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Respiratory failure
 
 
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The term respiratory failure, in medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, is used to describe inadequate gas exchange
Gas exchange

Gas exchange or respiration takes place at a respiratory surface?a boundary between the external environment and the interior of the body....
 by the respiratory system
Respiratory system

A respiratory system?s function is to allow gas exchange. The space between the alveoli and the capillaries, the anatomy or structure of the exchange system, and the precise physiological uses of the exchanged gases vary depending on the organism....
, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation
Oxygenation

Oxygenation refers to either the amount of oxygen in a medium or to the process of adding oxygen to a medium to increase its oxygen content....
 is known as hypoxemia
Hypoxemia

Hypoxaemia is a deficiency in the concentration of dissolved oxygen in arterial blood. A frequent error is made when the term is used to describe poor tissue diffusion as in hypoxia....
; a rise in arterial carbon dioxide
Carbon dioxide

Carbon dioxide is a chemical compound composed of two oxygen atoms covalent bond to a single carbon atom. It is a gas at standard temperature and pressure and exists in Earth's atmosphere in this state....
 levels is called hypercapnia
Hypercapnia

Hypercapnia or hypercapnea , also known as hypercarbia, is a condition where there is too much carbon dioxide in the blood. Carbon dioxide is a gaseous product of the human body metabolism and is normally expelled through the lungs....
. The normal reference values are: oxygen Pa
Partial pressure

In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....
O2
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 > 60 mmHg
Torr

The torr is a non-International System of Units unit of pressure defined as 1/760 of an Atmosphere . It was named after Evangelista Torricelli, an Italian physicist and mathematician who discovered the principle of the barometer in 1644....
, and carbon dioxide Pa
Partial pressure

In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....
CO2 < 45 mmHg
Torr

The torr is a non-International System of Units unit of pressure defined as 1/760 of an Atmosphere . It was named after Evangelista Torricelli, an Italian physicist and mathematician who discovered the principle of the barometer in 1644....
. Classification into type I or type II relates to the absence or presence of hypercapnia respectively.






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The term respiratory failure, in medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, is used to describe inadequate gas exchange
Gas exchange

Gas exchange or respiration takes place at a respiratory surface?a boundary between the external environment and the interior of the body....
 by the respiratory system
Respiratory system

A respiratory system?s function is to allow gas exchange. The space between the alveoli and the capillaries, the anatomy or structure of the exchange system, and the precise physiological uses of the exchanged gases vary depending on the organism....
, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation
Oxygenation

Oxygenation refers to either the amount of oxygen in a medium or to the process of adding oxygen to a medium to increase its oxygen content....
 is known as hypoxemia
Hypoxemia

Hypoxaemia is a deficiency in the concentration of dissolved oxygen in arterial blood. A frequent error is made when the term is used to describe poor tissue diffusion as in hypoxia....
; a rise in arterial carbon dioxide
Carbon dioxide

Carbon dioxide is a chemical compound composed of two oxygen atoms covalent bond to a single carbon atom. It is a gas at standard temperature and pressure and exists in Earth's atmosphere in this state....
 levels is called hypercapnia
Hypercapnia

Hypercapnia or hypercapnea , also known as hypercarbia, is a condition where there is too much carbon dioxide in the blood. Carbon dioxide is a gaseous product of the human body metabolism and is normally expelled through the lungs....
. The normal reference values are: oxygen Pa
Partial pressure

In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....
O2
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 > 60 mmHg
Torr

The torr is a non-International System of Units unit of pressure defined as 1/760 of an Atmosphere . It was named after Evangelista Torricelli, an Italian physicist and mathematician who discovered the principle of the barometer in 1644....
, and carbon dioxide Pa
Partial pressure

In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....
CO2 < 45 mmHg
Torr

The torr is a non-International System of Units unit of pressure defined as 1/760 of an Atmosphere . It was named after Evangelista Torricelli, an Italian physicist and mathematician who discovered the principle of the barometer in 1644....
. Classification into type I or type II relates to the absence or presence of hypercapnia respectively. (Values in kPa being PO2 below 8kPA and PCO2 above 6.7 kPa

Types


Type 1

Type 1 respiratory failure is defined as hypoxaemia without hypercapnia
Hypercapnia

Hypercapnia or hypercapnea , also known as hypercarbia, is a condition where there is too much carbon dioxide in the blood. Carbon dioxide is a gaseous product of the human body metabolism and is normally expelled through the lungs....
, indeed the CO2 level may be normal or low. It is typically caused by a ventilation/perfusion mismatch; the air flowing in and out of the lungs is not matched with the flow of blood to the lungs.Basic defect in type 1 respiratory failure is failure of oxygenation characterized by: PaO2-low(<60mmhg) PaCO2_normal/low(
  • Parenchymal disease(V/Q mismatch)
  • Diseases of vasculature and shunts: right to left shunt, ARDS, pneumonia.


    • Type 2

    Type 2 respiratory failure is caused by increased airway resistance; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide that has been generated by the body. The underlying causes include:
    • Reduced breathing effort (in the fatigued patient)
    • Increased resistance to breathing (such as in asthma
      Asthma

      Asthma is a common chronic obstructive pulmonary disease, in which the Lung constrict, become inflammation, and are lined with excessive amounts of thickened mucus, often in response to one or more triggers....
      )
    • A decrease in the area of the lung available for gas exchange (such as in emphysema
      Emphysema

      Emphysema is a chronic obstructive pulmonary disease . It is often caused by exposure to toxin Chemical substance, including long-term exposure to tobacco smoking....
      ).
    Basically, there is defect in ventilation, characterized by: Pao2-decreased, PaCO2-increased, PA-aO2-normal

    Causes

    • Pulmonary dysfunction
      • Asthma
        Asthma

        Asthma is a common chronic obstructive pulmonary disease, in which the Lung constrict, become inflammation, and are lined with excessive amounts of thickened mucus, often in response to one or more triggers....
      • Emphysema
        Emphysema

        Emphysema is a chronic obstructive pulmonary disease . It is often caused by exposure to toxin Chemical substance, including long-term exposure to tobacco smoking....
      • Chronic Obstructive Pulmonary Disease
      • Pneumonia
        Pneumonia

        Pneumonia is an Inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolus inflammation and abnormal alveolar filling with fluid ....
      • Pneumothorax
        Pneumothorax

        In medicine , a pneumothorax, or collapsed lung, is a potential medical emergency caused by accumulation of air or gas in the pleural cavity....
      • Pulmonary contusion
        Pulmonary contusion

        A pulmonary contusion is a contusion of the lung, caused by chest trauma. As a result of damage to capillary, blood and other fluids accumulate in the lung tissue....
      • Hemothorax
        Hemothorax

        A hemothorax is a condition that results from blood accumulating in the pleural cavity....
      • Acute Respiratory Distress Syndrome
        Acute respiratory distress syndrome

        'Acute respiratory distress syndrome' , also known as 'respiratory distress syndrome' or 'adult respiratory distress syndrome' is a serious reaction to various forms of injuries to the lung....
         (ARDS) is a specific and life-threatening type of respiratory failure.
      • Cystic Fibrosis
        Cystic fibrosis

        Cystic Fibrosis is a Genetic disorder affecting the exocrine glands of the lungs, liver, pancreas, and intestines, causing progressive disability due to multisystem failure....
    • Cardiac dysfunction
      • Pulmonary edema
        Pulmonary edema

        Pulmonary edema , or oedema , is swelling and/or fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure....
      • Cerebrovascular Accident
      • Arrhythmia
      • Congestive heart failure
        Congestive heart failure

        Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs....
      • Valve pathology
    • Other
      • Fatigue due to prolonged tachypnoea
        Hyperventilation

        In medicine, hyperventilation is the state of breathing faster and/or deeper than necessary, bringing about lightheadedness and other undesirable symptoms often associated with panic attacks....
         in metabolic acidosis
        Metabolic acidosis

        In medicine, metabolic acidosis is a process which if unchecked leads to acidemia, i.e. blood pH is low due to increased production of hydrogen by the body or the inability of the body to form bicarbonate in the kidney....
      • Intoxication with drugs (e.g. morphine
        Morphine

        Morphine is a highly potent opiate analgesic Medication, is the principal active agent in opium, and is considered to be the prototypical opioid....
        , benzodiazepine
        Benzodiazepine

        The benzodiazepines are a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic , anticonvulsant, muscle relaxant and anterograde amnesia properties, which are mediated by slowing down the central nervous system....
        s) that suppress respiration.
      • Neurological Disease
      • Toxic Epidermal Necrolysis
        Toxic epidermal necrolysis

        Toxic epidermal necrolysis , also known as Lyell's syndrome, is a life-threatening dermatology condition that is frequently induced by a reaction to medications....


    Treatment

    Emergency treatment follows the principles of cardiopulmonary resuscitation
    Cardiopulmonary resuscitation

    Cardiopulmonary resuscitation is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by layman or by emergency response professionals....
    . Treatment of the underlying cause is required. Endotracheal intubation and mechanical ventilation
    Mechanical ventilation

    In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous respiration .Mechanical ventilation is typically used after an invasive intubation, a procedure wherein an endotracheal tube or tracheostomy tube is inserted into the airway....
     may be required. Respiratory stimulant
    Respiratory stimulant

    A respiratory stimulant is a drug which acts to increase the action of the respiratory system.An example is doxapram.External links...
    s such as doxapram
    Doxapram

    Doxapram hydrochloride is a respiratory stimulant. Administered intravenously, doxapram stimulates an increase in Lung volumes, and respiration ....
     may be used, and if the respiratory failure resulted from an overdose of sedative
    Sedative

    A sedative is a substance that induces sedation by reducing irritability or excitement.At higher doses it may result in slurred speech, staggering gait , poor judgment, and slow, uncertain reflexes....
     drugs such as opioid
    Opioid

    An opioid is a chemical substance that has a morphine-like action in the body. The main use is for analgesia. These agents work by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract....
    s or benzodiazepines, then the appropriate antidote
    Antidote

    An antidote is a substance which can counteract a form of poison. The term ultimately derives from the Greek a?t?d?d??a? antididonai, "given against"....
     such as naloxone
    Naloxone

    Naloxone is a medication used to counter the effects of opioid Drug overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system....
     or flumazenil
    Flumazenil

    Flumazenil is a benzodiazepine receptor antagonist.It was introduced in 1987 by Hoffmann-La Roche under the trade name Anexate....
     will be given.

    See also

    • Ventilation/perfusion ratio
      Ventilation/perfusion ratio

      In respiratory physiology, the ventilation/perfusion ratio is a measurement used to assess the efficiency and adequacy of the matching of two variables:...
    • Pulmonary shunt
      Pulmonary shunt

      A pulmonary shunt is a physiological condition which results when the alveoli of the lung are perfusion with blood as normal, but Ventilation fails to supply the perfused region....