Respiratory failure diagnostic study of choice: Difference between revisions

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Revision as of 16:41, 16 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Respiratory failure is mainly diagnosed based on clinical presentation.

There is no single diagnostic study of choice for the diagnosis of respiratory failure, but respiratory can be diagnosed based on history, examination and arterial blood gases.

Diagnostic Study of Choice

Respiratory failure is mainly diagnosed based on clinical presentation.^[1]^[2]
There is no single diagnostic study of choice for the diagnosis of respiratory failure, but respiratory can be diagnosed based on history, examination and arterial blood gases.

Sequence of Diagnostic Studies

The arterial blood gases should be performed when:

The patient has been assessed for airway, breathing and circulation.
A venous line has been established and oxygen is administered in cases of desaturation.

Diagnostic Criteria

Hypoxic respiratory failure

Patients with a pre-existing chronic lung disease with an initial pulse oximetry (PaO2) on room air less than 80% or a decreasing pulse oximetry starting at 92%.
A pulse oximetry less than 60mmHg is categorized as severe respiratory failure.
Patients usually have a preexisting lung condition where pulse oximetry readings are already low, with baselines being as low as 50mmHg.
A fall of pulse oximetry that is more than 10% indicates entrance into respiratory failure.

Hypercapnic respiratory failure

Patients with a pre-existing chronic lung disease with an initial pulse oximetry on room air less than 80% or a decreasing pulse oximetry starting at 92% AND an acute increase in the PaCO2 more than 45mmHg.
An elevation in PaCO2 is usually accompanied by an acidosis, demonstrated by a pH below 7.35
Patients usually have a preexisting lung condition and can tolerate an increase in PaCO2 up to 80mmHg with renal compensation.
A fall in pH indicates entrance into respiratory failure.

References

↑ Vo P, Kharasch VS (November 2014). "Respiratory failure". Pediatr Rev. 35 (11): 476–84, quiz 485–6. doi:10.1542/pir.35-11-476. PMID 25361907.
↑ Mas A, Masip J (2014). "Noninvasive ventilation in acute respiratory failure". Int J Chron Obstruct Pulmon Dis. 9: 837–52. doi:10.2147/COPD.S42664. PMC 4136955. PMID 25143721.

Template:WH Template:WS

[pmid25361907-1] Vo P, Kharasch VS (November 2014). "Respiratory failure". Pediatr Rev. 35 (11): 476–84, quiz 485–6. doi:10.1542/pir.35-11-476. PMID 25361907.

[pmid25143721-2] Mas A, Masip J (2014). "Noninvasive ventilation in acute respiratory failure". Int J Chron Obstruct Pulmon Dis. 9: 837–52. doi:10.2147/COPD.S42664. PMC 4136955. PMID 25143721.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Respiratory failure}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}}{{HM}}
 == Overview ==
+Respiratory failure is mainly diagnosed based on clinical presentation.
+*There is no single diagnostic study of choice for the diagnosis of respiratory failure, but respiratory can be diagnosed based on history, examination and arterial blood gases.
 == Diagnostic Study of Choice ==
+*Respiratory failure is mainly diagnosed based on clinical presentation.<ref name="pmid25361907">{{cite journal |vauthors=Vo P, Kharasch VS |title=Respiratory failure |journal=Pediatr Rev |volume=35 |issue=11 |pages=476–84; quiz 485–6 |date=November 2014 |pmid=25361907 |doi=10.1542/pir.35-11-476 |url=}}</ref><ref name="pmid25143721">{{cite journal |vauthors=Mas A, Masip J |title=Noninvasive ventilation in acute respiratory failure |journal=Int J Chron Obstruct Pulmon Dis |volume=9 |issue= |pages=837–52 |date=2014 |pmid=25143721 |pmc=4136955 |doi=10.2147/COPD.S42664 |url=}}</ref>
+*There is no single diagnostic study of choice for the diagnosis of respiratory failure, but respiratory can be diagnosed based on history, examination and arterial blood gases.
-===== Template statements =====
+=====Sequence of Diagnostic Studies=====
+The arterial blood gases should be performed when:
-=== Study of choice: ===
+* The patient has been assessed for airway, breathing and circulation.
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+* A venous line has been established and oxygen is administered in cases of desaturation.
-* The following result of [gold standard test] is confirmatory of [disease name]:
-** Result 1
-** Result 2
-* The [name of the investigation] should be performed when:
-** The patient presented with symptoms/signs 1. 2, 3.
-** A positive [test] is detected in the patient.
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
-* The diagnostic study of choice for [disease name] is [name of the investigation].
-* There is no single diagnostic study of choice for the diagnosis of [disease name].
-* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
-* [Disease name] is mainly diagnosed based on clinical presentation.
-* Investigations:
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
-==== The comparison table for diagnostic studies of choice for [disease name] ====
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
-|}
-<small> ✔= The best test based on the feature </small>
-===== Diagnostic results =====
-The following result of [investigation name] is confirmatory of [disease name]:
-* Result 1
-* Result 2
-===== Sequence of Diagnostic Studies =====
-The [name of investigation] should be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-=== Diagnostic Criteria ===
-* Here you should describe the details of the diagnostic criteria.
-*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
-*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
-*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
-*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
-*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
-*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-** Criteria 1
-** Criteria 2
-** Criteria 3
-IF there are clear, established diagnostic criteria:
+===Diagnostic Criteria===
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+====Hypoxic respiratory failure====
-*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
+*Patients with a pre-existing chronic lung disease with an initial pulse oximetry (PaO2) on room air less than 80% or a decreasing pulse oximetry starting at 92%.
-*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
+*A pulse oximetry less than 60mmHg is categorized as severe respiratory failure.
-IF there are no established diagnostic criteria:
+*Patients usually have a preexisting lung condition where pulse oximetry readings are already low, with baselines being as low as 50mmHg.
-*There are no established criteria for the diagnosis of [disease name].
+*A fall of pulse oximetry that is more than 10% indicates entrance into respiratory failure.
+====Hypercapnic respiratory failure====
+*Patients with a pre-existing chronic lung disease with an initial pulse oximetry on room air less than 80% or a decreasing pulse oximetry starting at 92% '''AND''' an acute increase in the PaCO2 more than 45mmHg.
+*An elevation in PaCO2 is usually accompanied by an acidosis, demonstrated by a pH below 7.35
+*Patients usually have a preexisting lung condition and can tolerate an increase in PaCO2 up to 80mmHg with renal compensation.
+*A fall in pH indicates entrance into respiratory failure.
 ==References==