Respiratory failure

Respiratory failure
ICD-10	J96
ICD-9	518.81
DiseasesDB	6623
eMedicine	med/2011
MeSH	D012131

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Overview

Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. Respiratory failure can be indicated by observing a drop in blood oxygen level (hypoxemia) and/or a rise in arterial carbon dioxide (hypercapnia) which can be written as (PaO2 < 60 mmHg, PaCO2 >45 mmHg).

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 6.7kPa

Types

Type 1

• Type 1 respiratory failure is defined as hypoxia without hypercapnia, 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. This type is caused by conditions that affect oxygenation like:

1.parenchymal disease (v-q mismatch)

2.diseases of vasculature and shunts.

Type 2

• Type 2 respiratory failure is defined build up of carbon dioxide that has been generated by the body. The underlying causes are reduced breathing effort (in the fatigued patient), increased resistance to breathing (such as in asthma) or an increase in the area of the lung that is not available for gas exchange (such as in emphysema).

Causes

• Pulmonary dysfunction
  • Asthma
  • Emphysema
  • Chronic obstructive airway disease
  • Pneumonia
  • Pneumothorax
  • Hemothorax
  • Acute Respiratory Distress Syndrome (ARDS) is a specific and life-threatening type of respiratory failure.
  • Cystic Fibrosis
• Cardiac dysfunction
  • Pulmonary edema
  • Arrhythmia
  • Congestive heart failure
  • Heart valve pathology
• Other
  • Fatigue due to prolonged tachypnoea in metabolic acidosis
  • Intoxication with drugs (i.e. morphine, benzodiazepines) suppresses respiration.

Complete Differential Diagnosis of Causes of Respiratory Failure

(In alphabetical order)

3-Quinuclidinyl benzilate Abrin Acetylsalicylic acid Achondrogenesis Acute lung syndrome Acute motor axonal neuropathy Acute Porphyria Acute Respiratory Distress Syndrome Alcohol Aldicarb Alpha 1-antitrypsin deficiency Alpha-amanitin Amyotrophic Lateral Sclerosis Anaphylaxis Angioedema Antiphospholipid Antibody Syndrome Asbestosis Aspiration Atelectasis Atelosteogenesis, type II Atrial septal defect (ostium primum) Babesiosis Barium nitrate Becker's muscular dystrophy Bland-White-Garland Syndrome Blood transfusion Botulism Bronchial asthma Bronchiectasis Bronchiolitis Bronchiolitis obliterans Bronchogenic carcinoma Bronchopulmonary dysplasia Bufotenin Bungarotoxin Carbon monoxide poisoning Carnitine palmitoyltransferase II deficiency Cholesterol Emboli Syndrome Chronic Obstructive Pulmonary Disease Clitocybe dealbata Clozapine Coal worker pneumoconiosis Cocaine Codeine Colchicine Cone snail Congenital Central Hypoventilation Syndrome Congenital diaphragmatic hernia Crimean-Congo hemorrhagic fever Cystic adenomatoid malformation of lung Cystic fibrosis Cytisine Devic's disease Dicofol Duchenne's Muscular Dystrophy Ebstein anomaly Eisenmenger syndrome Elecrolyte abnormalities Emphysema Eosinophilic pneumonia EVAR Fallot tetralogy Familial dysautonomia Fat embolism Fentanyl Fetal circulation, persistent Fibrosing alveolitis Flail chest Foreign body Furfural Gamma-Hydroxybutyric acid Glotto Emphysema Glycogen storage disease type I Guillain-Barre syndrome

Hamman-Rich Syndrome Hantavirus Pulmonary Syndrome Heartworm Hemosiderosis Hepatic failure Hepatopulmonary syndrome Hereditary haemorrhagic telangiectasia Heroin Human ehrlichiosis Infant respiratory distress syndrome Interstitial fibrosis Ketamine Kyphoscoliosis Labetalol Laryngo-/Bronchospasm Legionella pneumophila Lidocaine Lorazepam Malignant hyperpyrexia Malignant Mesothelioma Marine toxins Meningitis Metabolic Acidosis Morphine Multiple chemical sensitivity Multiple organ dysfunction syndrome Muscarine Myasthenia Gravis Near-drowning Nitrazepam Omphalitis Opiate Osteogenesis imperfecta Oxymorphone Pleural effusion Pneumonia Pneumothorax Polio Polyrediculitis Post-polio syndrome Potter syndrome Pre-eclampsia Procainamide (patient information) Pulmonary alveolar proteinosis Pulmonary arterio-venous malformation Pulmonary edema Pulmonary embolism Pulmonary hypertension Pulmonary oedema Pulmonary valve stenosis Rabies Respiratory distress syndrome (neonatal) Restrictive Lung Disease Reye's syndrome Satoyoshi syndrome Saxitoxin Sepsis Smoke inhalation Snakebites (Patient information) Sodium thiopental Status asthmaticus Sulphur dioxide Tetanus Tetracycline antibiotics Tetrodotoxin Thanatophoric dysplasia Tick paralysis Transposition of great arteries Triazolam Tricuspid valve stenosis Ventricular septal defect Vinyl chloride Zellweger syndrome Zopiclone

Complete Differential Diagnosis of the Causes of Respiratory failure

(By organ system)

Cardiovascular	Atrial septal defect (ostium primum), Ebstein anomaly, Eisenmenger syndrome, Fallot tetralogy, Pulmonary valve stenosis, Transposition of great arteries, Tricuspid valve stenosis, Ventricular septal defect,
Chemical / poisoning	3-Quinuclidinyl benzilate, Abrin, Aldicarb, Alpha-amanitin, Barium nitrate, Bungarotoxin, Carbon monoxide poisoning, Cocaine, Cone snail, Furfural, Snakebites (Patient information),
Congenital	Atrial septal defect (ostium primum), Bland-White-Garland Syndrome, Congenital Central Hypoventilation Syndrome, Congenital diaphragmatic hernia, Fallot tetralogy, Fetal circulation, persistent, Respiratory distress syndrome (neonatal),
Dermatologic	No underlying causes
Drug Side Effect
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Asbestosis, Coal worker pneumoconiosis, Smoke inhalation, Sulphur dioxide,
Gastroenterologic	Hepatic failure, Hepatopulmonary syndrome,
Genetic	Achondrogenesis, Acute Porphyria, Alpha 1-antitrypsin deficiency, Atelosteogenesis, type II, Becker's muscular dystrophy, Carnitine palmitoyltransferase II deficiency, Cystic fibrosis, Duchenne's Muscular Dystrophy, Familial dysautonomia, Hereditary haemorrhagic telangiectasia, Osteogenesis imperfecta, Thanatophoric dysplasia,
Hematologic	Acute Porphyria, Cholesterol Emboli Syndrome, Fat embolism, Sepsis,
Iatrogenic	Blood transfusion, EVAR,
Infectious Disease	Babesiosis, Botulism, Crimean-Congo hemorrhagic fever, Hantavirus Pulmonary Syndrome, Heartworm, Post-polio syndrome, Rabies, Tetanus,
Musculoskeletal / Ortho	Kyphoscoliosis,
Neurologic	Amyotrophic Lateral Sclerosis, Meningitis, Polyrediculitis, Zellweger syndrome,
Nutritional / Metabolic	Metabolic Acidosis,
Obstetric/Gynecologic	No underlying causes
Oncologic	Malignant Mesothelioma,
Opthalmologic	No underlying causes
Overdose / Toxicity	Acetylsalicylic acid, Alcohol, Bufotenin, Clitocybe dealbata, Colchicine, Cytisine, Dicofol, Saxitoxin, Tetrodotoxin, Tick paralysis, Vinyl chloride,
Psychiatric	No underlying causes
Pulmonary	Acute lung syndrome, Acute Respiratory Distress Syndrome, Alpha 1-antitrypsin deficiency, Atelectasis, Bronchial asthma, Bronchiectasis, Bronchiolitis, Bronchiolitis obliterans, Bronchogenic carcinoma, Bronchopulmonary dysplasia, Chronic Obstructive Pulmonary Disease, Cystic adenomatoid malformation of lung, Emphysema, Eosinophilic pneumonia, Fibrosing alveolitis, Flail chest, Interstitial fibrosis, Laryngo-/Bronchospasm, Legionella pneumophila, Pleural effusion, Pneumonia, Pneumothorax, Pulmonary alveolar proteinosis, Pulmonary arterio-venous malformation, Pulmonary edema, Pulmonary embolism, Pulmonary hypertension, Pulmonary oedema, Restrictive Lung Disease, Status asthmaticus,
Renal / Electrolyte	Elecrolyte abnormalities,
Rheum / Immune / Allergy	Acute motor axonal neuropathy, Anaphylaxis, Angioedema, Antiphospholipid Antibody Syndrome, Devic's disease, Guillain-Barre syndrome, Hamman-Rich Syndrome, Myasthenia Gravis, Satoyoshi syndrome,
Trauma	Ebstein anomaly, Flail chest,
Urologic	No underlying causes
Miscellaneous	Aspiration, Foreign body, Malignant hyperpyrexia, Multiple organ dysfunction syndrome, Near-drowning, Reye's syndrome,

Differentials Diagnosis of Causes of Respiratory depression & distress

(DRUGS)

• Codeine,
• Clozapine,
• Fentanyl,
• Gamma-Hydroxybutyric acid,
• Heroin,
• Ketamine,
• Lidocaine,
• Labetalol,
• Lorazepam,
• Morphine,
• Nitrazepam,
• Opiate,
• Oxymorphone,
• Procainamide (patient information),
• Sodium thiopental,
• Triazolam,
• Zopiclone,

(Others)

• Glycogen storage disease type I,
• Hemosiderosis,
• Human ehrlichiosis,
• Infant respiratory distress syndrome,
• Multiple chemical sensitivity,
• Potter syndrome,
• Pre-eclampsia,

Treatment

Emergency treatment follows the principles of cardiopulmonary resuscitation. Treatment of the underlying cause is required. Mechanical ventilation may be required.

External Links

eMedicine Respiratory Failure [4]

de:Ateminsuffizienz no:Respirasjonssvikt fr:Insuffisance respiratoire