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Respiratory Insufficiency Research Paper
Gregory Go
Stanbridge University
PHIL 2010: Critical Reasoning and Ethics
Professor Allison Lyon
December 10, 2023
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Respiratory Insufficiency Research Paper
Introduction
Gasping for each breath can mark a dire health crisis: respiratory insufficiency. When
lungs fail to gather ample oxygen, both mind and body suffer—oxygen fuels them. We inhale
air; our lungs purge carbon dioxide—a cellular byproduct. Life hinges on this exchange. Blood
must carry oxygen from our lungs to nourish organs and tissues. Carbon dioxide overload can
harm these vital parts, starving or delaying the delivery of life-giving oxygen. Without warning,
breathing may halt abruptly—an acute event sparked by ailments like pneumonia or trauma such
as opioid overdose and stroke; perhaps a spinal cord mishap plays its part too. A gradual onset
exists: chronic respiratory failure, it's known as. Telltale signs may include breathlessness—as if
starved for air—fatigue hitting hard, exercise becoming a challenge (once routine), overpowering
sleepiness creeps in (van Goor et al., 2022). To confirm such failure, doctors assess blood for gas
levels: How fast does one breathe? Are breaths shallow? They measure lung exertion too while
considering lung function test outcomes. Treatments may demand added oxygen—through nasal
tubes or even ventilators—if severity calls for it. With myriad causes yet ample treatments
researched thoroughly, respiratory insufficiency stands out as prime material—for study and
expanded understanding.
Background
Respiratory insufficiency can be seen as the impairment of respiratory gas exchange
between the ambient air and circulating blood. Check arterial blood gases for all those gravely ill
or with signs of lung fail. A must: chest x-rays. Echocardiography—often not routine, yet it can
prove handy at times. PFTs might offer insight; while an ECG is vital to rule out heart issues
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causing lung woes, and it might spot bad rhythms due to low oxygen or high acid in the blood.
Some debate the value of right-heart cath tests.The main risk being organ failure due to lack of
air (hypoxemia). Once hypoxemia is addressed, stabilize breathing and blood flow, we must hunt
down and fix what caused the lung fail. Treatments will hinge on why the lungs failed first off.
Respiratory failure strikes when the lungs fail at one or both tasks: adding oxygen to and
taking carbon dioxide out of the blood. Medics split this condition into hypoxemic or
hypercapnic types (Murat Kaynar, 2021). Type I, known as hypoxemic respiratory failure,
happens with an arterial oxygen level (PaO2) below 60 mm Hg but normal or low CO2 pressure
(PaCO2). Most lung diseases that happen fast—like fluid buildup or alveoli collapse—can lead
to this kind. Fluid in the heart's sac, infection in the lungs, and bleeding within them serve as
prime examples. Type II—or hypercapnic respiratory failure—shows a PaCO2 above 50 mm Hg.
Patients breathing plain air often have low oxygen levels too.
Bicarbonate levels, which play an important part in this process, tend to fluctuate in
relation to the duration that one's carbon dioxide levels have been elevated. This type may stem
from overdose, muscle nerve issues, odd chest walls, or severe airway problems—for instance
asthma or COPD. One can also describe these failures as acute or chronic; acute cases are lifethreatening with quick changes in blood gases and body acid balance while chronic ones are less
obvious without immediate danger signs. Acute hypercapnic failures take place within minutes
to hours leading to pH values under 7.3; renal adjustments don't have time to kick in fully for
bicarbonate increase. Yet over days—and sometimes more—the body adjusts and ups its
bicarbonate thus not greatly dropping pH levels. Telling apart between long-term low oxygen
failures versus sudden ones just by looking at blood gases is tricky indeed! Signs like increased
red cell count—or heart strain due to lung disease—hint at persistent issues.
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Fallacies, Myths, Emotions, and Biases
Often associated with any illness are the false claims associated with the illness to either
reflect relaxation or despair. Some of these include “respiratory insufficiency is rare”, “only
smokers develop respiratory insufficiency”, “people with respiratory insufficiency cannot
exercise”, “shortness of breath is the only symptom of respiratory insufficiency”, and “a healthy
diet cannot help with respiratory insufficiency” (Newman, 2021). Contrary to these popular
beliefs, there is proof in numbers and research, evidencing that these claims are wrong. While
some of the notions put forth included the uncommonness of respiratory insufficiency, the idea
that only smokers develop such a condition, the inability of those with respiratory insufficiency
to exercise, shortness of breath being solely symptomatic, and diet having no impact, Newman in
2021 has challenged several of these preconceived notions. Contrary to these popular beliefs,
there is proof in numbers and research, evidencing that these claims are wrong. According to the
World Health Organization, respiratory insufficiency caused over 4 million deaths in 2019,
making it the third leading cause of death worldwide (Newman, 2021).
While tobacco smoking remains a primary cause of respiratory deficiencies, other
environmental factors such as air pollution, occupational hazards, infections, and particular
asthma types also notably endanger lung health. Approximately "10–20% of COPD patients
never smoked" and can develop it due to "secondhand smoke exposure, genetic predisposition,
or substantial exposure to air pollution” (Newman, 2021). A healthy diet can help respiratory
insufficiency patients. Healthier diets rich in fruits and fish, likely owing to their fiber and
omega-3 content respectively, have been found by studies exploring links between dietary
patterns and COPD to correlate with a decreased prevalence and risk of the disease, whereas less
nutritious eating habits devoid of such protective associations fail to share these benefits.
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Exercise is actually recommended for respiratory insufficiency patients and can "increase
their breathing capacity and improve their daily symptoms" according to doctors, though it may
be difficult without proper guidance (Newman, 2021).
Case Study
Gunter Schleicher, Warren Lowman, and Guy Richards conducted a study on a patient
with asthma and Covid-19, documenting the patient’s treatment plan associated with his
respiratory insufficencies. Patient care was impacted in several ways throughout this case study:
Asthma marked the patient for a tough fight against severe Covid-19 infection; hospital
admission soon followed his deteriorating health. The case study warns, "Long-term
corticosteroid users like asthmatics...might fail to rally an effective immune defense and thus are
vulnerable to harsh impacts from a Covid-19 attack. Following his admittance, no progress came
from antiviral meds alone. Over 5 days, "His condition plunged further downhill despite these
drugs," says the case study (Schelicher et al., 2020). Markers in his blood also climbed sharply—
proof that usual methods fell short. Soon after, he faced hyperinflammatory syndrome—CRS and
ARDS—to signal grave danger. The study paints a grim picture: this state brings worsening
ARDS, organ failures (MODS), blood clotting woes, heart inflammation—and often death.
Doctors turned to corticosteroids (methylprednisolone) plus tocilizumab for treatment as
they saw signs of hyperinflammation setting in. Relief was quick; within one day's time, he
showed clear gains in health markers and symptoms eased enough so mechanical breath support
wasn't needed.
To conclude and summarize the case study, initial high-risk due to asthma was noted by
the case study; typical remedies lacked effect; the disease advanced fiercely but tackling the
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hyperinflammatory phase with specific drugs brought swift improvement—a win for patient care
and healing.
Evidence-Based Practice
In order to provide the highest quality evidence-based patient care, it is imperative that
one incorporates the most recently validated research that is directly applicable to the precise
type of care being administered. Looking into the article regarding evidence-based practice for
patients with respiratory insufficiency, a deep analysis will be conducted on Ervin and her
colleague’s research.
The evidence they provided conducted a systematic review of other review studies and
guidelines to identify evidence-based practices that are recommended for treating patients
receiving invasive mechanical ventilation for acute respiratory failure or acute respiratory
distress syndrome (ARDS). It identified 20 evidence-based practices supported by over 117
individual studies involving more than 30,000 patients (Ervin et al.,2020). These practices
covered the full continuum of care - from intubation and initiating mechanical ventilation, to
preventing complications during ventilation, to safely removing ventilation. Some of the key
evidence-based practices included using “low tidal volumes for lung-protective ventilation,
conditional recommendations for higher positive end-expiratory pressure and prone positioning
for moderate-severe ARDS, protocols to minimize sedation and delirium, early mobility, and
ventilator liberation protocols” (Ervin et al., 2020).
Their research categorized the 20 evidence-based practices into the three phases of care:
6 related to intubation and escalating care, 10 for preventing complications, and 4 for safely
removing ventilation. It noted that optimizing the whole continuum is important rather than
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focusing on individual parts. In summary, Ervin was able to identify and organize the current
best practices for invasive ventilation based on various guidelines and reviews, to help clinicians
provide optimal care across the full process for patients with respiratory failure or ARDS.
Improved survival rates and quality of life after critical respiratory illness will lead to better
long-term outcomes for these patients.
Conclusion
From the background of respiratory insufficiency to fallacies associated with the illness
paired with evidence-based practice, studies and research can conclude that the illness can be
severe or mild, varying from each individual case. Along with the condition of the illness comes
the treatments that are currently valid within the medical community. With ongoing research,
new treatments may emerge that can better manage symptoms and improve quality of life for
those living with the condition. There is hope that future research will lead to more effective
treatments leading to better patient outcomes and a decreased amount in population mortality
rates because of respiratory insufficiency.
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References
Ervin, J. N., Rentes, V. C., Dibble, E. R., Sjoding, M. W., Iwashyna, T. J., Hough, C. L., Ng
Gong, M., & Sales, A. E. (2020). Evidence-Based Practices for Acute Respiratory Failure
and Acute Respiratory Distress Syndrome: A Systematic Review of Reviews. Chest,
158(6), 2381–2393. https://doi.org/10.1016/j.chest.2020.06.080
Murat Kaynar, A. (2021). Respiratory Failure. Medscape.
https://emedicine.medscape.com/article/167981-overview?form=fpf
Newman, T. (2021). 11 myths about COPD. Medical News Today.
https://www.medicalnewstoday.com/articles/medical-myths-all-about-copd
Schleicher, G. K., Lowman, W., & Richards, G. A. (2020). Case Study: A Patient with Asthma,
Covid-19 Pneumonia and Cytokine Release Syndrome Treated with Corticosteroids and
Tocilizumab. Wits Journal of Clinical Medicine, 2(SI), 47–52.
https://doi.org/10.18772/26180197.2020.v2nSIa9
van Goor, H. M. R., Vernooij, L. M., Breteler, M. J. M., Kalkman, C. J., Kaasjager, K. A. H., &
van Loon, K. (2022). Association of Continuously Measured Vital Signs With
Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort
Study. Interactive journal of medical research, 11(2), e40289.
https://doi.org/10.2196/40289