Chapter 29: Critical Care of Patients With Respiratory Emergencies

Acute respiratory failure (ARF) represents inadequate gas exchange resulting in hypoxemia, hypercapnia, or both, with causes ranging from chronic obstructive pulmonary disease exacerbation and pneumonia to pulmonary embolism and drug overdose. The condition presents in three forms: ventilatory failure involving impaired airflow, oxygenation failure characterized by diffusion impairment, and combined failure. Nurses recognize early warning signs including dyspnea, altered mental status, restlessness, tachycardia, and declining oxygen saturation, implementing immediate interventions such as upright positioning, oxygen delivery, airway maintenance, and preparation for ventilatory support. Acute respiratory distress syndrome (ARDS) represents a severe manifestation of hypoxemia distinguished by widespread alveolar inflammation and capillary permeability changes leading to noncardiogenic pulmonary edema, typically triggered by sepsis, trauma, aspiration, or massive transfusion. The defining characteristic is refractory hypoxemia resistant to high-concentration oxygen therapy, accompanied by bilateral chest infiltrates. Nursing interventions include early detection, mechanical ventilation with protective strategies using low tidal volumes and positive end-expiratory pressure, fluid management, and advanced techniques such as prone positioning and neuromuscular blockade. Mechanical ventilation modes including assist-control, synchronized intermittent mandatory ventilation, and pressure support ventilation require comprehensive monitoring of settings, lung sounds, oxygenation parameters, and prevention of complications such as barotrauma, volutrauma, and ventilator-associated pneumonia. The chapter emphasizes endotracheal intubation and tracheostomy management, including verification of tube placement, cuff pressure monitoring, secure positioning, and evidence-based suctioning. Weaning from mechanical ventilation involves systematic assessment of respiratory muscle function, gas exchange adequacy, and hemodynamic stability through spontaneous breathing trials. Comprehensive nursing care addresses infection prevention through oral care and secretion drainage, nutritional support, skin integrity, psychological support, and interprofessional collaboration. Communication strategies for intubated patients and education regarding ventilator dependence and pulmonary rehabilitation promote patient and family understanding during recovery.