Critical Care Nursing/ theory
Lecture: 3
Lecturer: Bakhan.F.Sharif
Diffusion of gasses
(exchange of gasses)
ernal respir on Internal respira on
Definition
The lungs can't meet the body's needs for oxygen
(O₂) or can't remove enough carbon dioxide (CO₂).
This means there's either not enough oxygen in the
blood, too much CO₂, or both
Respiratory failure is a syndrome of inadequate gas
exchange due to dysfunction of one or more of
essential components of respiratory system:
✓ CNS (medulla)
✓ Peripheral nervous system (phrenic nerve)
✓ Respiratory muscles
✓ Chest wall
✓ Lung
✓ Bronchial tree
✓ Alveoli
Hypoxemic RF Hypercapnic RF
PaO2 < 60 PaCO2 > 50
mmHg
mmHg
Acute Respiratory Failure
• Hypoxemia- inadequate O2 transfer
– PaO2 of 60mmHg or less
Hypercapnia- insufficient CO2 removal
Increases PaCO2
– Type 1 – Type 2
• Hypoxemic RF ** • Hypercapnic RF
• PaO2 < 60 mmHg with • PaCO2 > 50 mmHg
normal or ↓ PaCO2 • Hypoxemia is common
❑ Associated with acute • Drug overdose,
diseases of the lung neuromuscular disease,
❑ Pulmonary edema chest wall deformity,
(Cardiogenic), COPD, and Bronchial
noncardiogenic (ARDS), asthma
pneumonia, pulmonary
hemorrhage, and collapse
Impaired ventilation(flow of air
Into &out of alviola)
Impaired gas exchange
Causes Air way obstruction
Perfusion abnormalities
Perfusion(bloodflow) without ventilation(airflow)
(Shunting)
• Shunting is the most common cause for hypoxemic
respiratory failure in ICU patients.
• the alveoli are perfused but not adequately
ventilated. Blood passes through these
areas of the lung without being adequately
oxygenated, which can lead to hypoxemia.
Perfusion without ventilation
(shunting)
• causes:
▪ Small airways occluded ( e.g asthma, chronic bronchitis)
▪ Alveoli are filled with fluid ( e.g pulm edema, pneumonia)
▪ Alveolar collapse ( e.g atelectasis)
▪ Pulmonary hemorrhage
Ventilation without Perfusion
(Dead space ventilation)
The Alveoli are ventilated but not adequately perfused, as can
happen in conditions like pulmonary embolism. In this situation,
the inhaled oxygen isn’t effectively transferred to the blood, and
the carbon dioxide isn’t effectively removed.
Dead space vantilation
Cause :
• Emphysema(damage of the wall of the alveoli ).
• Blood flow is reduced e.g CHF, PE
• Over distended alveoli e.g positive- pressure
ventilatio
Symptoms and signs
Symptoms and signs of hypoxemia
• Dyspnea, irritability
• Confusion
• Tachycardia, arrhythmia
• Tachypnea
• Cyanosis
Symptoms and signs of hypercapnia
• Headache
• Change of behavior
• Coma
• Warm extremities
stridor
cyanosis
headache
S&s PaCO2
> 50
PaO2 <
60
✓ History
✓ Arterial blood gases (ABG)
✓ Chest X-ray
✓ urinalysis, electrocardiogram (ECG), blood and
sputum cultures—to determine underlying cause
and patient's condition
Principles of management are:
1) Improving oxygenation & ventilation
2) Treating the underling cause
3) Reducing anxiety
4) Preventing & managing complication
1) Improving oxygenation & ventilation through:
A. Non invasive O2 therapy ( nasal & mask)
B. Bronchodilators & mucolytics agent
C. Chest physiotherapy & positioning
D. Suctioning
E. If fails, start mechanical ventilation
3) Reducing anxiety
A. Keep the calm environment
B. Explain what you are doing
C. Teach Breathing to slow the rate & increase depth
D. Give a small dose of anxiety(relaxation) medicine (like
diazepam)
Principles of management are:
4) Preventing & managing complication
A. Pulmonary aspiration
B. Barotrauma
C. Volutrauma
1. Monitor breathing: Check for signs of distress (dyspnea, tachypnea,
retractions, fatigue).
2. Check mental status: Watch for changes in LOC.
3. Monitor oxygen and CO₂ levels: Use ABG and SpO₂ readings.
4. Administer oxygen and medications: As prescribed (e.g., antibiotics,
diuretics).
5. Support airway clearance: Use nebulizers, elevate head, reposition
patient.
6. Track fluid balance: Monitor intake/output and daily weight.
7. Prepare for ventilation support: Be ready to assist with noninvasive or
mechanical ventilation if needed
