Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

356 Chronic Respiratory Failure

■Enhanced suctioning facilitates nursing care

■Greater patient comfort, less sedation

■Allows aggressive physical therapy

Side Effects and Complications

■Intubation >3 wks: Impaired secretion clearance

➣Nosocomial pneumonia

➣Laryngeal stricture

➣Tracheomalacia

■Tracheostomy:

➣Perioperative hemorrhage

➣Swallowing dysfunction

➣Tracheal stricture

➣Tracheoinominate fistula

Contraindications to Weaning

■Absolut: Sepsis, pulmonary edema, myocardial ischemia, pneumo-

nia, bronchospasm

■Relative:

➣Severe musculoskeletal deconditioning

➣Malnutrition

➣Avoid anabolic steroids in the presence of hepatic dysfunction

or active infection.

➣Encephalopathy

➣Bronchitis and Hypersecretion

follow-up

During Treatment

■Assess nutrition with serial albumin, nitrogen balance, or respiratory

quotient.

■Titrate pressure support levels in increments of 2–5 cm H 2 Oto

achieve RR <25, RR/TV ratio <100

■Wean FiO 2 and pressure support to keep SpO 2 >90% or PaO 2 >60

mmHg

■Treat bronchospasm with albuterol aerosol.

Routine

■Serial CXRs

■Sedation as needed with narcotics and benzodiazepines for agitation

■Track progress with serial tidal volume and vital capacity measure-

ments q week

■Serial dead space measurement q 2–4 weeks.