Ventilation failure (Table 8) is defined as a rise in CO2 concentration when alveolar ventilation either falls or fails to respond adequately to increased CO2 production. The most common causes are acute exacerbation of asthma and COPD. Asthma is diffuse airway inflammation caused by household (dust mites, pets) and environmental (pollens) allergens in genetically susceptible patients resulting in irreversible bronchoconstriction. COPD (chronic bronchitis, emphysema) is a irreversible airway obstruction caused an inflammatory response to toxins, e.g., cigarette smoke.
Table 8. Ventilation Failure.
Prevention:
Identify at-risk patient
Reduce stress
Do not prescribe or administer respiratory depressants and COX-inhibitors
Ensure profound local anesthesia
Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Signs and symptoms:
Coughing, wheezing, shortness of breath (dyspnea)
Anxiety, restlessness, agitation
Pallor or cyanosis of the lips
Noticeable use of the accessory muscles of respiration
Patient may become confused and lethargic
Respiratory failure (in cases of severe exacerbation)
Emergency response:
Place patient in an upright position
Administer a short acting beta2 agonist bronchodilator
Two to 4 puffs of albuterol by metered-dose inhaler (up to 3 times 20 minutes apart)
Administer oxygen
Patients with asthma do not need O2 unless the O2sat is <90% as measured by a pulse oximeter
2 to 4 L/minute by nasal cannula
Patients with COPD require O2 supplementation, even those who do not need it chronically
2 L/minute by nasal cannula (higher levels of O2 may worsen respiratory failure)
If patient’s condition deteriorates
Notify EMS
Monitor vital signs
If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
Signs of recovery: the rate and character of breathing returns to normal
Signs of deterioration: no improvement in the rate and character of breathing, increased cyanosis
When ventilating a patient, squeeze the bag only until resistance is felt or the chest starts to rise and allow time for expiration
Attempting to ventilate with large volumes of air or too rapidly will increase “air-trapping” and may lead to pneumothorax
Patients with a particularly severe ongoing asthma attack (status asthmaticus) who do not respond to usual treatment may progress to acute respiratory arrest and death
