Respiratory Failure

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Respiratory Failure

• severe respiratory distress

• diminished respiratory effort, apnoea

• CNS signs of hypoxia

  • agitation

  • fatigue

  • drowsiness

• cyanosis

• collapse

Type I (pink puffer)

• pO2 < 8.0kPa without hypercapnia

• distressing breathlessness

• often underweight

• develop cyanosis, oedema, hypoxaemia, hypercapnoea late

Causes

Chronic

• Interstitial disease

• Chronic Obstructive Airways Disease

• drugs

• fibrosing alveolitis

• extrinsic allergic alveolitis

Acute

• Asthma

• pulmonary oedema

• pulmonary embolus

• Adult respiratory distress syndrome

• pneumonia

  • viral

  • diffuse

  • bacterial

  • aspiration

Treatment

• underlying disorder

• high concentration oxygen

Type II (blue bloater)

• PaO₂ <7.3 kPa and PCO2 > 6 kPA

• not so distressed

• often overweight and oedematous

• may develop right heart failure (cor pulmonale)

Chronic causes

• Cystic Fibrosis

• Chronic Obstructive Airways Disease

• terminal illness

Therapy

• controlled increase in inhaled O₂ concentration

• antibiotics

• bronchodilators

• physiotherapy

• positive pressure ventilation

  • intermittent / continuous

• doxapram

Acute causes

• asphyxia

• airway obstruction

  • foreign body

  • epiglottitis

  • laryngeal oedema

  • vocal cord - bilateral paralysis

• drugs

  • narcotics

• chest trauma

  • tension pneumothorax

  • haemothorax

  • flail chest

• CNS

  • brainstem lesions

  • cervical cord lesion

  • neuromuscular poisons

    • organophosphates

    • botulinum toxin

  • Myasthenia gravis

  • Guillain-Barre

Treatment

• underlying cause

Acute Management

• Beware acidosis

• Controlled oxygen therapy

• Consider

  • doxapram hydrochloride

  • assisted ventilation

Chronic Management

• ? Long term oxygen therapy

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