Respiratory evaluation of patients requiring ventilator support due to acute respiratory failure


This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully evaluated by nurses, physiotherapists, respiratory care practitioners and physicians regarding the elucidation of the cause of the acute episode of respiratory failure by means of physical examination with the measurement of respiratory parameters and assessment of arterial blood gases analysis to make a correct respiratory diagnosis. After the initial evaluation, the patient must quickly receive adequate oxygen and ventilatory support that has to be carefully monitored until its discontinuation. When available, a noninvasive ventilation trial must be done in patients presenting desaturation during oxygen mask and or PaCO2 retention, especially in cases of cardiogenic pulmonary edema and severe exacerbation of chronic obstructive pulmonary disease. In cases of noninvasive ventilation trial-failure, endotracheal intubation and invasive protective mechanical ventilation must be promptly initiated. In severe ARDS patients, low tidal ventilation, higher PEEP levels, prone positioning and recruitment maneuvers with adequate PEEP titration should be used. Recently, new modes of ventilation should allow a better patient-ventilator interaction or synchrony permitting a sufficient unloading of respiratory muscles and increase patient comfort. Patients with chronic obstructive pulmonary disease may be considered for a trial for early extubation to noninvasive positive pressure ventilation in centers with extensive experience in noninvasive positive pressure ventilation.

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Barbas, C. , Lopes, G. , Vieira, D. , Couto, L. , Dourado, L. and Caser, E. (2012) Respiratory evaluation of patients requiring ventilator support due to acute respiratory failure. Open Journal of Nursing, 2, 336-340. doi: 10.4236/ojn.2012.223049.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] McLean, B.A. (2012) Acute respiratory failure and intensive measures. Critical Care Nursing Clinics of North America, 24, 361-375. doi:10.1016/j.ccell.2012.06.008
[2] Ricard, J.D. (2012) High flow nasal oxygen in acute respiratory failure. Minerva Anestesiol, 78, 836-41.
[3] Sferrazza P.G.F., Di Marco, F., Akoumianaki, E. and Brochard, L. (2012) Recent advances in interfaces for noninvasive ventilation: From bench studies to practical issues. Minerva Anestesiol, 78, 1146-1153.
[4] Pisani, L., Carlucci, A. and Nava, S. (2012) Interfaces for noninvasive mechanical ventilation: Technical aspects and efficiency. Minerva Anestesiol, 78, 1154-1161.
[5] Keenan, S.P., Sinuff, T., Burns, K.E., Muscedere, J., Kutsogiannis, J, Mehta, S., Cook, D.J., Ayas, N., Adhikari, N.K., Hand, L., Scales, D.C., Pagnotta, R., Lazosky, L., Rocker, G., Dial, S., Laupland, K., Sanders, K., Dodek, P. and Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group (2011) Clinical practice guidelines for the use of noninvasive positive-pressure ventilation andnoninvasive continuous positive airway pressure in the acute care set- t
[6] Brochard, L., Martin, G.S., Blanch, L., Pelosi, P., Belda, F.J., Jubran, A., Gattinoni, L., Mancebo, J., Ranieri, V.M., Richard, J.C., Gommers, D., Vieillard-Baron, A., Pesenti, A., Jaber, S., Stenqvist, O. and Vincent, J.L. (2012) Clinical review: Respiratory monitoring in the ICU: A consensus of 16. Critical Care, 16, 219.
[7] Domingo, C., Blanch, L., Murias, G. and Luján, M. (2010) State-of-the-Art Sensor Technology in Spain: Invasive and non-invasive techniques for monitoring respiratory variables. Sensors (Basel), 10, 4655-4674. doi:10.3390/s100504655
[8] Kipnis, E., Ramsingh, D., Bhargava, M., Dincer, E., Cannesson, M., Broccard, A., Vallet, B., Bendjelid, K. and Thibault, R. (2012) Monitoring in the Intensive Care. Critical Care Research and Practice, 2, 473-507.
[9] Ortega, R., Connor, C., Kim, S., Djang, R. and Patel, K. (2012) Monitoring ventilation with capnography. New England Journal of Medicine, 367, e27.
[10] Kallet, R.H. (2012) Measuring dead-space in acute lung injury. Minerva Anestesiol, 78, 1297-1305.
[11] Papazian, L., Forel, J., Gacouin, A., Penot-Ragon, C., Perrin, G., Loundou, A., et al. (2010) Neuromuscular blockers in early acute respiratory distress syndrome. The New England Journal of Medicine, 363, 1107-1116. doi:10.1056/NEJMoa1005372
[12] The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England Journal of Medicine, 342, 1301e8.
[13] Burns, K.E.A., Adhikari, N.K.J., Slutsky, A.S., Guyatt, G.H., Villar, J., Zhang, H.B., Zhou, Q., Cook, D.J., Stewart, T.E. and Meade, M.O. (2011) Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: A systematic review and meta-analysis. PLoS One, 6, e14623. doi:10.1371/journal.pone.0014623
[14] Amato, M.B., Barbas, C.S., Medeiros, D.M., Magaldi, R.B., Schettino, G.P., Lorenzi-Filho, G., Kairalla, R.A., Deheinzelin, D., Munoz, C., Oliveira, R., et al.(1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. The New England Journal of Medicine, 338, 347-354. doi:10.1056/NEJM199802053380602
[15] Villar, J., Kacmarek, R.M., Perez-Mendez, L. and Aguirre-Jaime, A. (2006) A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: A randomized, controlled trial. Critical Care Medicine, 34, 1311-1318. doi:10.1097/01.CCM.0000215598.84885.01
[16] Briel, M., Meade, M., Mercat, A., Brower, R.G., Talmor, D., Walter, S.D., Slutsky, A.S., Pullenayegum, E., Zhou, Q., Cook, D., Brochard, L., Richard, J.C., Lamontagne, F., Bhatnagar, N., Stewart, T.E. and Guyatt, G. (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: Systematic review and meta-analysis. Journal of the American Medical Association, 303, 865-873. doi:10.1001/jama.2010.218
[17] Abroug, F., Ouanes-Besbes, L., Dachraoui, F., Ouanes, I. and Brochard, L. (2011). An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury. Critical Care, 15, R6. doi:10.1186/cc9403
[18] Marini, J.J. (2010) Safer ventilation of the injured lung: One step closer. Critical Care, 14, 192. doi:10.1186/cc9028
[19] Barbas, C.S., Matos, G.F.J., Amato, M.B.P. and Carvalho, C.R.R. (2012) Goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome. Critical Care Research and Practice, 2012, 952168. doi:10.1155/2012/952168
[20] Younsuck, K. (2007) Ventilatory management in patients with chronic airflow obstruction. Critical Care Clinics, 23, 169-181.
[21] Marini, J.J. (2011) Dynamic hyperinflation and auto-positive end-expiratory pressure: Lessons learned over 30 years. American Journal of Respiratory and Critical Care Medicine, 184, 756-762.
[22] Glossop, A.J., Shepherd, N., Bryden, D.C. and Mills, G.H. (2012) Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: A meta-analysis. British Journal of Anaesthesia, 109, 305-314. doi:10.1093/bja/aes270
[23] Moerer, O. (2012) Effort-adapted modes of assisted breathing. Current Care, 18, 61-69.

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