eMedicine Specialties > Critical Care > Medical Topics

Respiratory Failure: Follow-up

Author: Ata Murat Kaynar, MD, Assistant Professor, Departments of Critical Care Medicine and Anesthesiology, University of Pittsburgh School of Medicine
Coauthor(s): Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: May 20, 2009

Follow-up

Complications

  • Pulmonary
    • Common pulmonary complications of acute respiratory failure include pulmonary embolism, barotrauma, pulmonary fibrosis, and complications secondary to the use of mechanical devices.
    • Patients are also prone to develop nosocomial pneumonia.
    • Regular assessment should be performed by periodic radiographic chest monitoring.
    • Pulmonary fibrosis may follow acute lung injury associated with acute respiratory distress syndrome (ARDS).
    • High oxygen concentrations and the use of large tidal volumes may worsen acute lung injury.
  • Cardiovascular
    • Common cardiovascular complications in patients with acute respiratory failure include hypotension, reduced cardiac output, arrhythmia, pericarditis, and acute myocardial infarction.
    • These complications may be related to the underlying disease process, mechanical ventilation, or the use of pulmonary artery catheters.
  • Gastrointestinal
    • The major gastrointestinal complications associated with acute respiratory failure are hemorrhage, gastric distention, ileus, diarrhea, and pneumoperitoneum.
    • Stress ulceration is common in patients with acute respiratory failure; the incidence can be reduced by routine use of antisecretory agents or mucosal protectants.
  • Infectious
    • Nosocomial infections, such as pneumonia, urinary tract infections, and catheter-related sepsis, are frequent complications of acute respiratory failure.
    • These usually occur with the use of mechanical devices.
    • The incidence of nosocomial pneumonia is high and associated with significant mortality.
  • Renal
    • Acute renal failure and abnormalities of electrolytes and acid-base homeostasis are common in critically ill patients with respiratory failure.
    • The development of acute renal failure in a patient with acute respiratory failure carries a poor prognosis and high mortality. The most common mechanisms of renal failure in this setting are renal hypoperfusion and the use of nephrotoxic drugs (including radiographic contrast material).
  • Nutritional
    • These include malnutrition and its effects on respiratory performance and complications related to administration of enteral or parenteral nutrition.
    • Complications associated with nasogastric tubes, such as abdominal distention and diarrhea, also may occur.
    • Complications of parenteral nutrition may be mechanical due to catheter insertion, infectious, or metabolic (eg, hypoglycemia, electrolyte imbalance).

Prognosis

  • The mortality rate for acute respiratory distress syndrome (ARDS) is approximately 40%. Younger patients (<60 y) have better survival rates than older patients. Approximately two thirds of patients who survive an episode of acute respiratory distress syndrome (ARDS) manifest some impairment of pulmonary function 1 or more years after recovery.
  • Significant mortality also occurs in patients admitted with hypercapnic respiratory failure. This is because these patients have a chronic respiratory disorder and other comorbidities such as cardiopulmonary, renal, hepatic, or neurologic disease. These patients also may have poor nutritional status. For patients with COPD and acute respiratory failure, the overall mortality rate has declined from approximately 26% to 10%.

Patient Education

For excellent patient education resources, visit eMedicine's Lung and Airway Center. Also, see eMedicine's patient education article Acute Respiratory Distress Syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Risks of oxygen therapy are oxygen toxicity and carbon dioxide narcosis. Pulmonary oxygen toxicity rarely occurs when an FiO2 of less than 0.6 is used; therefore, an attempt to lower the inspired oxygen concentration to this level should be made in critically ill patients.
  • Carbon dioxide narcosis occasionally occurs when some patients with hypercapnia are given oxygen to breathe. PaCO2 increases sharply and progressively with severe respiratory acidosis, somnolence, and coma. The mechanism is primarily the reversal of pulmonary vasoconstriction and the increase in dead space ventilation.
  • Respiratory failure is a common and a life-threatening condition that demands prompt diagnosis and assessment and appropriate management.
  • Failure to visualize an obvious abnormality on chest radiographs in hypoxemic respiratory failure suggests the possibility of right-to-left shunting.
  • The vast majority of patients in acute respiratory failure due to cardiogenic pulmonary edema respond to measures to reduce preload and afterload.
  • Those with acute respiratory distress syndrome (ARDS) require early elective intubation because the duration of respiratory failure is longer.
  • Hypercapnic respiratory failure occurs secondary to a variety of causes, including an increased respiratory muscle load, impaired neuromuscular function, or decreased respiratory drive caused by CNS depression.
 


More on Respiratory Failure

Overview: Respiratory Failure
Differential Diagnoses & Workup: Respiratory Failure
Treatment & Medication: Respiratory Failure
Follow-up: Respiratory Failure
Multimedia: Respiratory Failure
References
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References

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Further Reading

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Keywords

respiratory failure, hypoxemic respiratory failure, chronic respiratory failure, hypercapnic respiratory failure, type I respiratory failure, type II respiratory failure, chronic obstructive pulmonary disease, COPD, chronic obstructive pulmonary disease, respiratory system failure, respiratory system, system failure, PaO2 value, oxygenation, carbon dioxide elimination, hypoxemic, hypercapnic

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Contributor Information and Disclosures

Author

Ata Murat Kaynar, MD, Assistant Professor, Departments of Critical Care Medicine and Anesthesiology, University of Pittsburgh School of Medicine
Ata Murat Kaynar, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Chest Physicians, American Society of Anesthesiologists, American Society of Critical Care Anesthesiologists, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Cory Franklin, MD, Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science; Director, Division of Critical Care Medicine, Cook County Hospital
Cory Franklin, MD is a member of the following medical societies: New York Academy of Sciences and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Harold L Manning, MD, Associate Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School
Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM, Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center
Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, Shock Society, and Society of Critical Care Medicine
Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

 
 
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