12th January 2024

Treatment of Acute Respiratory Failure

Patients identified to be in acute respiratory failure need to be managed in a stepwise ABCDE approach.

Acute management of Type 1 respiratory failure (TR1F)

In type 1 respiratory failure (oxygenation deficit), high concentration oxygen will usually relieve hypoxia by increasing alveolar PO2. In some cases, however, mechanical ventilation may be needed where there is severe alveolar damage.

One of the treatment options for T1RF, which has not responded to medical management, is to give Continuous Positive Airways Pressure (CPAP). It involves delivering a continuous positive pressure during both inspiration and expiration, improving oxygenation and reducing work of breathing. It is usually indicated in worsening T1RF, acute cardiogenic pulmonary oedema and sometimes in obstructive sleep apnoea (domiciliary setting).

Acute management of Type 2 respiratory failure (T2RF)

Type 2 respiratory failure in an acute setting is an emergency needing immediate management, including ventilatory support.

It is very important to identify the underlying condition precipitating T2RF and to treat it with pharmacological interventions first. For instance, in patients with COPD, initial management will involve rigorous use of back-to-back nebulisers, intravenous antibiotics, steroids and serial ABGs for monitoring. If the pH, Pco2 and PO2 do not show a convincing improvement after 1 hour of active medical management, non-invasive ventilation should be considered.