Respiratory failure medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

There is no treatment for respiratory failure; however, medication may be used to allow for easier intubation and to ease anxiety in the patient. Recently, studies have demonstrated a strong recommendation against the use of sedatives or analgesics. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms.

Medical therapy includes:^[1][2]

• Naloxone:
  • Naloxone is used as an antidote to opioid overdose – induced respiratory depression.
• Flumazenil:
  • Flumazenil is used as an antidote in benzodiazepine overdose – induced respiratory depression.
• Sedatives, activated charcoal and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive respiratory acidosis with:
  • Anxiety
  • Rapid shallow breathing
  • Respiratory arrest
  • Moderate to severe expiratory airway resistance
  • Dynamic hyperinflation

• 1 Opiate overdose
  • 1.1 Naloxone
    • 1.1.1 Adult
      • Preferred regimen (1): Naloxone 0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater

    Note (1): Apneic patients with suspected opiate overdose should receive higher first doses of naloxone between 0.2 – 1 mg

    Note (2): Cardiorespiratory with suspected opiate overdose should receive a minimum of 2 mg of naloxone

• 2 Benzodiazepine overdose
  • 2.1 Flumazenil
    • 2.1.1 Adult
      • Preferred regimen (1): Flumazenil 0.2 mg IV over 30 seconds

    Note (1): Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved

    Note (2): Maximum dose of 3mg is given within any hour

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