ROLE OF CONTINUOUS RESPIRATORY MONITORING IN DETECTION OF RESPIRATORY FAILURE IN CRITICALLY ILL PATIENTS

Abstract

Background: Respiratory failure is an inability of the respiratory system to maintain adequate gas exchange, leading to hypoxemia, Hypercapnia, or both. It is a leading cause of intensive care unit (ICU) admissions and mortality. Early detection through continuous respiratory monitoring is essential for timely intervention. This study aimed to evaluate the role of constant respiratory monitoring in detecting respiratory failure in critically ill patients.

Methodology: A cross-sectional observational study was conducted at Mufti Mahmood Memorial Teaching Hospital, involving 200 critically ill adult patients admitted to the ICU over four months. The inclusion criteria comprised patients with conditions such as sepsis, pneumonia, ARDS, or post-surgical complications that required mechanical ventilation. Data were collected on demographics, respiratory parameters (SpO₂, EtCO₂, respiratory rate), arterial blood gases (PaO₂, PaCO₂, pH), and ventilator settings (tidal volume, PEEP, plateau pressure). Statistical analysis was performed using SPSS version 22, employing descriptive statistics and chi-square tests to examine relationships between variables.

Results: The study population was predominantly male (60.5%) and aged over 60 years (33.5%). Pneumonia (23%) and COPD (21%) were the most common causes of respiratory failure. Key findings included low PaO₂ levels (<80 mmHg) in 78% of patients, abnormal PaCO₂ levels in 61.5%, and abnormal pH in 68.5%. The most frequent ventilator modes were SIMV (42.5%) and volume-controlled ventilation (27%). Statistical analysis revealed significant correlations between SpO₂ and FiO₂ (p = 0.003), PaO₂ and PEEP (p = 0.036), and lung compliance and plateau pressure (p < 0.001). Capnography effectively detected airway resistance, and EtCO₂ levels closely mirrored PaCO₂ trends (p<0.001).

Conclusion: it is concluded thah the  patients with respiratory failure, key ventilator and clinical parameters like SpO₂-FiO₂, PaO₂-PEEP, and tidal volume-lung compliance showed significant associations, indicating the need for coordinated monitoring. Most patients were elderly males, with COPD and pneumonia as common causes. While many parameters were within normal ranges, some showed high pressures and poor lung compliance. Age, gender, and a few variables showed no significant relationships. Overall, effective management requires adjusting multiple respiratory parameters together.