What does respiratory failure look like?

  • May be agitated, confused or drowsy

  • May have a productive cough, with purulent secretions ( a sign of pneumonia). Patients ability to cough and clear secretions maybe altered by pain or muscle weakness.

  • May be present due to lung pathology either pushing (pneumothorax) or pulling (collapse) the trachea.

  • Could be low due to respiratory depression, or more often high to attempt to meet increased demands of the body when unwell. Patient may feel short of breath.

  • Might be reduced, increased or unequal.

  • Such as wheeze, crackles or reduced/ absent breath sounds.

  • Found in the shoulders, neck, upper chest and abdomen. Not often used in breathing at rest, so a sign of respiratory distress.

  • Or a gradual / sudden increase in oxygen demand to maintain target saturation

Assessment

  • Look

    Do they appear breathless?

    Are they using accessory muscles?

    Is chest expansion equal?

    Is the trachea central?

    Are there signs of cyanosis?

  • ear

    Listen

    Can they speak in full sentences?

    Can you hear secretions, cough, wheeze from the bedside?

    On auscultation is there equal air entry? Are there any added sounds?

  • touch

    Feel

    Is the chest expanding?

    Is the chest wall movement equal?

    Any chest wall abnormalities?

  • monitor

    Measure

    Count the respiration rate over 1 minute

    What are the saturations? And on how much oxygen?

Secondary data

  • This will tell you if the patient has a type 1 or type 2 respiratory failure. More information can be found in Skills – ABG. Remember in the acute setting, do not remove oxygen to take a blood gas as it puts the patient at unnecessary risk of hypoxia.

  • Chest x-ray

    CT scan

    Ultrasound

  • Peak flow

    Forced vital capacity (FVC)