Page 375 - ACCCN's Critical Care Nursing

Respiratory Alterations
14 and Management

Maria Murphy
Sharon Wetzig
Judy Currey

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required mechanical ventilation; a statistic of 41% in
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Learning objectives 2008. Failure or inadequate function of the respiratory
system occurs as a result of direct or indirect pathophysio-
After reading this chapter, you should be able to: logical conditions. The process of mechanical ventilation
● describe the pathophysiological mechanisms of acute may also injure a patient’s lungs, further impacting func-
respiratory failure (ARF) and key principles of patient tioning of the respiratory system. Preventing or minimis-
management ing ventilator-associated lung injury is therefore also a
● differentiate between hypoxaemic (type I) and primary goal of patient care. Chapter 13 described the
hypercapnoeic (type II) respiratory failure relevant anatomy and physiology and assessment and
● outline the incidence of respiratory alterations in the monitoring practices for a patient with life-threatening
Australasian critical care context respiratory dysfunctions. This chapter describes the
● discuss the aetiology, pathophysiology, clinical incidence, pathophysiology, clinical manifestations and
management of common respiratory disorders that result
manifestations and management of common respiratory in acute respiratory failure, specifically pneumonia
disorders managed in intensive care, specifically (including discussion of respiratory epidemics), asthma,
pneumonia, respiratory epidemics, asthma, chronic chronic obstructive pulmonary disease (COPD), acute
obstructive pulmonary disease (COPD), acute lung injury lung injury (ALI), pneumothorax and lung transplanta-
(ALI) and pneumothorax tion. Discussion of oxygenation and ventilation strategies
● describe the evidence base for key components of nursing to support respiratory function during a critical illness is
and collaborative practice involved in the management of presented in Chapter 15.
patients with ARF in ICU
● outline the principles and immediate postoperative
management for lung transplant recipients. INCIDENCE OF RESPIRATORY
ALTERATIONS
Respiratory diseases are common and affect significant
numbers of the population in Australia, accounting for
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Key words almost half of all hospital admissions. These diseases are
also the most common illness responsible for emergency
admission to hospital, the most common reason to visit
acute respiratory failure a general practitioner and represent the most commonly
acute respiratory distress syndrome reported long-term illnesses in children. Despite these
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hypoxaemic respiratory failure findings, the incidence of respiratory alterations is diffi-
hypercapnoeic respiratory failure cult to quantify as the number of patients who require
influenza admission to hospital as a result of respiratory disease
oxygenation represent a small proportion of the total number affected.
ventilator-associated pneumonia Further, patients who require admission to ICU as a result
of respiratory disease represent only a fraction of all hos-
pital admissions. 5,6
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INTRODUCTION Data presented in Table 14.1 illustrates the total number
of patients (adults and children) admitted to hospital as
The most common reason that patients require admis- a result of a range of respiratory diseases. While it is dif-
sion to an intensive care unit (ICU) is for support of their ficult to determine the number of patients in each diag-
respiratory system. Over the last decade, almost half of nostic group who required admission to ICU as part of
352 all patients admitted to ICU in Australia and New Zealand their management, ICU admissions account for around