such as maintaining the function of the heart and lungs, etc.

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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.

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How to treat respiratory failure?

Treatment of patients with respiratory failure is primarily medical, focusing on suppressing or relieving the causes and triggers of respiratory failure, improving lung ventilation and gas exchange as much as possible, and treating and improving the function and condition of various vital organs. First, it is important to actively treat the primary disease causing respiratory failure. If there is a concurrent bacterial infection, sensitive antibiotics should be used, and triggers should be removed as much as possible. Simultaneously, maintaining airway patency and effective ventilation volume is necessary, which can involve administering bronchodilators and expectorants such as salbutamol, terbutaline sulfate, acetylcysteine, and ambroxol. When necessary, corticosteroids can be administered intravenously. If internal medicine treatment does not improve symptoms, tracheotomy and mechanical ventilation may be necessary to assist breathing. (Medications should be taken under the guidance of a physician, based on the actual situation.)