II. Types: Hypoventilatory Respiratory Failure or Hypercapnic Respiratory Failure (Bellows Failure)
- Defining features
- High PaCO2 >50 mmHg (not due to respiratory compensation for Metabolic Alkalosis)
- Normal A-a Gradient
- Causes: Compromised lung mechanics
- Upper airway obstruction
- Pulmonary muscle Fatigue (Skeletal muscle Fatigues at >40% of maximum load)
- Obesity
- Ascites
- Pleural Effusion
- Supine position
- Kyphoscoliosis
- Ankylosing Spondylitis
- Hypercarbia (fever, Sepsis, burns)
- Inefficient breathing (flat diaphragm, high Residual Volume)
- Unstable chest wall
- Pneumothorax
- Flail Chest or multiple Rib Fractures
- Diaphragmatic Rupture
- Causes: Neuromuscular
- Drug Overdose or depressant drugs
- Opioids
- Benzodiazepines
- Barbiturates
- Procedural Anesthesia (e.g. Propofol)
- Phencyclidine (PCP)
- Toxins (or other medication adverse effects)
- Electrolyte and endocrine abnormalities
- Hyponatremia
- Hypocalcemia
- Hypokalemia
- Hyperkalemia
- Hypomagnesemia
- Severe Hypophosphatemia
- Hypothyoidism
- Brainstem injury
- Severe global CNS injury
- Head Trauma
- Intracranial Hemorrhage
- CNS Infection (Meningitis, Encephalitis, Brain Abscess, West Nile Encephalitis, Poliomyelitis)
- Central Sleep Apnea
- Central Alveolar Hypoventilation Syndrome (CHS)
- Nerve dysfunction
- Spinal cord injury
- Polyneuritis (e.g. Guillain-Barre Syndrome)
- Amyotrophic Lateral Sclerosis
- Multiple Sclerosis
- Nerve Agent Exposure (e.g. Organophosphates)
- Phrenic nerve injury
- Muscular dysfunction
- Drug Overdose or depressant drugs
III. Types: Ventilation-perfusion mismatch (venous admixture)
- Defining features
- High PaCO2
- Increased A-a Gradient
- Often improves with Supplemental Oxygen
- Causes
IV. Types: Hypoxemic Respiratory Failure (or physiologic right to left shunting)
- Defining features
- Low PaCO2
- Low PaO2 <50-60 mmHg on room air
- A-a Gradient may be increased
- May not improve with Supplemental Oxygen
- Causes
- Cardiac Pulmonary Edema (high pressure edema)
- Left Ventricular Failure
- Acute Myocardial Ischemia (left ventricle)
- Malignant Hypertension
- Mitral Regurgitation or stenosis
- Lung Conditions
- Lobar Pneumonia
- Atelectasis
- Pulmonary Contusion
- Alveolar Hemorrhage
- Bronchospasm
- Cystic Fibrosis
- Acute Respiratory Distress Syndrome (ARDS)
- Increased permeability (low pressure edema)
- Cardiac Pulmonary Edema (high pressure edema)
V. Signs
-
General appearance
- Altered Mental Status
- Diaphoresis
- Increased work of breathing
- Cardiovascular changes
- Mucous membrane and nail bed Cyanosis
- Tachycardia
- Hypertension
VI. Differential Diagnosis
- See Causes above
- See Dyspnea Causes
- See Tachypnea Causes
- See Hypoxia
VII. Management: General
- See Emergency Breathing Management
- See Advanced Airway
- See Non-Invasive Positive Pressure Ventilation
- Specific Approaches
VIII. Management: Approach to Non-Invasive Positive Pressure Ventilation Selection
- Hypoxemic Respiratory Failure (Inadequate oxygenation)
- Reflected by Arterial Blood GasPaO2 and Oxygen Saturation
- Concepts
- Increase oxygen delivered to the lung (esp. FIO2) or
- Increase mean airway pressure (or Positive End-Expiratory Pressure)
- Interventions
- Hypercarbic Respiratory Failure (Inadequate ventilation)
- Reflected by Arterial Blood GasPaCO2 and pH
- Concepts (increase minute ventilation)
- Increase Tidal Volume (TV) or
- Increase Respiratory Rate (RR)
- Interventions
- References
- Mallemat and Runde in Herbert (2015) EM:Rap 15(2): 7-8
IX. References
- (2016) Fundamental Critical Care Support, p. 46-60
- Davies (1986) Acute Respiratory Failure, Cyberlog
- Presberg in Noble (2001) Primary Care, p. 705-16
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Related Studies
Definition (NCI) | Life-threatening respiratory failure that develops rapidly. Causes include injury, sepsis, drug overdose, and pancreatitis. It manifests with dyspnea and cyanosis and may lead to cardiovascular shock. |
Concepts | Disease or Syndrome (T047) |
ICD9 | 518.81 |
ICD10 | J96.0 |
SnomedCT | 65710008 |
English | Acute respiratory failure, ARF - Acute respirat failure, ARF, acute respiratory failure (diagnosis), acute respiratory failure, Acute respiratry failure, acute failure respiratory, arf, ARF - Acute respiratory failure, Acute respiratory failure (disorder), Acute Respiratory Failure |
Italian | Insufficienza respiratoria acuta, Insufficienza renale acuta |
Dutch | ANF, Acute respiratoire insufficiëntie, acuut ademhalingstekort |
French | IRA, Défaillance respiratoire aiguë |
German | ARF, Akute respiratorische Insuffizienz, anderenorts nicht klassifiziert, akute respiratorische Insuffizienz |
Portuguese | Insuficiência renal aguda, Insuficiência respiratória aguda |
Spanish | FRA, fallo respiratorio agudo, falla respiratoria aguda (trastorno), falla respiratoria aguda, difucultad respiratoria aguda, dificultad respiratoria aguda (trastorno), dificultad respiratoria aguda, fallo respiratorio agudo (trastorno), Insuficiencia respiratoria aguda |
Japanese | 急性腎不全, 急性呼吸不全, キュウセイジンフゼン, キュウセイコキュウフゼン |
Czech | Akutní respirační selhání, Akutní renální selhání |
Korean | 급성 호흡기능상실 |
Hungarian | Heveny légzési elégtelenség, ARF |
Ontology: Respiratory Failure (C1145670)
Definition (MEDLINEPLUS) |
Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body's organs, such as your heart and brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can't remove carbon dioxide (a waste gas) from your blood. Too much carbon dioxide in your blood can harm your body's organs. Diseases and conditions that affect your breathing can cause respiratory failure. Examples include
Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) and how severe it is. It also depends on the underlying cause. You may receive oxygen therapy and other treatment to help you breathe. NIH: National Heart, Lung, and Blood Institute |
Definition (NCI) | The significant impairment of gas exchange within the lungs resulting in hypoxia, hypercarbia, or both, to the extent that organ tissue perfusion is severely compromised. Causes include chronic obstructive pulmonary disease, asthma, emphysema, acute respiratory distress syndrome, pneumonia, pulmonary edema, pneumothorax, and congestive heart failure. Treatment requires intubation and mechanical ventilation until the time the lungs recover sufficient function. |
Definition (NCI_CTCAE) | A disorder characterized by impaired gas exchange by the respiratory system resulting in hypoxemia and a decrease in oxygenation of the tissues that may be associated with an increase in arterial levels of carbon dioxide. |
Definition (CSP) | respiratory function fails to maintain adequate oxygen supply and carbon dioxide removal. |
Concepts | Disease or Syndrome (T047) |
MSH | D012131 |
ICD10 | J96.9 |
SnomedCT | 207552005, 207555007, 51395007, 196165003, 158731006, 158734003, 409622000 |
English | Respiratory Failure, Respiratory failure, unspecified, [D]Respiratory failure (context-dependent category), [D]Respiratory failure NOS (context-dependent category), [D]Respiratory failure, [D]Respiratory failure NOS, respiratory failure (diagnosis), respiratory failure, Respiration failure, Failure respiratory, Failure;respiratory, respiratory insufficiency, respiratory insufficiency/failure, [D]Respiratory failure NOS (situation), [D]Respiratory failure (situation), RESPIRATORY FAILURE, FAILURE, RESPIRATORY, Respiratory failure, NOS, Respiratory failure, Respiratory failure (disorder), Respiratory failure NOS |
Italian | Insufficienza respiratoria, Crisi respiratoria |
German | Atemversagen, Versagen Atmung, Respiratorische Insuffizienz, ATEMVERSAGEN, Respiratorische Insuffizienz, nicht naeher bezeichnet, respiratorische Insuffizienz |
Spanish | Fallo de la respiración, [D]falla respiratoria (categoría dependiente del contexto), Paro Respiratoria, [D]falla respiratoria (situación), [D]falla respiratoria, Insuficiencia respiratoria, falla respiratoria (trastorno), falla respiratoria |
Japanese | 呼吸不全, コキュウフゼン |
Portuguese | Falência Respiratória, FALENCIA RESPIRATORIA, Insuficiência respiratória |
French | Défaillance respiratoire, DEFAILLANCE RESPIRATOIRE |
Czech | Respirační selhání, Selhání respirační, respirační selhání |
Korean | 상세불명의 호흡기능상실 |
Hungarian | Respiratiós insufficientia, Légzési elégtelenség, Légzési insufficientia |
Norwegian | Respirasjonssvikt |
Dutch | Respiratoire insufficiëntie, niet gespecificeerd, respiratoir falen, Ademhalingsinsufficiëntie |