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What is respiratory failure? What are the symptoms of respiratory failure? What causes respiratory failure? How is respiratory failure treated? What are the potential complications of respiratory failure? |
| Acute Respiratory Failure |
| Chronic Respiratory Failure |
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What is respiratory failure? Respiratory failure is the inability of the respiratory system to supply oxygen or remove carbon dioxide, resulting in low blood oxygen or high blood carbon dioxide levels, respectively. Multiple conditions can cause one or both of these problems. Acute or sudden respiratory failure can happen as the result of trauma, injury, drug or alcohol overdose, or inhalation of carbon monoxide. Chronic, or long-term, respiratory failure is commonly caused by chronic obstructive pulmonary disease (COPD), neuromuscular disease, or even morbid obesity. The signs and symptoms of respiratory failure differ depending on the severity and underlying cause. Acute respiratory failure occurs rapidly and can resolve with treatment. Chronic respiratory failure, on the other hand, is a progressive disease, which typically worsens over time. Symptoms of respiratory failure include difficulty breathing, cyanosis (blue or purple coloration of the skin), and lethargy. Treatment depends on the severity of the disease and may include oxygen support, bronchodilators, and ventilatory support. Respiratory failure can be a serious or life-threatening condition. Seek immediate medical care if you, or someone you are with, have serious symptoms, such as severe difficulty breathing; severe sharp chest pain; bluish coloration of the lips or fingernails; a change in level of consciousness or alertness, such as passing out or unresponsiveness; and rapid heart rate. Seek prompt medical care if you are being treated for respiratory failure but mild symptoms recur or are persistent. SYMPTOMS What are the symptoms of respiratory failure? Respiratory failure causes insufficient oxygenation or ventilation and can cause a number of symptoms, which can be severe. Common symptoms of respiratory failure Respiratory failure is accompanied by a number of symptoms including: * Bluish coloration of the lips or fingernails * Confusion or loss of consciousness * Fainting or change in level of consciousness or lethargy * Fatigue * Irregular heart rate (arrhythmia) * Rapid breathing (tachypnea) or shortness of breath Serious symptoms that might indicate a life-threatening condition In some cases, respiratory failure can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: * Bluish coloration of the lips or fingernails * Change in level of consciousness or alertness, such as passing out or unresponsiveness * Rapid heart rate (tachycardia) * Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking What causes respiratory failure? Respiratory failure is the inability of the respiratory system to supply oxygen or remove carbon dioxide, resulting in low blood oxygen or high blood carbon dioxide levels. Multiple conditions can cause one or both of these problems. Respiratory failure can transpire quickly as the result of trauma, injury, drug or alcohol overdose, or inhalation of carbon monoxide. Chronic, or long-term, respiratory failure is commonly caused by chronic obstructive pulmonary disease (COPD), neuromuscular disease, or even morbid obesity. Causes of acute respiratory failure A number of conditions may cause acute respiratory failure, many of which are life-threatening or serious conditions. Examples include: Common causes of type I respiratory failure Asthma. Pneumonia. Pulmonary oedema. Pulmonary fibrosis. Pneumothorax. Pulmonary embolism. Pulmonary hypertension. Cyanotic congenital heart disease. Bronchiectasis. Acute respiratory distress syndrome. Kyphoscoliosis. Obesity. Causes of chronic respiratory failure A number of conditions may cause chronic respiratory failure, many of which are serious conditions. Examples include: * Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease; a severe neuromuscular disease that causes muscle weakness and disability) * Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis * Cystic fibrosis (buildup of thick mucus in the lungs and digestive tract) * Guillain-Barré syndrome (autoimmune nerve disorder) * Morbid obesity * Myasthenia gravis (autoimmune neuromuscular disorder that causes muscle weakness) * Sarcoidosis (inflammatory disease most commonly affecting the lungs, skin and eyes) * Severe curvature of the spine (scoliosis) How is respiratory failure treated? Treatment for respiratory failure begins with seeking medical care from your health care provider. The goals of treatment for respiratory failure are to increase oxygenation and improve ventilation. Treatment depends on the severity of the respiratory failure and the cause. Acute respiratory failure treatment will address the underlying cause and include ventilation and oxygenation as needed. Treatment for chronic respiratory failure may be administered at home. Exacerbation of chronic respiratory failure by infection may require hospitalization, and treatment may include oxygenation and ventilator support. Bronchodilators may improve airway patency. Respiratory failure treatment options Multiple options are available for the treatment of respiratory failure. Examples include: * Antibiotics for respiratory infections * Bilevel positive airway pressure (BiPAP) * Bronchodilators, including anticholinergics, such as tiotropium (Spiriva), or beta agonists, such as albuterol (Proventil) * Continuous positive airway pressure (CPAP) * Inhaled steroid medications to decrease inflammation * Lung transplant, in rare cases * Mechanical ventilation, if oxygen therapy if not sufficient to increase blood oxygen levels * Oxygen therapy to increase blood oxygen levels * Tracheostomy, a hole made in the front of the neck to help you breathe What are the potential complications of respiratory failure? Complications of untreated respiratory failure can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of respiratory failure include: * Heart failure * Myocardial infarction (heart attack) * Organ failure or dysfunction * Pneumonia * Respiratory arrest * Shock People with respiratory failure are treated in an intensive care unit. A patient with a long history of asthma, emphysema, or chronic obstructive lung disease A patient who is undergoing major surgery in the abdomen, heart, or lung A person who has taken an overdose of sleeping pills or certain depressant drugs A premature baby who weighs less than 3 pounds A baby with bronchopulmonary dysplasia A person who has received multiple physical injuries A person who has suffered extensive burns A person who has bled extensively from a gunshot wound A person who has almost drowned A patient with severe heart failure A patient with severe infections A person who is extremely obese Major management techniques used in the ICU are described below. * PO2 of greater than 100 Torr to avoid cerebral tissue hypoxia * PCO2 of 35-40 Torr to avoid cerebral hyperemia or excessive vasoconstriction and induction of cerebral ischemia * Maintenance of a neutral cervical spine position to avoid impairment of cerebral venous drainage * Avoidance of jugular venous lines on the ipsilateral side of a brain injury * Drainage of CSF with an external ventricular drainage (EVD) catheter when the ICP is greater than 20 mm Hg * Isovolemic dehydration for patients with cerebral edema and a high ICP * Avoidance of any unnecessary glucose for the first 48 hours after injury * Avoidance of hyposmolarity to prevent increasing cerebral edema Controversy surrounds nursing patients in the head-of-bed up position, as this may decrease cerebral oxygen delivery. Mannitol is generally avoided in the patient without cerebral edema because of the risk of hypovolemia from excessive intravascular volume loss. The use of craniectomy is controversial in the management of cerebral edema. Interrogate for intra-abdominal hypertension in the patient with intractably elevated ICP, as there are reports of successful management with abdominal decompression. ICP can be measured by various routes and devices; however, the criterion standard is considered to be a fluid-coupled ventriculostomy catheter inserted into a lateral ventricle (normal ICP < 15 mm Hg). Other devices may be placed into the brain parenchyma, such as the fiberoptically tipped parenchymal pressure monitoring catheter. Some of these devices are also coupled with a tissue oximeter probe to measure cerebral parenchymal tissue oxygen tension. Their use in enhancing outcome is not yet clear. Moreover, these devices do not afford the ability to remove CSF as part of the treatment for elevations in ICP. Causes of hypoventilation * Brainstem
o metabolic encephalopathy o depressant drugs
* Nerve
o motor neuron disease
o disuse atrophy o myopathy o malnutrition
o decreased lung, pleural or chest wall compliance In both forms of respiratory failure, therapy is directed toward the underlying diseases as well as the ventilatory and hypoxic components. In addition to these components, there is an acute and a chronic component to respiratory failure. Patients with chronic respiratory failure frequently can maintain lower PO2 and higher PCO2 than patients with acute respiratory failure. (i) Treatment of type I respiratory failure is administration of high concentrations of inspired oxygen, which may be delivered by mask or nasal cannula. These high concentrations are safe to administer to patients with type I respiratory failure because there is no risk of carbon dioxide retention in these individuals. (ii) Treatment of type II respiratory failure depends upon recognition of its cause. (a) In the common variety arising from exacerbations of COPD, the basis of therapy is controlled administration of oxygen (i.e., low-flow oxygen treatment). Target SaO2 88-92% in these patients (b) Type II respiratory failure that arises from causes other than COPD usually is an indication for mechanical ventilation. |