Respiratory Failure Questions & Answers

Updated: Apr 07, 2020
  • Author: Ata Murat Kaynar, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Questions & Answers

Overview

What is respiratory failure?

How is hypoxemic respiratory failure (type I) characterized?

How is hypercapnic respiratory failure (type II) characterized?

What are the differences between acute and chronic respiratory failure?

What is included in the workup of suspected respiratory failure?

What is the danger of hypoxemia in respiratory failure?

In which component of the respiratory system does respiratory failure originate?

What is the role of ventilatory capacity in the pathogenesis of respiratory failure?

Which processes for respiration are engaged in the pathogenesis of respiratory failure?

What is the role of gas exchange in the pathophysiology of respiratory failure?

What is the oxygen hemoglobin dissociation curve?

In which forms is carbon dioxide transported in the pathophysiology of respiratory failure?

What is the role of blood flow and ventilation in the pathophysiology of respiratory failure?

Which equation represents the relationship between the rate of carbon dioxide production by the tissues and the rate of carbon dioxide elimination by the lung in the pathophysiology of respiratory failure?

How is the alveolar-arterial PO2 gradient measured in the pathophysiology of respiratory failure?

What are the pathophysiologic mechanisms for hypoxemic respiratory failure?

What is the role of the ventilation-to-perfusion ratio (V/Q) in the pathophysiology of respiratory failure?

What causes a low ventilation-to-perfusion ratio (V/Q) in the pathophysiology of respiratory failure?

What is the benefit of 100% oxygen for patients experiencing respiratory failure?

What is the role of shunt in the pathophysiology of respiratory failure?

What is an anatomic shunt in the pathophysiology of respiratory failure?

When is a shunt a cause of hypoxemia in respiratory failure?

How is arterial carbon dioxide tension (PaCO2) measured in the pathogenesis of respiratory failure?

What is the role of hypoventilation in the pathophysiology of respiratory failure?

How are the etiologies of respiratory failure categorized?

Which metabolic disorders of the central nervous system (CNS) lead to respiratory failure?

Which disorders of the peripheral nervous system (PNS), respiratory muscles, and chest wall lead to respiratory failure?

Which severe-upper airway disorders cause respiratory failure?

Which diseases of the alveoli can result in respiratory failure?

What are common causes of type I (hypoxemic) respiratory failure?

What are common causes of type II (hypercapnic) respiratory failure?

What is the overall prevalence of respiratory failure?

What are the racial predilections in incidence of respiratory failure?

What is the mortality rate for respiratory failure?

Presentation

How is respiratory failure diagnosed?

Which history findings suggest cardiogenic pulmonary edema resulting in respiratory failure?

What are the risk factors for respiratory failure following kidney transplantation?

What are the signs and symptoms of acute respiratory failure?

Which physical findings are characteristic of type I and type II respiratory failure?

What is the significance of a finding of cyanosis in suspected type I respiratory failure?

What may contribute to dyspnea in respiratory failure?

Which nervous system findings suggest respiratory failure?

What causes cor pulmonale occur in respiratory failure?

What are the diagnostic criteria for acute respiratory distress syndrome (ARDS)?

What are the categories of complications of acute respiratory failure (ARF)?

What are the pulmonary complications of acute respiratory failure (ARF)?

What are the cardiovascular complications of acute respiratory failure (ARF)?

What are the GI complications of acute respiratory failure (ARF)?

Which nosocomial infections are complications of respiratory failure?

Which complications are common in critically ill patients with respiratory failure?

What are the nutritional complications of acute respiratory failure (ARF)?

DDX

What is respiratory failure?

What radiographic finding suggests right-to-left shunting in respiratory failure?

When is early intubation indicated for respiratory failure?

What causes of hypercapnic respiratory failure (type II)?

What are the differential diagnoses for Respiratory Failure?

Workup

What is the role of arterial blood gas measurement in the diagnosis of respiratory failure?

What is the role of imaging in the diagnosis of respiratory failure?

How is the clinical diagnosis of respiratory failure confirmed?

What is the role of a CBC count in the diagnosis of respiratory failure?

What is the role of a chemistry panel in the evaluation of respiratory failure?

How is myocardial infarction excluded in the evaluation of respiratory failure?

What is the role of thyroid-stimulating hormone (TSH) testing in the diagnosis of respiratory failure?

What is the role of chest radiography in the diagnosis of respiratory failure?

What is the role of echocardiography in the diagnosis of respiratory failure?

What is the role of pulmonary function tests (PFTs) in the diagnosis of respiratory failure?

What is the role of right-sided heart catheterization in the diagnosis and management respiratory failure?

What is the role of the pulmonary capillary wedge pressure in the diagnosis of respiratory failure?

Treatment

What are the risks of oxygen therapy for respiratory failure?

What should be done once hypoxemia is corrected in patients with respiratory failure?

When is bed rest indicated in the treatment of respiratory failure?

Which specialist consultations are required for treatment of respiratory failure?

What is the first objective for treatment of respiratory failure?

When is inpatient care indicated for respiratory failure?

What is the role of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory failure?

What is the role of endotracheal intubation in the treatment of respiratory failure?

How is coexistent hypercapnic respiratory failure and respiratory acidosis managed?

What are the benefits of mechanical ventilation in the treatment of respiratory failure?

What is the role of negative pressure ventilation in the treatment of respiratory failure?

What is the evolution of mechanical ventilators used for the treatment of respiratory failure?

What are the differences between positive-pressure and negative-pressure ventilators for the treatment of respiratory failure?

What are the differences between controlled and patient-initiated ventilators for the treatment of respiratory failure?

Which variables are set for positive-pressure ventilation in respiratory failure?

What is volume-targeted (or volume preset) ventilation for respiratory failure?

What is pressure-targeted (or pressure preset) ventilation for respiratory failure?

How does endotracheal intubation mechanically ventilate patients with respiratory failure?

What is pressure support ventilation (PSV) for respiratory failure?

What is intermittent mandatory ventilation (IMV) for respiratory failure?

What are the benefits of synchronized intermittent mandatory ventilation (SIMV) for respiratory failure?

What is assist-control ventilation for respiratory failure?

What is volume-control ventilation for respiratory failure?

When is pressure-control ventilation indicated for respiratory failure?

What is pressure-control inverse-ratio ventilation (PCIRV) for respiratory failure?

What is patient-initiated (assisted) ventilation for respiratory failure?

How is a pressure triggering ventilator used to treat respiratory failure?

How is a flow triggering ventilator used to treat respiratory failure?

What is positive end-expiratory pressure (PEEP) ventilation for respiratory failure?

How is positive end-expiratory pressure (PEEP) used for treatment of respiratory failure?

What is the role of positive end-expiratory pressure (PEEP) in the treatment of respiratory failure?

How does positive end-expiratory pressure (PEEP) affect intrathoracic pressure in patients with respiratory failure?

What is the role of inspiratory flow in volume-targeted ventilation for respiratory failure?

Which flow patterns are commonly used in mechanical ventilation for respiratory failure?

What is the role of inspiratory flow in pressure-targeted ventilation for respiratory failure?

What are the manifestations of barotrauma caused by mechanical ventilation for the treatment of respiratory failure?

Which factors increase the risk of lung damage from mechanical ventilation for respiratory failure?

What is the benefit of low tidal volumes in the mechanical ventilation for respiratory failure?

How is the mode of ventilation selected for the treatment of respiratory failure?

What is the recommended ventilation regimen for patients with respiratory failure?

What is the primary objective of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS)?

What is the traditional ventilation strategy for acute respiratory distress syndrome (ARDS)?

How is the target tidal volume determined for patients with acute respiratory distress syndrome (ARDS)?

What can minimize alveolar wall stress and improve oxygenation in patients with acute respiratory distress syndrome (ARDS)?

What are the benefits of a lung-protective strategy in the treatment of acute respiratory distress syndrome (ARDS)?

Why is the prone position beneficial in the treatment of acute respiratory distress syndrome (ARDS)?

What are the risks of mechanical ventilation in patients with obstructive airway disease-related respiratory failure?

What are the goals of mechanical ventilation in obstructive airway disease-related respiratory failure?

How is severe dynamic hyperinflation treated in patients with respiratory failure?

When is hypercapnia tolerated in patients with obstructive airway disease-related respiratory failure?

What is the role of sedation in the treatment of obstructive airway disease-related respiratory failure?

When is measurement of end-inspiratory volume indicated in the treatment of respiratory failure?

What is the role of positive end-expiratory pressure (PEEP) in the treatment of COPD-related respiratory failure?

When does asynchrony in the mechanical ventilation occur in the treatment of respiratory failure?

How is synchrony achieved during mechanical ventilation for respiratory failure?

How is patient-ventilator asynchrony minimized in the treatment of respiratory failure?

What are ventilation-related recommendations and suggestions for adults with COVID-19?

When is noninvasive ventilation (NIV) considered for the treatment of respiratory failure (ARF)?

What are the benefits of noninvasive positive-pressure ventilation (NPPV) in the treatment of respiratory failure?

What are the benefits of noninvasive positive-pressure ventilation (NPPV) in the treatment of acute hypoxemic respiratory failure?

What are the benefits of noninvasive positive-pressure ventilation (NPPV) in patients with chronic respiratory failure?

What are the benefits of noninvasive positive-pressure ventilation (NPPV) the treatment of obesity-hypoventilation syndrome-related respiratory failure?

Which mode of noninvasive positive-pressure ventilation (NPPV) is preferred for the treatment of respiratory failure?

How is weaning from mechanical ventilation initiated in patients with respiratory failure?

When should patients with respiratory failure be considered for discontinuance of mechanical ventilation?

Which criteria are used to predict success in weaning from mechanical ventilation for respiratory failure?

What should be the focus of treatment for respiratory failure in those unable to wean from mechanical ventilation?

How might a weaning protocol be designed for patients with respiratory failure?

What is the role of peak inspiratory and plateau pressure assessment in patients with respiratory failure?

What is included in the long-term monitoring of respiratory failure?

Guidelines

What are the ERS/ATS guidelines for use of bilevel noninvasive mechanical ventilation (NIV) in the treatment of COPD-related acute respiratory failure (ARF)?

According to ERS/ATS guidelines when is bilevel noninvasive mechanical ventilation (NIV) an alternative treatment for acute respiratory failure?

What are the ERS/ATS guidelines indications for bilevel noninvasive mechanical ventilation (NIV) in the treatment of acute respiratory failure (ARF)?

What are the ERS/ATS recommendations for ventilation in patients with acute respiratory failure (ARF) due to cardiogenic pulmonary edema?

What are the ERS/ATS guidelines for noninvasive mechanical ventilation (NIV) in immunocompromised patients with acute respiratory failure?

Medications

Which medications are used in the treatment of respiratory failure?

Which medications in the drug class Corticosteroids are used in the treatment of Respiratory Failure?

Which medications in the drug class Anticholinergics, Respiratory are used in the treatment of Respiratory Failure?

Which medications in the drug class Xanthine Derivatives are used in the treatment of Respiratory Failure?

Which medications in the drug class Beta2 Agonists are used in the treatment of Respiratory Failure?

Which medications in the drug class Inotropic Agents are used in the treatment of Respiratory Failure?

Which medications in the drug class Opioid Analgesics are used in the treatment of Respiratory Failure?

Which medications in the drug class Nitrates are used in the treatment of Respiratory Failure?

Which medications in the drug class Diuretics, Other are used in the treatment of Respiratory Failure?