Acute Respiratory Failure
I am wondering what level of treatment would be considered "enough" to validate the diagnosis of Acute Respiratory Failure? I have had 2 cases recently that I questioned validity. The most recent one, the pt is admitted with Acute Exacerbation of COPD and Acute on Chronic Respiratory Failure, H/P said "She has home oxygen at 1L. It was noted that she was at 78%, with her oxygen off. She required 2.5L to attain 92%". (That is the highest the O2 was needed 2.5L) There were no ABG done, her respiratory rate 18-24 throughout stay. I asked the attending what criteria he looked for in considering the Acute Resp failure diagnosis. He said if they needed O2 and weren't normally on it or if they needed a higher amount than normally needed and if they we treated with increased nebulizers, etc. I fear they are using the diagnosis a little loosely and wonder what your thoughts are?
Peggy
Peggy
Comments
A few thoughts
Did you search this site for sources as many of our physicians have provided insight on this issue.
The CDI pocket guide has an extensive amount of information on this topic, and respecting copyright, I won't quote that on this forum. But, this is a very good resource
What strikes me is that FI02 at 2.5 liters probably does not justify ARF...most of the articles citing this state something to the effect that at least 4L/min should be provided and that such milder intervention is required for at least 2 hours or longer. Some citations state that a flow rate of 40% FI02 implies treatment of ARF. In your question, I assume NC was used. I personally like to compute the P/F ratio when dealing w/ this issue, but COPD negates use of that tool.
Ref: Maryland Hospital Association
Paul Evans, RHIA, CCDS
For acute on chronic, we look at gases for evidence of acidosis with pCO2 >10 over baseline.
In the situation you have described, I probably would have asked for clinical validation as well, unless there was a gas to support acute on chronic RF.
Jackie Touch
CHOC Children's, Orange, CA