Management of Respiratory Failure

Abstract

Respiratory failure (including both oxygenation and ventilation failure) is common in asthma, and is probably a mode of death in at least a subset of fatal cases of asthma. Good management of respiratory failure includes careful initial clinical assessment, measurement of expiratory flow, and assessment of oxygenation. Serial determinations of pulmonary function and ABG analysis can help determine the response to therapy. Supplemental oxygen should be administered in a controlled fashion and titrated by the results of ABC analysis. Aggressive treatment with inhaled β₂-agonists is the first line of therapy. Patients who fail to respond to several doses of sympathomimetics, or who obviously require admission to the hospital, should be treated with parenteral corticosteroids. Parasympatholytics may be useful adjuncts, and an adequate level of hydration should be maintained. Relatively few asthma patients treated in this way will require intubation and mechanical ventilation, For those who do, the duration of ventilation is often short. Efforts should be made to minimize barotrauma. Optimal management of respiratory failure in asthma may be an important factor in reducing mortality associated with this disease.