From the Guidelines
For a patient in respiratory distress, immediately administer supplemental oxygen via nasal cannula (2-6 L/min) or face mask (10-15 L/min) targeting oxygen saturation above 94% (88-92% for COPD patients) as the first line of treatment. This is based on the most recent and highest quality study available, which emphasizes the importance of timely oxygen therapy in managing respiratory distress 1.
Key Interventions
- Assess airway, breathing, and circulation while positioning the patient upright to maximize lung expansion
- Administer supplemental oxygen as described above
- Call for emergency medical assistance if available
- For bronchospasm, consider administering a short-acting bronchodilator like albuterol
- Continuously monitor vital signs including respiratory rate, heart rate, blood pressure, and oxygen saturation
Rationale
The immediate administration of oxygen is critical in managing respiratory distress, as it supports tissue oxygenation and can help alleviate hypoxemia 1. The use of supplemental oxygen via nasal cannula or face mask is recommended, with the target oxygen saturation levels being above 94% for most patients, but 88-92% for those with COPD to avoid inducing hypercapnia 1.
Additional Considerations
For patients with severe distress, preparation for potential intubation and mechanical ventilation is crucial, along with continuous monitoring of vital signs 1. The management of respiratory distress requires a prompt and multifaceted approach to prevent progression to respiratory failure and cardiopulmonary arrest.
Prioritization of Care
The prioritization of care should focus on maintaining airway patency, ensuring adequate oxygenation, and supporting circulation, with the goal of minimizing morbidity, mortality, and improving quality of life for the patient 1.
From the Research
Immediate Steps for a Patient in Respiratory Distress
The immediate steps for a patient in respiratory distress include:
- Giving oxygen 2, 3
- Moving the patient to the ICU if necessary 2, 4
- Calling for help to ensure the patient receives appropriate care 2
Assessment and Treatment
Assessment skills are crucial in creating a differential diagnosis for respiratory distress 2. The treatment plan should be based on the underlying cause of the respiratory distress, and local treatment protocols should be followed 2. Noninvasive positive pressure ventilation (NPPV) can be an effective treatment for acute hypercapnic respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease (COPD) 4.
Monitoring and Prevention of Further Decompensation
Monitoring of the respiratory patient is essential and can involve serial physical examination, pulse oximetry, and arterial blood gas analysis 3. Identifying patients at risk for respiratory compromise and monitoring those who have developed respiratory compromise can allow for earlier interventions to prevent or mitigate further decompensation 5. Classification of acutely ill respiratory patients into distinct subsets based on pathophysiological mechanisms can help in selecting the most appropriate screening and monitoring strategies 5.