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Acute respiratory failure and acute respiratory distress syndrome 

Acute respiratory failure and acute respiratory distress syndrome
Chapter:
Acute respiratory failure and acute respiratory distress syndrome
Author(s):

Luciano Gattinon

and Eleonora Carlesso

DOI:
10.1093/med/9780199687039.003.0064_update_001

Update:

Many minor changes as well as added new sub-headings and paragraphs throughout.

Big updates to “Imaging,” “Noninvasive Ventilation (NIV),” “Risk Factors,” and “Tidal Volume and Plateau Pressure.”

Updated equations

22 new references

Updated on 22 February 2018. The previous version of this content can be found here.
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date: 14 October 2019

Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.

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