Excellent Recovery In Type II Respiratory Failure
45 Yrs / Female, K/C/O HTN admitted with complaints of Breathlessness since 3 to 4 Days, Fever since 1 Day, Generalized Weakness & Pedal Oedema since 3 Days. Admitted outside and received Primary Treatment. Increased Breathlessness, desaturating during hospitalisation hence shifted to VishwaRaj Hospital at midnight 1 am. Patient received at emergency room with Tachypnea, Tachycardia and Desaturation. Bilateral wheezing present on auscultation. Primary management done at ER with Oxygen therapy by face mask. All required investigation such as X-Ray, ABG, Lab tests were done.
Management at ICU –
- ABG S/O Severe Respiratory Acidosis (Type II Respiratory Failure)
- Patient was unable to maintain Oxygen saturation with high ow oxygen hence was taken on Non Invasive Ventilator – BIPAP.
- After 2 Hrs, Patient is in Persistent Respiratory Acidosis & became Drowsy with increased tachypnea and tachycardia.
- In view of Co2 narcosis patient intubated and taken on invasive ventilation.
- Neuro Physician opinion taken for drowsiness.
- Post Intubation ABG done after 4 Hrs. Suggestive of Resolving Respiratory Acidosis.
- Patient ventilated for 24 Hrs.
- After ensuring hemodynamic stability and resolving acidosis patient was extubated on day 2nd.
- Patient was taken on Elective BIPAP.
- ABG improved on Day 3rd ( PH – 7.43, PCo2 – 52, Po2 – 93, Hco3 – 33.9, LACT – 0.74 on 35% fio2 ) off NIV trial was given.
1. Early Identification of Type II Respiratory Failure.
2. Effective Utilization of NIV.
3. Vigilant “Respiratory & Neuro Monitoring” during NIV.
4. Avoid Delay in Intubation.
5. Post Extubation NIV.
Dr Kapil Borawake
Dr Vijay Khandale
Dr Sushant Shinde
Dr Sanesh Garde
Dr Mahabal Shah
Dr Subhash Auti
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