Respiratory distress vs respiratory failure and how to treat them:
Respiratory Distress:
A patient is said to be in respiratory distress whenever they enter a state where they are not able to exchange sufficient levels of oxygen and CO2 at the alveolar level using a “normal” respiratory rate and rhythm. This can happen for a number of reasons, including pulmonary edema, COPD exacerbation, anaphylaxis, asthma, aspiration, etc. The key point being: this is an issue with OXYGENATION.
What we will see when assessing this patient is:
Tachycardia
Tachypnea
diminished SPO2
Accessory muscle use
Potentially tripod positioning
Agitation
Our first line treatment for any patient in obvious respiratory distress, is to address the oxygenation issue. This may be done using supplemental O2 or NIPPV devices such as CPAP or BIPAP. The goal here is to provide a higher FIO2, with will allow the patient to reduce the work they have to do in order to exchange gasses at the alveolar level. Ultimately we are trying to prevent further decompensation into respiratory failure.
Respiratory Failure:
Unlike respiratory distress, which is primarily a compensatory mechanism for impaired oxygenation, respiratory failure is a VENTILATION issue, arising from exhaustion caused by a prolonged period of respiratory effort. Like any other muscles, those used in breathing will tire in cases of significant exertion. A period of prolonged respiratory distress exhausts the body’s resources, and the failure point is reached.
In respiratory failure we see:
Diminishing LOC
Bradypnea (generally <8 breaths per minute)
Tachycardia gradually transitions to bradycardia
Worsening of SPO2
Elevated ETCO2
This is an issue with the ability of the patient to ventilate adequately, therefore our treatment is aimed at supporting those ventilations with a BVM.
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