Medication Summary
The use of medications in the treatment of respiratory failure depends on the underlying disorder. For example, corticosteroids and beta-agonist medications treat an asthma exacerbation, whereas antibiotics treat bacterial pneumonia. Patients with pulmonary edema from myocardial dysfunction improve with diuretics and inotropic support.
Pulmonary Vasodilators
Class Summary
Inhaled nitric oxide (NO) is a pulmonary vasodilator indicated to treat pulmonary hypertension. NO is also being studied for severe hypoxemia in acute respiratory distress syndrome (ARDS).
Nitric oxide, inhaled (INOmax)
NO is produced endogenously from the action of the enzyme NO synthetase on arginine. It relaxes vascular smooth muscle by binding to the heme moiety of cytosolic guanylate cyclase, activating guanylate cyclase and increasing intracellular levels of cyclic guanosine monophosphate (cGMP), which then leads to vasodilation. When inhaled, NO decreases pulmonary vascular resistance and improves lung blood flow.
Lung Surfactants
Class Summary
Exogenous surfactant can be helpful in the treatment of airspace disease. After inhalation, surface tension is reduced and alveoli are stabilized, decreasing the work of breathing and increasing lung compliance. These drugs are indicated for the prevention and treatment of neonatal RDS. They are also being investigated for the treatment of hypoxemia secondary to ARDS.
Calfactant (Infasurf)
This is a natural bovine calf lung extract containing phospholipids, fatty acids, and surfactant-associated proteins B (260 mcg/mL) and C (390 mcg/mL). Surfactant is an endogenous complex of lipids and proteins that lines alveolar walls and promotes alveolar stability by reducing surface tension. Relative surfactant deficiency is variably present in many lung diseases.
Poractant alfa (Curosurf)
Poractant alfa lines the alveolar walls and promotes alveolar stability against collapse by reducing surface tension at the air-liquid interface of the alveoli.
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Pediatric Respiratory Failure. Bilateral airspace infiltrates on this chest radiograph film were secondary to acute respiratory distress syndrome that resulted in respiratory failure.
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Pediatric Respiratory Failure. Extensive left-lung pneumonia caused respiratory failure; the mechanism of hypoxia is intrapulmonary shunting.
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Pediatric Respiratory Failure. A bilevel positive airway pressure (BIPAP) support machine is shown. It could be used in spontaneous mode or timed mode (the backup rate could be set).
