3 Guidelines for Acute Respiratory Failure and Airway Protection


The COVID-19 pandemic made acute respiratory distress one of the most common emergencies faced by first responders. Without prompt intervention, the virus led to respiratory failure and life-threatening complications.


When will the next novel virus or influenza epidemic strike? No one knows, but it pays to be prepared. The guidelines in this article can help you offer appropriate airway protection to treat and ideally prevent acute respiratory failure.


Know the Risk Factors

The pandemic shed light on the groups who face a higher risk of severe respiratory illness. These include those with diabetes, with a body mass index (BMI) above 40, geriatrics, newborns, and people with respiratory diseases.

Other risk factors for acute respiratory distress include: 


  • Chronic obstructive pulmonary disease (COPD)
  • A history of smoking
  • Sepsis
  • Pneumonia 
  • Dementia


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Know the Warning Signs 

Identifying a patient who is at risk of respiratory failure and treating them early in the crisis is key to saving their life and preventing long-term pulmonary complications. Watch for these signs


  • Loss of consciousness 
  • Confusion
  • Gasping for air
  • Blue tint to the lips, tongue, or fingers
  • Sweating
  • Hypercapnia 
  • Rapid heart rate or heart arrhythmias
  • Panic
  • Shallow breathing 


Promptly Intervene

These guidelines can help you promptly and effectively treat patients who are experiencing acute respiratory failure:


Administer Oxygen 

Begin by administering supplemental oxygen. In most cases, you can do this through a nasal cannula. In others, you may need to intubate the patient. Continue to monitor vital signs and respiration to ensure the patient is getting sufficient oxygen. 


Suction the Patient If Necessary 

Many patients experiencing either respiratory distress or respiratory failure have other underlying conditions, physical injuries, or an airway obstruction. If the patient cannot clear their airway, or airway secretions interfere with breathing, suction the patient.


Treat the Patient Where You Find Them 

Prompt treatment can save lives, so don’t delay treatment by moving the patient. You should be ready to go with portable suction and oxygen. This is because moving the patient may expose more people to a potentially lethal virus. Many interventions create aerosolized particles that more effectively transmit viruses, so moving the patient while treating them is particularly risky. 


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Avoid Transmitting Infection

The cost of spreading an illness to vulnerable people in hospital and emergency settings is extraordinarily high. To reduce the risk of spread: 


  • Suction patients away from others—if you can install a partition to prevent the spread of aerosolized particles, you may save lives
  • Ask all patients to wear masks
  • Always wear properly fitted personal protective equipment
  • Practice aggressive handwashing before and after touching patients or equipment
  • Sterilize all equipment according to the manufacturer’s specifications
  • Store equipment in a secure, sealed location to reduce the risk of contaminating it 


Identify the Underlying Cause

Treatment should not be limited to managing the immediate crisis. It’s important to identify the underlying cause so you can provide ongoing treatment. Many patients will need ongoing rehabilitative care to prolong their life and reduce the risk of subsequent medical emergencies. 


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Editor's Note: This blog was originally published in December, 2020. It has been re-published with additional up to date content.