Lightning Learning: Respiratory Failure
Acute hypercapnic respiratory failure is seen on an ABG and is defined as:
PaCO2 > 6kPa
pH < 7.35
There is often an element of hypoxia, which can be corrected with supplemental oxygen to a target SaO2 of 88-92%.
Hypercapnia can result in:
Exacerbations of COPD can lead to retention of CO2 and 1-in-5 results in AHRF. This can be life-threatening. Following maximal medical management, non-invasive ventilation can be used to improve patient's own respiratory effort. Contraindications to NIV.
Absolute: Severe facial deformity, Facial burns, Fixed upper airway obstruction
Relative: pH <7.15, pH <7.25 and additional, adverse features, GCS <8,Agitation/confusion, Cognitive impairment
- NICE Guidance: Chronic obstructive pulmonary disease in over 16s
- BTS/ICS: Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults
- RCEM Learning: Chronic Obstructive Pulmonary Disease
- #EM3: How to set up an NIV (video)