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For further information, see CMDT Part 9-44: Acute Respiratory Failure

Key Features

Essentials of Diagnosis

  • Arterial blood gas criteria: PO2 < 60 mm Hg (7.8 kPa) or a PCO2 > 50 mm Hg (6.5 kPa)

General Considerations

  • Defined as respiratory dysfunction resulting in abnormalities of oxygenation (hypoxemia) or ventilation (CO2 elimination) severe enough to threaten the function of vital organs

  • May occur in a variety of pulmonary and nonpulmonary disorders (Table 9–26)

Table 9–26.Selected causes of acute respiratory failure in adults.

Clinical Findings

  • Symptoms and signs of acute respiratory failure are those of the underlying disease combined with those of hypoxemia or hypercapnia

    • Chief symptom of hypoxemia: dyspnea, though profound hypoxemia may exist in the absence of complaints

    • Signs of hypoxemia

      • Cyanosis

      • Restlessness

      • Confusion

      • Anxiety

      • Delirium

      • Tachypnea

      • Bradycardia or tachycardia

      • Hypertension

      • Tremor

    • Cardinal symptoms of hypercapnia: dyspnea and headache

    • Signs of hypercapnia

      • Peripheral and conjunctival hyperemia

      • Hypertension

      • Tachycardia

      • Tachypnea

      • Impaired consciousness

      • Papilledema

      • Myoclonus

      • Asterixis


  • Obtain arterial blood gas analysis if respiratory failure is suspected


General supportive care

  • Maintenance of adequate nutrition is vital; parenteral nutrition should be used only when conventional enteral feeding methods are not possible

  • Sedative-hypnotics and opioid analgesics are frequently used in the intubated patient; titrate carefully to avoid oversedation, leading to prolongation of intubation

  • Temporary paralysis with a nondepolarizing neuromuscular blocking agent is occasionally used to facilitate mechanical ventilation and to ...

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