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Overview of Respiratory Failure

By Jesse B. Hall, MD, Professor Emeritus of Medicine and Anesthesia and Critical Care, University of Chicago School of Medicine ; Pamela J. McShane, MD, Assistant Professor of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago

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Respiratory failure is a life-threatening impairment of oxygenation, CO2 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 O2, control of secretions, and ventilatory assistance if needed.

The respiratory system oxygenates and eliminates CO2 from venous blood. Thus, a useful classification of respiratory failure is whether the principal abnormality is inadequate oxygenation or inadequate CO2 elimination (which means inadequate ventilation), although many disorders affect both. Although temporizing measures exist, respiratory failure frequently necessitates mechanical ventilation.