Respiratory Failure

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Respiratory failure is a clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which PaO2 lower than 60 mmHg and/or PaCO2 higher than 50 mmHg. Respiratory failure is classified according to blood gases abnormalities into type 1 and type 2.

Hypoxemic respiratory failure (type I): has a PaO2 < 60 mmHg with normal or subnormal PaCO2. In this type, the gas exchange is impaired at the level of alveoli-capillary membrane. Examples of type I respiratory failures are carcinogenic or non-cardiogenic pulmonary edema and severe pneumonia.

Hypercapnic respiratory failure (type II): has a PaCO2 > 50 mmHg. Hypoxemia is common, and it is due to respiratory pump failure

Investigations

  • ABG
  • FBP
  • Creatine kinase
  • ECHO
  • ECG
  • Troponin-I
  • TSH
  • CXR
  • Electrolytes
  • Creatinine and BUN
  • AST/ALT/ALP/GGT, albumin and bilirubin total, direct
  • PFT-if patient able to perform

Non-pharmacological Treatment

Noninvasive Ventilatory Support: Patients with mild-to-moderate acute respiratory failure.

Mechanical Ventilation

Refer to management of cardiogenic pulmonary edema and acute exacerbations of chronic obstructive pulmonary disease (COPD) in obstructive lung disease