II. Types: Hypoventilatory Respiratory Failure (Bellows Failure)

  1. Defining features
    1. High PaCO2
    2. Normal A-a Gradient
  2. Causes: Compromised lung mechanics
    1. Upper airway obstruction
    2. Pulmonary muscle Fatigue (Skeletal muscle Fatigues at >40% of maximum load)
      1. Obesity
      2. Ascites
      3. Supine position
      4. Scoliosis
      5. Ankylosing Spondylitis
      6. Hypercarbia (fever, Sepsis, burns)
      7. Inefficient breathing (flat diaphragm, high Residual Volume)
        1. Asthma
        2. Emphysema
    3. Unstable chest wall
      1. Pneumothorax
      2. Flail Chest
  3. Causes: Neuromuscular
    1. Drug Overdose or depressant drugs
      1. Example: Phencyclidine (PCP)
    2. Brainstem injury
    3. Severe global CNS injury
      1. Head Trauma
      2. Intracranial Hemorrhage
      3. CNS Infection
    4. Nerve dysfunction
      1. Spinal cord injury
      2. Polyneuritis (e.g. Guillain-Barre Syndrome)
      3. Amyotrophic Lateral Sclerosis
      4. Poliomyelitis
      5. Nerve Agent Exposure (e.g. Organophosphates)
      6. Phrenic nerve injury
        1. Example: Phrenic Nerve Injury from Birth Trauma
    5. Muscular dysfunction
      1. Muscular Dystrophy
      2. Polymyositis
      3. Severe Hypophosphatemia

III. Types: Ventilation-perfusion mismatch (venous admixture)

IV. Types: Hypoxemic Respiratory Failure (Right to left shunting)

  1. Defining features
    1. Low PaCO2
    2. Low PaO2
    3. A-a Gradient may be increased
    4. May not improve with Supplemental Oxygen
  2. Causes
    1. Adult Respiratory Distress Syndrome (ARDS)
      1. Increased permeability (low pressure edema)
    2. Cardiac pulmonary edema (high pressure edema)
      1. Left Ventricular Failure
      2. Acute Myocardial Ischemia (left ventricle)
      3. Malignant Hypertension
      4. Mitral Regurgitation or stenosis
    3. Focal Lesions
      1. Lobar Pneumonia
      2. Atelectasis
      3. Pulmonary Contusion
      4. Alveolar Hemorrhage

V. Management: Approach to Non-Invasive Positive Pressure Ventilation Selection

  1. Hypoxemic respiratory failure (Inadequate oxygenation)
    1. Concepts
      1. Increase oxygen delivered to the lung or
      2. Increase mean airway pressure (or Positive End-Expiratory Pressure)
    2. Interventions
      1. Continuous Positive Airways Pressure (CPAP)
  2. Hypercarbic respiratory failure (Inadequate ventilation)
    1. Concepts
      1. Increase Tidal Volume or
      2. Increase Respiratory Rate
    2. Interventions
      1. Bilevel Positive Airway Pressure (BiPap)
  3. References
    1. Mallemat and Runde in Herbert (2015) EM:Rap 15(2): 7-8

VI. References

  1. Davies (1986) Acute Respiratory Failure, Cyberlog
  2. Presberg in Noble (2001) Primary Care, p. 705-16

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Ontology: Acute respiratory failure (C0264490)

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