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Overview of Respiratory Failure

by Jesse B. Hall, MD, Pamela J. McShane, MD

Respiratory failure is a life-threatening impairment of oxygenation, CO 2 elimination, or both. Respiratory failure may occur because of impaired gas exchange, decreased ventilation, or both. Common manifestations include dyspnea, use of accessory muscles of respiration, tachypnea, tachycardia, diaphoresis, cyanosis, altered consciousness, and, without treatment, eventually obtundation, respiratory arrest, and death. Diagnosis is clinical, supplemented by ABGs and chest x-ray. Treatment is usually in an ICU and involves correction of the underlying cause, supplemental O 2 , control of secretions, and ventilatory assistance if needed.

The respiratory system oxygenates and eliminates CO 2 from venous blood. Thus, a useful classification of respiratory failure is whether the principal abnormality is inadequate oxygenation or inadequate CO 2 elimination (which means inadequate ventilation), although many disorders affect both. Although temporizing measures exist, respiratory failure frequently necessitates mechanical ventilation.

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