Identifying respiratory failure in patients involves careful analysis of clinical symptoms, diagnostic tests, and consideration of underlying conditions. The clinical presentation commonly includes signs of hypoxia or hypercapnia, such as dyspnea, tachypnea, and altered mental status Nitu & Eigen, 2009). Initially, the use of quantitative waveform capnography (EtCO2) and pulse oximetry (SpO2) can assist in the early identification of respiratory failure, through the observation of EtCO2 raising, Respiratory Rate Rising, and SpO2 falling. Measurements of arterial blood gases (ABGs) are useful for confirming respiratory failure, typically indicating hypoxemia (PaO2 < 60 mmHg) or hypercapnia (PaCO2 > 50 mmHg) following initial management goals (Nitu & Eigen, 2009; Hasan et al., 2020).
In patients with underlying conditions, such as myasthenia gravis (MG) or chronic obstructive pulmonary disease (COPD), the identification of respiratory failure becomes more nuanced due to the complexity of these diseases.
In COVID-19 patients, two-thirds have been reported to develop respiratory failure, particularly associated with pneumonia and significant inflammatory responses (Ohuabunwa et al., 2022; . This underscores the importance of comprehensive assessment in older adults with viral infections, where specific characteristics can predict the likelihood of respiratory failure and related mortality (Ohuabunwa et al., 2022). The role of noninvasive ventilation is becoming increasingly acknowledged as an effective strategy to manage acute respiratory failure in these populations, significantly reducing mortality in severe cases (Pavliša, 2023; Bhurayanontachai, 2021).
Myasthenia gravis is another condition that demands attention when considering respiratory failure. Respiratory muscle weakness can be life-threatening, with individuals potentially experiencing myasthenic crises that necessitate mechanical ventilation (Shiozumi et al., 2023). It is significant that respiratory failure often manifests as a presenting symptom in MG, particularly in cases involving muscle-specific kinase (MuSK) antibodies, emphasizing the need for vigilance in recognizing these symptoms early (Shiozumi et al., 2023; Wang et al., 2024). Reports suggest that myasthenic crises may occur in approximately 7.7% of MG patients, complicating their clinical management (Shiozumi et al., 2023).
Moreover, patients with relapsing polychondritis may present with respiratory failure during sedation due to underlying muscle weakness affecting ventilation (Lee et al., 2022). In advanced COPD, chronic daytime hypercapnia can precede significant respiratory events, and nocturnal hypoventilation, often linked to sleep-disordered breathing, can contribute to ongoing respiratory insufficiency (Lee et al., 2022). A thorough understanding of these diverse presentations across various underlying conditions is crucial in identifying and appropriately managing respiratory failure in patients.
In summary, the identification of respiratory failure relies on a combination of clinical assessment, laboratory analysis, and an understanding of the patient's medical history and coexisting conditions. The integration of these factors is essential for timely intervention and improved patient outcomes in respiratory distress scenarios, particularly in conditions known to predispose individuals to acute respiratory failure, such as COVID-19, MG, and COPD (Ohuabunwa et al., 2022; Shiozumi et al., 2023; Lee et al., 2022; Nitu & Eigen, 2009).
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