Respiratory Failure

• Respiratory failure occurs when the breathing

system fails to keep adequate blood oxygen
levels. There may also be difficulties in
removing waste gases, mainly blood carbon
dioxide.
• pH 7.35-7.45
• PaO2 >70 mmHg
• PaCO2 35-45 mmHg
• HCO3 22-28 mmol/l

• Minute ventilation = Tidal volume X Respiratory rate

• ↓pH Acidosis
• ↑pH Alkalosis
• ↓ PaO2 Hypoxemia
• ↑PaCO2 Hypercapnia
• ↓pH+ ↑PaCO2 R. acidosis
– ↑HCO3
• ↑pH+↓PaCO2 R.Alkalosis
– ↓HCO3
Causes :
Every time we take a breath in we are taking oxygen from
the air down to the lungs which then crosses over into
the blood and is then transported to the various organs.
At the same time carbon dioxide, which is the waste gas
produced by organs, crosses from the blood and into the
lungs - we then breathe this out. This whole process
requires an interplay of various systems such as the
lungs, the heart, the chest muscles and the brain. When
any of these are impaired we are at risk of respiratory
failure. Respiratory failure is defined by low blood oxygen
levels and there may also be raised blood carbon dioxide
levels.
• There are various causes of respiratory failure,
the most common being due to the lungs or
heart. The lung disorders that lead to
respiratory failure include chronic obstructive
pulmonary disease (COPD), asthma and
pneumonia. Heart disease that can lead to
respiratory failure can be heart failure which
may or may not be accompanied by a heart
attack.
Symptoms :
Very early on there may not be any symptoms
or just tiredness after exertion. Gradually, as the
respiratory failure worsens, there is an inability to
get oxygen to the body's organs. The most common
features are shortness of breath (which may be at
rest or on exertion) and becoming tired easily. There
may also be symptoms of the underlying causes,
such as a raised temperature in pneumonia or leg
swelling in heart failure.
Diagnosis :
People with sudden respiratory failure or new
respiratory failure are likely to need urgent hospital
admission. Further tests will be required to make the
diagnosis and to find the underlying cause. These
tests are likely to include blood tests, a chest X-ray, a
heart ultrasound scan (echocardiography) and a
computerised tomography (CT) scan of the lungs.
Treatment:
Treatmentof sudden or new respiratory failure often
requires emergency measures to make the patient more stable
medically. This may require resuscitation and artificial
ventilation. Patients may need to be admitted to the intensive
care unit or the high dependency unit (based on how unwell
the patient is).
• Treatment will aim to improve the blood oxygen levels and
remove the waste gas carbon dioxide if it is raised. This will
usually require artificial ventilation. Further treatment will
be aimed towards the underlying cause, such as antibiotics
in pneumonia or diuretics in heart failure.