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  ICD9          = {{ICD9|518.81}} |
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{{SI}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}  {{MUT}}
 
==Overview==
 
'''Respiratory failure''' is a [[medicine|medical]] term for inadequate [[gas exchange]] by the [[respiratory system]]. Respiratory failure can be indicated by observing a drop in blood [[oxygen]] level ([[Hypoxia (medical)|hypoxemia]]) and/or a rise in arterial [[carbon dioxide]] ([[hypercapnia]]) which can be written as ([[Partial pressure|Pa]][[Oxygen|O2]] < 60 mmHg, [[Partial pressure|Pa]]CO2 >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 CO<sub>2</sub> 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 of Hypoventilation==
 
Drugs
 
*[[Codeine]],
*[[Clozapine]],
*[[Fentanyl]],
*[[Gamma-Hydroxybutyric acid]],
*[[Heroin]],
*[[Ketamine]],
*[[Lidocaine]],
*[[Labetalol]],
*[[Lorazepam]],
*[[Morphine]],
*[[Nitrazepam]],
*[[Opiate]],
*[[Oxymorphone]],
*[[Procainamide (patient information)]],
*[[Sodium thiopental]],
*[[Triazolam]],
*[[Zopiclone]],
more on [[Dyspnea]]
 
==Complete Differential Diagnosis of Causes of Respiratory Failure==
 
 
(In alphabetical order)
{{MultiCol}}
*[[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]]
*Coal worker pneumoconiosis
*[[Cocaine]]
*[[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]]
*[[Fetal circulation, persistent]]
*[[Fibrosing alveolitis]]
*[[Flail chest]]
*[[Foreign body]]
*[[Furfural]]
*[[Glotto Emphysema]]
*[[Glycogen storage disease type I]]
*[[Guillain-Barre syndrome]]
{{ColBreak}}
*[[Hamman-Rich Syndrome]]
*[[Hantavirus Pulmonary Syndrome]]
*[[Heartworm]]
*[[Hemosiderosis]]
*[[Hepatic failure]]
*[[Hepatopulmonary syndrome]]
*[[Hereditary haemorrhagic telangiectasia]]
*[[Human ehrlichiosis]]
*[[Infant respiratory distress syndrome]]
*[[Interstitial fibrosis]]
*[[Kyphoscoliosis]]
*[[Laryngo-/Bronchospasm]]
*[[Legionella pneumophila]]
*[[Malignant hyperpyrexia]]
*[[Malignant Mesothelioma]]
*[[Marine toxins]]
*[[Meningitis]]
*[[Metabolic Acidosis]]
*[[Multiple chemical sensitivity]]
*[[Multiple organ dysfunction syndrome]]
*[[Muscarine]]
*[[Myasthenia Gravis]]
*Near-drowning
*[[Omphalitis]]
*[[Osteogenesis imperfecta]]
*[[Pleural effusion]]
*[[Pneumonia]]
*[[Pneumothorax]]
*[[Polio]]
*[[Polyrediculitis]]
*[[Post-polio syndrome]]
*[[Potter syndrome]]
*[[Pre-eclampsia]]
*[[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)]]
*[[Status asthmaticus]]
*Sulphur dioxide
*[[Tetanus]]
*[[Tetracycline antibiotics]]
*[[Tetrodotoxin]]
*[[Thanatophoric dysplasia]]
*[[Tick paralysis]]
*[[Transposition of great arteries]]
*[[Tricuspid valve stenosis]]
*[[Ventricular septal defect]]
*[[Vinyl chloride]]
*[[Zellweger syndrome]]
{{EndMultiCol}}
 
===Complete Differential Diagnosis of the Causes of Respiratory failure===
(By organ system)
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Atrial septal defect (ostium primum)]],
[[Ebstein anomaly]],
[[Eisenmenger syndrome]],
[[Fallot tetralogy]],
[[Pulmonary valve stenosis]],
[[Transposition of great arteries]],
[[Tricuspid valve stenosis]],
[[Ventricular septal defect]],
 
|-
|-
|-bgcolor="LightSteelBlue"
| [[File:Siren.gif|30px|link=Respiratory failure resident survival guide]]|| <br> || <br>
| '''Chemical / poisoning'''
| [[Respiratory failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|bgcolor="Beige"| [[3-Quinuclidinyl benzilate]],
|}
[[Abrin]],
[[Aldicarb]],
[[Alpha-amanitin]],
[[Barium nitrate]],
[[Bungarotoxin]],
[[Carbon monoxide poisoning]],
[[Cocaine]],
[[Cone snail]],
[[Furfural]],
[[Snakebites (Patient information)]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Congenital'''
|bgcolor="Beige"|
[[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)]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect '''
|bgcolor="Beige"|
 
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|
[[Asbestosis]],
Coal worker pneumoconiosis,
[[Smoke inhalation]],
Sulphur dioxide,
 
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Hepatic failure]],
[[Hepatopulmonary syndrome]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
[[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]],


|-
'''For patient information, click [[Respiratory failure (patient information)|here]]'''
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|
[[Acute Porphyria]],
[[Cholesterol Emboli Syndrome]],
[[Fat embolism]],
[[Sepsis]],


|-
{{Respiratory failure}}
|-bgcolor="LightSteelBlue"
{{CMG}}; {{AE}} {{MKA}}; {{HM}}
| '''Iatrogenic'''
|bgcolor="Beige"|
[[Blood transfusion]],
[[EVAR]],


|-
{{SK}}: Acute respiratory failure, type I respiratory failure, type II respiratory failure, type III respiratory failure, type IV respiratory failure, type 1 respiratory failure, type 2 respiratory failure, type 3 respiratory failure, type 4 respiratory failure
|-bgcolor="LightSteelBlue"
==[[Respiratory failure overview|Overview]]==
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Babesiosis]],
[[Botulism]],
[[Crimean-Congo hemorrhagic fever]],
[[Hantavirus Pulmonary Syndrome]],
[[Heartworm]],
[[Post-polio syndrome]],
[[Rabies]],
[[Tetanus]],


==[[Respiratory failure historical perspective|Historical Perspective]]==


|-
==[[Respiratory failure classification|Classification]]==
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
[[Kyphoscoliosis]],


|-
==[[Respiratory failure pathophysiology|Pathophysiology]]==
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Amyotrophic Lateral Sclerosis]],
[[Meningitis]],
[[Polyrediculitis]],
[[Zellweger syndrome]],


|-
==[[Respiratory failure causes|Causes]]==
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Metabolic Acidosis]],


|-
==[[Respiratory failure differential diagnosis|Differentiating Respiratory Failure from other Diseases]]==
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|
[[Malignant Mesothelioma]],


|-
==[[Respiratory failure epidemiology and demographics|Epidemiology and Demographics]]==
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Acetylsalicylic acid]],
[[Alcohol]],
[[Bufotenin]],
[[Clitocybe dealbata]],
[[Colchicine]],
[[Cytisine]],
[[Dicofol]],
[[Saxitoxin]],
[[Tetrodotoxin]],
[[Tick paralysis]],
[[Vinyl chloride]],


|-
==[[Respiratory failure risk factors|Risk Factors]]==
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|
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]],


==[[Respiratory failure screening|Screening]]==


==[[Respiratory_failure_natural_history,_complications_and_prognosis|Natural History, Complications and Prognosis]]==


|-
==Diagnosis==
|-bgcolor="LightSteelBlue"
[[Respiratory failure diagnostic study of choice|Diagnostic Study of Choice]] |[[Respiratory failure history and symptoms|History and Symptoms]] | [[Respiratory failure physical examination|Physical Examination]] | [[Respiratory failure laboratory findings|Laboratory Findings]] | [[Respiratory failure electrocardiogram|Electrocardiogram]] | [[Respiratory failure chest x ray|Chest X Ray]] | [[Respiratory failure CT|CT]] | [[Respiratory failure MRI|MRI]] | [[Respiratory failure ultrasound|Echocardiography or Ultrasound]] | [[Respiratory failure other imaging findings|Other Imaging Findings]] | [[Respiratory failure other diagnostic studies|Other Diagnostic Studies]]
| '''Renal / Electrolyte'''
|bgcolor="Beige"|  
Elecrolyte abnormalities,


|-
==Treatment==
|-bgcolor="LightSteelBlue"
[[Respiratory failure medical therapy|Medical Therapy]] | [[Respiratory failure surgery|Surgery]] | [[Respiratory failure primary prevention|Primary Prevention]] | [[Respiratory failure secondary prevention|Secondary Prevention]] | [[Respiratory failure cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Respiratory failure future or investigational therapies|Future or Investigational Therapies]]
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
[[Acute motor axonal neuropathy]],
[[Anaphylaxis]],
[[Angioedema]],
[[Antiphospholipid Antibody Syndrome]],
[[Devic's disease]],
[[Guillain-Barre syndrome]],
[[Hamman-Rich Syndrome]],
[[Myasthenia Gravis]],
[[Satoyoshi syndrome]],
 
 
 
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|
[[Ebstein anomaly]],
[[Flail chest]],


|-
==Case Studies==
|-bgcolor="LightSteelBlue"
[[Respiratory failure case study one|Case #1]]
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Aspiration]],
[[Foreign body]],
[[Malignant hyperpyrexia]],
[[Multiple organ dysfunction syndrome]],
Near-drowning,
[[Reye's syndrome]],
 
|-
|}
 
 
==Treatment==
Emergency treatment follows the principles of [[cardiopulmonary resuscitation]]. Treatment of the underlying cause is required. [[Mechanical ventilation]] may be required.


{{Respiratory pathology}}
{{Respiratory pathology}}
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[[Category:Intensive care medicine]]
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Latest revision as of 06:35, 28 July 2020



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]; Hadeel Maksoud M.D.[3]

Synonyms and keywords:: Acute respiratory failure, type I respiratory failure, type II respiratory failure, type III respiratory failure, type IV respiratory failure, type 1 respiratory failure, type 2 respiratory failure, type 3 respiratory failure, type 4 respiratory failure

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Respiratory Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice |History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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