Clinical Case Database / Category: Patient Management

Management of acute type 2 respiratory failure

Publication details

S Paramothayan
Foundation Years Journal, volume 5, issue 9, p.44 (123Doc Education, London, October 2011)

Abstract

Acute type 2 (hypercapnic) respiratory failure is a potentially life-threatening complication that is more likely to develop in patients with certain underlying conditions. The morbidity and mortality from the consequent disturbance in acid-base balance can be significant. In hospital it can develop as the result of inappropriate oxygen therapy and is therefore often preventable. Awareness of those at risk and an understanding of the principles of oxygen therapy can prevent it from developing in many cases. Patients with type 2 respiratory failure may develop confusion, irritability and decreased consciousness although the diagnosis can only be made by arterial blood gas (ABG) interpretation. The precipitating cause can be determined by routine investigations, including chest X-ray and bloods tests. The immediate management includes treatment of the underlying cause, careful prescribing and monitoring of oxygen therapy (by serial ABGS) and the commencement of non-invasive positive-pressure ventilation (NIPPV), usually Bi-level Positive Airways Pressure (BiPAP), the use of which is supported by evidence from randomized controlled trials (RCTs) and included in national guidelines. Although NIPPV has significantly improved mortality and morbidity in patients with type 2 respiratory failure, there are contraindications. When BiPAP is contraindicated or not tolerated, respiratory stimulants can be administered. As many patients who develop type 2 respiratory failure have severe, chronic disease, there are ethical issues regarding escalation of treatment and invasive ventilation in the Intensive Care Unit (ICU).

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Authors

S Paramothayan

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References

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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