Principles of management

1. Ensure SaO2 compatible with survival (i.e. usually >80%, preferably >90-95%)

2. Correct abnormality where possible, e.g. drain pneumothorax, relieve/bypass obstruction.

3. Support therapy until recovery

• Positive pressure ventilation

• Non-invasive respiratory support

• Pharmacological treatment, e.g. bronchodilators, antibiotics, opiate antagonists, respiratory stimulant

• General measures, e.g. hydration, airway humidification, removal of secretions, physiotherapy, bronchoscopy

4. Unless the patient is symptomatic (e.g. drowsy, dyspnoeic) while being mechanically ventilated, the PaCO2 may be left elevated to minimise ventilator trauma (permissive hypercapnia).Higher PaCO2 values may also be tolerated if the patient is chronically hypercapnic (Type II respiratory failure).


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