Ventilatory failure treatment

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. 

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. 

Figure 1 Rate of use of three different noninvasive interfaces (oro-nasal mask, nasal mask, nasal pillows), as reported by the studies where noninvasive ventilation was utilized to treat acute left) and chronic (right) patients. The oro-nasal mask is the interface of choice in patients with acute or acute on chronic ventilatory failure, while it is less commonly employed for domiciliary treatment of stable chrcniic ventilatory failure. The nasal mask is preferred for long-term treatment of chronic patients. Source From Refs. 39 and 40.

In a series of studies of ACE inhibitor-induced improvement in pulmonary function, treatment with aspirin 325 mg/day for 8 weeks in patients with mild to moderate heart failure due to primitive dilated cardiomyopathy did not affect ventilation and peak oxygen consumption during exercise when the patients were not taking an ACE inhibitor but worsened pulmonary diffusion capacity and made the ventilatory response to exercise (tidal volume, ventilation to carbon dioxide production) less effective in those who were, regardless of the duration of ACE inhibition (108). 

Treatment is supportive and may require prolonged intensive care (weeks to months). The severe cases may require intubation and ventilatory support. Respiratory failure is the usual cause of death, but with good care the mortality rate should be less than 5%. There is an antitoxin available for use in certain circumstances. 

Before any specific treatment starts, there must be a rapid assessment of the patient s airway, ventilatory and circulatory status. Immediate life-support measures are required for patients presenting in respiratory failure or arrest and for circulatory collapse. Patients may also present with both toxic and physical trauma which may compound the situation. Box 8.1 summarises actions of toxic agents causing respiratory failure. 

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