レッスン: 急性呼吸不全 V: 共同ケア

Oxygen therapy begins with low-flow devices like nasal cannulas at 1-2 L/min or Venturi masks at 24-28% oxygen concentration for responsive patients. Unresponsive patients or those with severe hypoxemia require mechanical ventilation with higher oxygen concentrations. Device selection depends on the patient's respiratory status, ability to maintain an open airway, and capacity to breathe spontaneously.

Short-acting bronchodilators relax lung muscles and expand airways, promoting easier breathing and improved respiratory function. Intravenous corticosteroids reduce airway inflammation and bronchospasm. Together, these medications address the underlying airway obstruction and inflammatory response, facilitating better oxygenation and ventilation in acute respiratory failure.

Effective secretion management combines vigorous coughing, chest physiotherapy with percussion and vibration, and suctioning through nasal or oral catheters. Humidification using aerosols of sterile normal saline or mucolytic drugs via nebulizer prevents secretion drying. Adequate hydration of 2-3 liters daily thins secretions, facilitating removal and promoting ciliary clearance.

Adequate nutrition supports immune function, wound healing, and preserves respiratory muscle strength. Calorie intake must be personalized to avoid overfeeding, which increases carbon dioxide production and oxygen consumption. Sufficient protein prevents muscle wasting, while micronutrients like Vitamin C, Vitamin D, Zinc, and Selenium enhance immune response and recovery.

Antibiotics combat bacterial infections that may cause or complicate acute respiratory failure. Intravenous diuretics alleviate pulmonary congestion by eliminating excess fluid in the lungs, improving oxygenation and ventilation. Drug selection depends on identifying the underlying cause and addressing specific infection types or fluid overload conditions.

Continuous monitoring tracks respiratory status changes, arterial blood gas trends, and clinical improvement signs. Arterial blood gas analysis identifies acid-base imbalances and hypoxemia severity, guiding oxygen therapy adjustments. Collaborative healthcare teams use this data to tailor respiratory support, drug therapy, and interventions based on patient response.

Positioning patients upright or in tripod position promotes airflow and secretion drainage. Early ambulation when feasible enhances respiratory function and prevents complications. Proper patient positioning, combined with techniques from pneumonia nursing management and prevention, reduces infection risk and supports overall recovery in acute respiratory failure.