Hypoxemic vs. Hypercapnic Respiratory Failure (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Hi, welcome to our respiratory video series.

    00:04 In this video, we're gonna take a look at respiratory failure, acute and chronic and the differences in between that.

    00:11 So we're gonna start off the pretty simple straightforward definition.

    00:15 What is respiratory failure? Respiratory failure is a syndrome, so that's when the respiratory system isn't able to function adequately for what the body needs.

    00:26 Now it can be hypoxemic or hypercapnic.

    00:30 Let's look at that first one, hypo-, -oxemic, right? I broke those two down because hypo- means "low", -ox- is talking about oxygen in the blood so when the respiratory system is in failure, it causes a low level of oxygen in the blood that's why we call it, hypoxemic respiratory failure.

    00:51 Now at the other end hypercapnic, hyper- means "high", If we're talking about -capnia, we're talking about the CO2 level in the blood, the carbon dioxide.

    01:01 So in respiratory failure causes a high level of carbon dioxide in the blood, it's called hypercapnic respiratory failure.

    01:10 Yeah trust me, you don't want either one of these.

    01:14 You want enough oxygen and not too much carbon dioxide in the blood in order to be breathing adequately.

    01:21 So respiratory failure is a syndrome.

    01:24 Now it might be low oxygen or extra high carbon dioxide, but either way it's respiratory failure.

    01:32 So do you have respiratory failure that's one or both? Well respiratory failure is failing in one or the other, so it's not just both have to be present but in respiratory failure, the respiratory system is failing either in one or both of the gas exchanges that it controls.

    01:50 Now the respiratory system's job is to bring oxygen in, take carbon dioxide out.

    01:56 So the patient may have one or both of these values way out of wack So this is the way we talk about respiratory failure, it's either type I or type II.

    02:07 type I is low oxygen, hypoxemic respiratory failure.

    02:12 Type II is hypercapnic - that's high CO2, high carbon dioxide respiratory failure.

    02:20 Now how do we determine which one it really is or what the problem is? We are gonna need to have arterial blood gases.

    02:28 We're gonna start off with type I - so this is low oxygen.

    02:32 Now how we technically define it is a PaO2, which I would find in an arterial blood gas, that's lower than 60 (mmHg) So I look at the ABG so I draw an arterial blood gas sample, the O2 would be lower than 60 (mmHg) but the CO2, the carbon dioxide is normal or a little bit low, that would make hypoxemic or type I respiratory failure.

    02:55 Now type I is the most common form of respiratory failure.

    03:00 It's usually caused by acute diseases of the lungs that cause the alveoli to fill with fluid or to collapse so you'll see a lot of type I respiratory failure.

    03:10 Now let's talk a little bit more of some of the diseases of the lungs that cause the alveoli to fill with fluid or collapse.

    03:16 Really feel like it today, pause the video and see if you can list out 3 to 4 diagnoses.

    03:29 Okay, let's see which of these you came up with.

    03:32 Some examples of type I respiratory failure are cardiogenic or noncardiogenic pulmonary edema.

    03:40 Now, -gen you think of producing something like 'genesis', cardiogenic means the heart caused the pulmonary edema.

    03:48 that means the heart couldn't pump efficiently and fluid start backing up into the lungs.

    03:54 Noncardiogenic pulmonary edema is still pulmonary edema but it's not the heart's fault.

    04:00 Pneumonia and pulmonary hemorrhage are other examples of what disease of the lungs that cause the alveoli to fill with fluid or collapse.

    04:09 So when you think of those two things we're going to end up in type I respiratory failure, pulmonary edema pneumonia or pulmonary hemorrhage Let's talk about type II, this is hypercapnic respiratory failure.

    04:25 Now this is when the carbon dioxide or the PaCO2 is higher than 50 (mmHg) on the arterial blood gases.

    04:32 Okay, now patient can also commonly have hypoxemia -low oxygen when they have hypercapnic respiratory failure if they're breathing room air.

    04:43 So we're looking at the marker, the definition of a CO2, a carbon dioxide that's higher than 50 (mmHg) on arterial blood gases, and also keeping in mind if they're breathing room air or probably also hypoxemic.

    04:58 So what can cause this, well these are some really sad stories.

    05:02 This could be a drug overdose, neuromuscular disease, something wrong with the chest wall, he might have a severe airway disorder like asthma, COPD, those chronic type diseases so you can also see hypercapnic respiratory failure which is type II.

    05:19 So pause for just a minute and make sure you're very clear on the differences of type I and type II, it's all about the O2 levels and the CO2 levels on arterial blood gases.

    About the Lecture

    The lecture Hypoxemic vs. Hypercapnic Respiratory Failure (Nursing) by Rhonda Lawes, PhD, RN is from the course Lung Disorders (Nursing).

    Included Quiz Questions

    1. Hypoxemia
    2. Hypercapnia
    3. Hypoventilation
    4. COPD exacerbation
    1. Hypercapnia
    2. Hypoxemia
    3. Acute respiratory distress syndrome (ARDS)
    4. Hyperventilation
    1. Arterial blood gases
    2. Chest X-ray
    3. Chest CT scan
    4. SpO2 monitor

    Author of lecture Hypoxemic vs. Hypercapnic Respiratory Failure (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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