Respiratory failure pathophysiology: Difference between revisions
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==Genetics== | ==Genetics== | ||
* | *Genes variants that can influence susceptibility to acute respiratory distress syndrome include:<ref name="pmid23048207">{{cite journal |vauthors=Tejera P, Meyer NJ, Chen F, Feng R, Zhao Y, O'Mahony DS, Li L, Sheu CC, Zhai R, Wang Z, Su L, Bajwa E, Ahasic AM, Clardy PF, Gong MN, Frank AJ, Lanken PN, Thompson BT, Christie JD, Wurfel MM, O'Keefe GE, Christiani DC |title=Distinct and replicable genetic risk factors for acute respiratory distress syndrome of pulmonary or extrapulmonary origin |journal=J. Med. Genet. |volume=49 |issue=11 |pages=671–80 |date=November 2012 |pmid=23048207 |pmc=3654537 |doi=10.1136/jmedgenet-2012-100972 |url=}}</ref> | ||
* | **Functional single nucleotide polymorphism (SNP) in POPDC3 gene | ||
**Functional SNP in FAAH gene | |||
*ARDS in severe sepsis is associated with the presence of allele D of the ACE gene<ref name="pmid23364437">{{cite journal |vauthors=Cardinal-Fernández P, Ferruelo A, El-Assar M, Santiago C, Gómez-Gallego F, Martín-Pellicer A, Frutos-Vivar F, Peñuelas O, Nin N, Esteban A, Lorente JA |title=Genetic predisposition to acute respiratory distress syndrome in patients with severe sepsis |journal=Shock |volume=39 |issue=3 |pages=255–60 |date=March 2013 |pmid=23364437 |doi=10.1097/SHK.0b013e3182866ff9 |url=}}</ref> | |||
==Associated Conditions== | ==Associated Conditions== | ||
Revision as of 15:02, 21 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Pathophysiology
Pathogenesis
The pathogenesis of respiratory failure is as follows:[1]
- The respiratory system is formed by 2 parts:
- The gas exchanging organ, the lung
- The pump that ventilates the lungs, the pump consists of:
- Chest wall, the respiratory muscles
- The respiratory control system in the central nervous system (CNS)
- The spinal and peripheral pathways that connect the CNS control system with the respiratory muscles
- The respiratory system has 2 main functions oxygenation of mixed venous blood and elimination of carbon dioxide.
- Respiratory failure is a condition where there is loss of one or both of the functions of the respiratory system resulting in inadequate gas exchange.
- Respiratory failure is defined as:
- Respiratory failure can be caused by lung failure or pump failure.
- Lung failure, which is gas exchange failure resulting in hypoxemia (<PaO2).
- Pump failure, which is ventilatory failure resulting in alveolar hypoventilation which in turn results in hypercapnia (>PaCO2).
- Hypercapnic respiratory failure can be caused by:
- Mechanical defects
- Central nervous system depression
- Imbalance of energy demands and supplies
- Adaptation of central controllers
- Neuromuscular transmission impairment
- Mechanical defect of the rib cage
- Fatigue of respiratory muscles
- Lung failure and pump failure can coexist in the same patient in cases of:
- Chronic obstructive pulmonary disease (COPD) with carbon dioxide retention
- Severe pulmonary edema
- Asthmatic crisis
- Acute respiratory failure can develop in minutes to hours
- Chronic respiratory failure takes days to develop
- The ph drops below 7.35 in acute hypercapnia respiratory failure
- In underlying chronic respiratory failure the PaCO2 rises unto 20mmHg above baseline
- Presentation of respiratory failure can be:
- Acute
- Chronic
- Acute on chronic (COPD exacerbation)
Genetics
- Genes variants that can influence susceptibility to acute respiratory distress syndrome include:[2]
- Functional single nucleotide polymorphism (SNP) in POPDC3 gene
- Functional SNP in FAAH gene
- ARDS in severe sepsis is associated with the presence of allele D of the ACE gene[3]
Associated Conditions
Conditions associated with respiratory failure include:[4][5][6][7][8][9][10][11][12][13][14]
- Acute respiratory distress syndrome (ARDS)
- Chronic obstructive pulmonary disease (COPD)
- Opioid Toxicity
- Pulmonary edema
- Pulmonary embolism
- Pneumonia
- Idiopathic lung fibrosis
- Asthma
- Myasthenia gravis
- Guillain-Barré syndrome
- Post-operative atelectasis
- Shock
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Roussos C, Koutsoukou A (November 2003). "Respiratory failure". Eur Respir J Suppl. 47: 3s–14s. PMID 14621112.
- ↑ Tejera P, Meyer NJ, Chen F, Feng R, Zhao Y, O'Mahony DS, Li L, Sheu CC, Zhai R, Wang Z, Su L, Bajwa E, Ahasic AM, Clardy PF, Gong MN, Frank AJ, Lanken PN, Thompson BT, Christie JD, Wurfel MM, O'Keefe GE, Christiani DC (November 2012). "Distinct and replicable genetic risk factors for acute respiratory distress syndrome of pulmonary or extrapulmonary origin". J. Med. Genet. 49 (11): 671–80. doi:10.1136/jmedgenet-2012-100972. PMC 3654537. PMID 23048207.
- ↑ Cardinal-Fernández P, Ferruelo A, El-Assar M, Santiago C, Gómez-Gallego F, Martín-Pellicer A, Frutos-Vivar F, Peñuelas O, Nin N, Esteban A, Lorente JA (March 2013). "Genetic predisposition to acute respiratory distress syndrome in patients with severe sepsis". Shock. 39 (3): 255–60. doi:10.1097/SHK.0b013e3182866ff9. PMID 23364437.
- ↑ Bernard GR (October 2005). "Acute respiratory distress syndrome: a historical perspective". Am. J. Respir. Crit. Care Med. 172 (7): 798–806. doi:10.1164/rccm.200504-663OE. PMC 2718401. PMID 16020801.
- ↑ Budweiser S, Jörres RA, Pfeifer M (2008). "Treatment of respiratory failure in COPD". Int J Chron Obstruct Pulmon Dis. 3 (4): 605–18. PMC 2650592. PMID 19281077.
- ↑ Hornik C, Meliones J (August 2016). "Pulmonary Edema and Hypoxic Respiratory Failure". Pediatr Crit Care Med. 17 (8 Suppl 1): S178–81. doi:10.1097/PCC.0000000000000823. PMID 27490597.
- ↑ Wilson KC, Saukkonen JJ (2004). "Acute respiratory failure from abused substances". J Intensive Care Med. 19 (4): 183–93. doi:10.1177/0885066604263918. PMID 15296619.
- ↑ Neuhaus A, Bentz RR, Weg JG (April 1978). "Pulmonary embolism in respiratory failure". Chest. 73 (4): 460–5. PMID 630962.
- ↑ Bauer TT, Ewig S, Rodloff AC, Müller EE (September 2006). "Acute respiratory distress syndrome and pneumonia: a comprehensive review of clinical data". Clin. Infect. Dis. 43 (6): 748–56. doi:10.1086/506430. PMID 16912951.
- ↑ Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE, Kondoh Y, Myers J, Müller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schünemann HJ (March 2011). "An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management". Am. J. Respir. Crit. Care Med. 183 (6): 788–824. doi:10.1164/rccm.2009-040GL. PMC 5450933. PMID 21471066.
- ↑ Mier A, Laroche C, Green M (May 1990). "Unsuspected myasthenia gravis presenting as respiratory failure". Thorax. 45 (5): 422–3. PMC 462503. PMID 2382251.
- ↑ Massard G, Wihlm JM (August 1998). "Postoperative atelectasis". Chest Surg. Clin. N. Am. 8 (3): 503–28, viii. PMID 9742334.
- ↑ Vincent JL, De Backer D (October 2013). "Circulatory shock". N. Engl. J. Med. 369 (18): 1726–34. doi:10.1056/NEJMra1208943. PMID 24171518.
- ↑ Mehta S (September 2006). "Neuromuscular disease causing acute respiratory failure". Respir Care. 51 (9): 1016–21, discussion 1021–3. PMID 16934165.