Principles of oxygen therapy for respiratory failure

Written by Peng Miao Yun
Internal Medicine
Updated on September 30, 2024
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Patients with respiratory failure undergoing oxygen therapy should be treated differently depending on the type of respiratory failure. If it is Type I respiratory failure, it is simply hypoxia without accompanying carbon dioxide retention. Our oxygenation principle can provide slightly higher oxygen flow, with an oxygen flow rate exceeding 5 liters per minute. However, if it is Type II respiratory failure, which comes with severe carbon dioxide retention, it requires continuous low-flow oxygenation. This type of respiratory failure is often caused by chronic pulmonary diseases. Because if high-flow oxygen is provided, the peripheral chemoreceptors' response to hypoxia will decrease in the short term, which will exacerbate respiratory suppression, leading to increased carbon dioxide retention and worsening the condition. Therefore, for Type II respiratory failure, low-flow continuous oxygen should be provided, with an oxygen flow rate controlled below 3 liters per minute.

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Causes of CO2 retention in respiratory failure

Respiratory failure manifests as hypoxia and the retention of carbon dioxide. The main cause of carbon dioxide retention is pathological changes in the respiratory system, such as chronic obstructive pulmonary disease with respiratory failure, status asthmaticus, pulmonary heart disease, lung cancer, etc. Some neuropathies that cause paralysis of the respiratory muscles can lead to respiratory dysfunction, resulting in the retention of carbon dioxide in the body, affecting normal cellular metabolism, causing disturbances in acid-base balance and nervous system function, and posing life-threatening conditions. The most important pathogenic mechanism causing carbon dioxide retention in these diseases is still inadequate alveolar ventilation.

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Is respiratory failure uncomfortable?

Respiratory failure is quite uncomfortable, and clinically, the symptoms feel severe, and the patient's own state is also very affected. Respiratory failure is mainly caused by a decrease in oxygen partial pressure, during which time the patient may experience wheezing, chest tightness, and even a feeling of being near death. There are many causes of respiratory failure, with severe infections being common, such as severe pneumonia or sepsis. A systemic inflammatory response can lead to respiratory failure. Another situation is when heart failure occurs, which can also accompany pulmonary congestion, causing pulmonary ventilation dysfunction that can also lead to respiratory failure. The treatment of respiratory failure focuses on removing the causative factors and selectively choosing different treatment plans, which can start with oxygen therapy or the use of a ventilator in severe cases to correct hypoxemia and sustain life.

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Can people with respiratory failure exercise?

Whether people with respiratory failure can exercise depends mainly on whether the respiratory failure occurred acutely or chronically. Generally, it is usually advised against exercising during acute respiratory failure, such as severe pulmonary inflammation, drowning, or failure of the nervous system functions. Exercise during this time can worsen the body's oxygen deficit and increase oxygen consumption, potentially exacerbating the symptoms of the disease. However, for chronic respiratory failure, such as chronic obstructive pulmonary disease (COPD) or chronic pulmonary interstitial fibrosis, patients have long been enduring hypoxia or hypercapnia. These individuals can engage in appropriate respiratory rehabilitation exercises, such as respiratory rehabilitation gymnastics and some traditional Chinese medicine practices, which can greatly aid in the recovery from the disease, particularly respiratory failure. The decision primarily depends on the patient’s specific condition and their physical tolerance.

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Care for patients with respiratory failure

Patients with respiratory failure are always emergency and critically ill patients in clinical settings. For patients with respiratory failure, we need to pay close attention in nursing: first, strictly monitor the patient's vital signs, observe the frequency of respiration, blood pressure, and consciousness state; take good care of the skin and oral cavity to prevent dependent pneumonia and bedsores; and timely remove the patient’s sputum. Encourage conscious patients to cough more and expectorate sputum. For those with weak coughs, assist regularly with turning and patting the back to facilitate the removal of sputum. For comatose patients, mechanical suction or tracheostomy for mechanical ventilation can be performed. At the same time, avoid factors that can induce respiratory difficulty such as cold air and poor air circulation. Patients with respiratory failure consume a lot of energy, especially those on mechanical ventilation, who are in a stress state with increased catabolism. Therefore, daily protein intake should be increased, encourage the patient to eat more to enhance nutrition, and provide a diet high in protein, high in fat, and low in carbohydrates.

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How to rescue respiratory failure

Respiratory failure is a very serious condition clinically, and if not handled promptly, many patients may have their lives endangered. The emergency measures for respiratory failure include the following. First, it is necessary to maintain the patency of the airway. If the patient is unconscious, the patient should be placed in a supine position with the head tilted back, the lower jaw lifted, and the mouth opened to clear the airway of secretions and foreign objects. If this is insufficient, tracheal intubation and other methods should be considered to maintain airway patency. Additionally, oxygen therapy, which involves inhaling oxygen, can correct the patient's hypoxic state. If the respiratory function is very poor, consideration should also be given to using a ventilator to assist breathing. Other emergency measures include etiological treatment, supportive treatment, and protecting the function of other vital organs, among others.