Respiratory failure oxygen therapy and endotracheal intubation: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 33: Line 33:
**Nasal masks increase resistance to air flow and therefore, increase respiratory effort
**Nasal masks increase resistance to air flow and therefore, increase respiratory effort
**Face masks make it easier to assess aspiration risk in comparison to a nasal mask
**Face masks make it easier to assess aspiration risk in comparison to a nasal mask
===Ventilatory modes===
Will be discussed in the mechanical ventilation section of this chapter.
===Monitoring NIV===
*Success or failure of NIV therapy is established within an initial observation period of 8 hours.
**During this time adjustments should be made, whilst looking for signs of destabilization.
*An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV.
*Indications of failed NIV include:
**A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours
**Encephalopathy
**Agitation
**Unclearable secretions
**Intolerable mask interface
**Decreased oxygen saturation
**Hemodynamic instability
*Successful selection of patients with indications for NIV by physicians is poor and therefore, a third of patients that receive a trial of NIV fail.
*The use of sedatives and analgesics, for purposes of comfort and anxiety is not recommended as studies have demonstrated an increase in NIV failure rates with pretreatment of these agents.





Revision as of 18:34, 9 March 2018

Respiratory failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Respiratory Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Electrocardiogram

CT

MRI

Echocardiography and ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical therapy

Oxygen therapy

Mechanical ventilation

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Respiratory failure oxygen therapy and endotracheal intubation On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Respiratory failure oxygen therapy and endotracheal intubation

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Respiratory failure oxygen therapy and endotracheal intubation

CDC on Respiratory failure oxygen therapy and endotracheal intubation

Respiratory failure oxygen therapy and endotracheal intubation in the news

Blogs on Respiratory failure oxygen therapy and endotracheal intubation

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Respiratory failure oxygen therapy and endotracheal intubation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Oxygen therapy

  • The aim of oxygen therapy is to correct hypoxia
  • These therapies may include:
    • Non-invasive ventilatory support
    • Extracorporeal membrane oxygenation

Non-invasive ventilatory support (NIV)

  • Non-invasive ventilatory support (NIV) uses positive pressure ventilation delivered through a face or nasal mask or nasal prongs as a non-invasive way of delivering oxygen.
  • Non-invasive ventilatory support (NIV) is indicated for:
    • Acute hypoxemic respiratory failure
    • Chronic obstructive pulmonary disease (COPD) complicated by hypercapnic acidosis
  • Use of (NIV) is contraindicated in cases of need of emergent intubation, such as:
    • Myocardial arrest
    • Respiratory arrest
    • Inability to preserve a patent airways
    • Severely altered consciousness
    • Life threatening organ failiure of nonpulmonary origin
    • Abnormalities of facial structure for any reason
    • High risk of aspiration
    • Expected long term treatment with mechanical ventilation
    • Recent esophageal surgery with anastomoses

Mask selection

  • Studies have demonstrated that a face mask confers the largest physiological improvement, whilst nasal masks and prongs are tolerated the best.
  • Face masks are preferred in several studies and have the following advantages:
    • Less air leaks compared to volumes lost with nasal masks through the oral cavity
    • Nasal masks increase resistance to air flow and therefore, increase respiratory effort
    • Face masks make it easier to assess aspiration risk in comparison to a nasal mask

Ventilatory modes

Will be discussed in the mechanical ventilation section of this chapter.

Monitoring NIV

  • Success or failure of NIV therapy is established within an initial observation period of 8 hours.
    • During this time adjustments should be made, whilst looking for signs of destabilization.
  • An improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours is indicative of successful NIV.
  • Indications of failed NIV include:
    • A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours
    • Encephalopathy
    • Agitation
    • Unclearable secretions
    • Intolerable mask interface
    • Decreased oxygen saturation
    • Hemodynamic instability
  • Successful selection of patients with indications for NIV by physicians is poor and therefore, a third of patients that receive a trial of NIV fail.
  • The use of sedatives and analgesics, for purposes of comfort and anxiety is not recommended as studies have demonstrated an increase in NIV failure rates with pretreatment of these agents.



References

Template:WH Template:WS