For ventilatory failure

Emergency use Nalmefene is not the primary treatment for ventilatory failure. In most emergency settings, treatment with nalmefene should follow, not precede, the establishment of a patent airway, ventilatory assistance, administration of oxygen, and establishment of circulatory access. 

Premature failure can also occur as a result of lack of attention to design. Facilities should, therefore, be provided for ventilatory drainage of water (rain, condensation, etc.), and all structures should be designed so as to permit ready access for repainting. Due consideration by architects and structural engineers at the design stage can indeed help to obviate certain of the causes of paint failure mentioned in this section (see also Sections 9.3 and 11.5). 

The term analeptics refers to convulsants and respiratory stimulants (i.e. central nervous system stimulants). They comprise a reverse group of agents (for example amphifrnazole and doxapram (respiratory stimulants) and strychnine, biculline and picrotoxin). Analeptics are mainly experimental drugs. Only amphifrnazole and doxapram are occasionally used for the treatment of acute ventilatory failure. 

Respiratory acidosis is characterized by a reduced arterial pH, a primary increase in the arterial PaC02 and, when present for sufficient time, a compensatory rise in the HCOf concentration. Because increased C02 is a potent respiratory stimulus, respiratory acidosis represents ventilatory failure or impaired central control of ventilation as opposed to an increase in C02 production. As such, most patients will have hypoxemia in addition to hypercapnia. The most common etiologies of respiratory acidosis are listed in Table 25-6. 

In order to effectively treat respiratory acidosis, the causative process must be identified and treated. If a cause is identified, specific therapy should be started. This may include naloxone for opiate-induced hypoventilation or bronchodilator therapy for acute bronchospasm. Because respiratory acidosis represents ventilatory failure, an increase in... 

A 36-year-old HIV-infected woman who had been receiving stavudine, saquinavir, ritonavir, and didanosine developed lactic acidosis (serum lactate 11.4 mmol/1) and hepatomegaly. She had acute pancreatitis and, despite ventilatory support for respiratory failure, died after 8 weeks. 

Doxapram increases the tidal volume and respiratory rate by stimulating carotid chemoreceptors. Its use has been limited since the introduction of non-invasive ventilatory techniques for respiratory failure. 

Respiratory stimulants have a much reduced role in the management acute ventilatory failure, with the ready availability of mechanical methods for assisting respiration. Situations where they may still be encountered are ... 

Smith IE, Shneerson JM. A progressive care programme for prolonged ventilatory failure analysis of outcome. Br J Anaesth 1995 75 399 104. 

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