PREVENTING RESPIRATORY FAILURE

Certain patients in hospital are at greater risk than others of developing respiratory problems such as pneumonia. Identifying these patients early, instituting preventative measures and identifying the early signs of deterioration can reduce the morbidity associated with respiratory failure.

Patients at risk:

• Immobile patients
• Increasing age
• Obese patients
• Post operative patients (particularly post abdominal surgery)
• Pre-existing lung problems (e.g. COPD, asthma)
• Smokers

Measures to prevent respiratory deterioration:

• Identify patients at risk
• Monitor NEWS2
• Ensure patient’s own bronchodilators prescribed and given
• Regular physiotherapy & deep breathing exercises
• Mobilise
• Ensure adequate analgesia if post operative (abdominal pain will prevent adequate deep breathing and predisposes to chest infections)
• Saline nebulisers and humidified Oxygen therapy to prevent drying of secretions
• Risk assess for thromboprophylaxis (to prevent pulmonary embolism)
• Early sputum cultures and blood cultures if signs of chest infection
• Prompt antibiotic therapy if appropriate

Patients who have a respiratory arrest normally have a period of deterioration with the patient becoming increasingly fatigued prior to the arrest.  Signs of tiring include increasing respiratory rate, using accessory muscles of breathing, sweating, declining tidal volumes, gasping or irregular breathing, paradoxical abdominal movements, confusion, agitation and obtundation. If there are signs of imminent respiratory arrest then it is necessary to assist ventilation with a bag and mask until further help arrives.