Acute Respiratory Failure

 Diagnostic criteria: Hypoxemic, Hypercapnic, or both - with signs of respiratory difficulty on exam

• Acute hypoxemic
• pO2 <60mmHg on RA per ABG, or
• SpO2 <91% on RA per pulse oximetry, or
• P/F ratio <300 on O2 - with new O2 need (not chronic supplemental oxygen-dependent)
• Acute on chronic hypoxemic
• worse dyspnea w/increased O2 need, or
• worse hypoxemia: decrease in baseline pO2 by >10mmHg or SpO2 <91% on usual home O2
• Example: home O2 at 2 L/min and baseline SpO2 >91%, but pt with dyspnea and requiring 4 L/min to keep SpO2 >91%
• Acute hypercapnic (acute retention, impaired ventilation)
• pCo2 > 50mmHg with pH <7.35
• Acute on chronic hypercapnic
• pCO2 > 50mmHg with pH <7.35, or
• increase in baseline pCO2 by ≥10mmHg on ABG

 Tip: COPD patients without home O2 need because baseline SpO2 >91% are not in chronic respiratory failure.

Examples of word specifiers:

• "acute hypercapnic respiratory failure with respiratory acidosis" (not just "pt has respiratory acidosis")
• "acute hypoxemic respiratory failure as evidenced by P/F ratio <300 on 3L/min supplemental oxygen" or pO2 <60mmHg on room air...
• "acute exacerbation of chronic hypoxemic respiratory failure requiring a increase in supplemental oxygen above baseline..."

"Respiratory insufficiency" describes a symptom and some sort of hypoxia, but probably in the pO2 60-79.9mmHg or SpO2 91-95% range.

• If patient meets diagnostic criteria for respiratory failure, you may be queried to specify.

Acute Respiratory Failure in Pediatrics (29 days -18 yrs); (neonates ≤28 days/old)

Diagnostic criteria: similar numbers to adults, but at UNMH consensus guideline is that neonate respiratory failure is defined by SaO2 ≤87% or requiring more than 3 LPM NC or requires High Flow Oxygen.

•  Hypoxemic respiratory failure
• pO2 < 60 mmHg on room air, or
• P/F ratio <300 on supplemental oxygen, or
• 10-15 mmHg decrease in pO2 from baseline (if known)
• Hypercapnic respiratory failure
• pCO2 > 50 mmHg with pH <7.35, or
• VBG in lieu of ABG
• End-tidal CO2 level >45 mmHg on capnography
• 10-15 mmHg increase in baseline pCO2 (if known)

Word specifics:

• In babies ≤28 days old, "respiratory insufficiency" = respiratory failure.
• In pediatric hospitalized patients, if SpO2 >87% on RA or not requiring more than 3 LPM NC, you can use "acute respiratory distress" to indicate higher severity of illness.
• Different than adults where we try not to use "acute respiratory distress" or "acute respiratory insufficiency."

 Tip: Check in these babies whether they require High Flow Oxygen before using either term (respiratory insufficiency or failure).

 Documentation guideline from Pediatrics team attached.

 UNM Pediatric Resp Failure Guidelines.doc