Definition

• In respiratory failure, the lungs are unable to

oxygenate the blood & remove carbon dioxide
adequately.
• Respiratory failure is often defined by arterial
blood gas values. An arterial oxygen level (PO2)
of less than 50-60 mmHg and a arterial carbon
dioxide level ( PCO2 ) of greater than 50 mmHg
are generally accepted as indicators of
respiratory failure ( Porth, 1994; Tierney et
al.,1994 )
 Selected Conditions Leading to
Respiratory Failure

Type of Dysfunction Examples

Impaired ventilation
• airway obstruction laryngospasm, aspiration, airway edema.
• Respiratory disease Asthma, COPD
• Neurologic cause Spinal cord injury
• Chest wall injury Pneumothoraks
Impaired diffusion
• Alveolar disorder Pneumonia
• Pulmonary edema Hearth failure
Ventilation -perfusion Pulmonary embolism
mismatch
 Patofisiology
Ventilation –
Impaired diffusion Impaired ventilation
perfusion mismatch

Hipoxemia Hipercapnea

Respiratory Failure
Manifestation Manifestation
• Dyspnoe, Tachypnoe • Dyspnoe respiratory
depresion
• Cyanosis
• Headache
• Restlessness
• Papilledema
• Confusion
• Tachycardia, dysrhytmias
• Tachycardia, dysrhytmias
• Coma
• Hypertension
• Sistemic vasodilatation,
• Metabolic acidosis
hearth failure
• Respiratory acidosis
 Laboratory and Diagnostic Tests
Type of Dysfunction Arterial Blood Gases Value
COPD PO2 menurun 10-15
mmHg
Non COPD PO2 menurun 50-60
mmHg
Hipoxemic PCO2 Normal/menurun
pH menurun
HCO3 menurun
Hipoventilation PCO2 meningkat
Hipoxemic + pH menurun
Hipoventilation Asidosis combined
 Pharmacology
• Bronchodilator ; methyxanthine/iv
• Antibiotik
• Corticosteroid
• Neuromuscular blocker
 Oxygen Therapy
Type of Oxygen Therapy
Dysfunction
COPD 1-3 l / nasal canule atau
28%/ventury mask
ARDS/Pneumonia 40%-60% / ventury mask
( Short periods  to
avoid O2 toxicity 
surfactant synthesis is
impaired  atelestasis )
Oxygen therapy + ETT
Hipoventilation + Mechanical ventilation
 Airway Management
• Chronic ventilatory support 
tracheostomy
• Acut respiratory failure  ETT + Ventilator
( weaned from ventilator  patient must
be able to sustain effective spontaeous
respiration )
 Nursing Care
Inability to sustain spontaneous ventilation
• Assess and document respiratory rate and other vital
signs every 15-30 minutes.
• Assess the client for other signs of respiratory distress ;
use of accessory muscles, inter costal retraction,
increasing restlessness, decreased level of
consciousness.
• Monitor arterial blood gas and pulse oximetry
• Administer oxygen as prescribed , monitoring the client's
response.
• Place the client in Fowler's position
• Minimize activities and energy expenditure
• Avoid sedatives and respiratory depresant drugs
• Prepare ETT intubation and mechanical ventilation
 Nursing Care
Ineffective Airway Clearance
• Assess the client's respiratory status ; rate, ventilator
setting , chest movement, and lung sounds.
• Assess coordination of respiratory efforts with ventilator
• Monitor and assess oxygen saturations and ABGs.
• Suction the client as needed to maintain a patent airway.
• Obtain a specimen for culture if the sputum appears
purulent.
• Perform percussion, vibration and postural drainage as
ordered.
• Asses the client's fluid balance and maintain adequate
hydration.
• Change the client's position frequently, using semi
Fowler's and Fowler's position if tolerated