RECOGNITION AND ASSESSMENT

  • Respiratory failure is present when lungs are unable to maintain normal gas exchange at rest,
    • PaO2 <8.0 kPa and/or PaCO2 >6.0 kPa.
  • Identify the underlying cause

Symptoms and signs

  • Drowsiness
  • Warm peripheries, bounding pulse, tachycardia
  • Central cyanosis (difficult to detect in anaemic patients)
  • In patients with rising PaCO2 flapping tremor and papilloedema

Investigations

  • ABG while breathing air
    • if clinical condition does not allow ABG when breathing air, record FiO2
  • Chest X-ray
  • FBC
  • U&E
  • ECG

IMMEDIATE TREATMENT

  • Treat underlying cause
  • Follow Treatment of hypoxaemia guideline
  • Refer patients with neuromuscular disease or kyphoscoliosis presenting with type 2 respiratory failure to respiratory physician

DISCHARGE AND FOLLOW-UP

  • Advice on life-style appropriate to underlying disease that precipitated admission
  • Refer all patients with type 1 or type 2 respiratory failure for follow up with respiratory physician

© 2022 The Bedside Clinical Guidelines Partnership.

Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.

Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa