Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide or both cannot be kept at normal levels. A drop in the oxygen carried in blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type I or Type II, based on whether there is a high carbon dioxide level. The definition of respiratory failure in clinical trials usually includes increased respiratory rate, abnormal blood gases (hypoxemia, hypercapnia, or both), and evidence of increased work of breathing.
|Specialty||Pulmonology, Intensive care medicine|
Several types of condition can potentially result in respiratory failure:
Type 1 respiratory failure is defined as a low level of oxygen in the blood (hypoxemia) with either a normal (normocapnia) or low (hypocapnia) level of carbon dioxide (PaCO2) but not an increased level (hypercapnia). It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs. The basic defect in type 1 respiratory failure is failure of oxygenation characterized by:
|PaO2||decreased (< 60 mmHg (8.0 kPa))|
|PaCO2||normal or decreased (<50 mmHg (6.7 kPa))|
This type of respiratory failure is caused by conditions that affect oxygenation such as:
Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
The basic defect in type 2 respiratory failure is characterized by:
|PaO2||decreased (< 60 mmHg (8.0 kPa))|
|PaCO2||increased (> 50 mmHg (6.7 kPa))|
Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the buildup of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
Types 3 and 4 - https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/mechanical-ventilation/respiratory-failure-mechanical-ventilation.pdf -https://www.physio-pedia.com/Respiratory_Failure -https://www.mcgill.ca/criticalcare/teaching/files/acute
Treatment of the underlying cause is required. Endotracheal intubation and mechanical ventilation are required in cases of severe respiratory failure (PaO2 less than 50 mmHg). Respiratory stimulants such as doxapram are rarely used, and if the respiratory failure resulted from an overdose of sedative drugs such as opioids or benzodiazepines, then the appropriate antidote (naloxone or flumazenil, respectively) will be given.
There is tentative evidence that in those with respiratory failure identified before arrival in hospital, continuous positive airway pressure can be useful when started before conveying to hospital.
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Diseases of the respiratory system (J, 460–519)
|Lower RT/lung disease|