What is acute respiratory failure?

Written by Li Tao
Pulmonology
Updated on September 16, 2024
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Respiratory failure refers to the severe dysfunction in pulmonary ventilation and gas exchange in the respiratory system caused by various reasons under normal conditions. This dysfunction leads to ineffective gas exchange during respiration, resulting in hypoxia in the body and retention of carbon dioxide, thereby causing a series of physiological and metabolic disorders. Typically, under resting conditions at sea-level atmospheric pressure, respiratory failure is defined when arterial oxygen tension falls below 60 mmHg, accompanied by carbon dioxide retention, with carbon dioxide tension exceeding 50 mmHg, or without an increase in carbon dioxide tension. It is categorized into acute respiratory failure and chronic respiratory failure.

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Written by Wang Xiang Yu
Pulmonology
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Is respiratory failure contagious?

First, it's important to understand what respiratory failure is. Respiratory failure is a syndrome, not a disease, meaning it can result from many causes. For instance, airway obstruction, lung tissue pathology, diseases of the pulmonary vessels, and diseases of the thorax and pleura, as well as neuromuscular diseases, can all lead to impaired ventilation or gas exchange in the lungs. This impairment makes it impossible for the body to maintain adequate gas exchange even in a resting state, resulting in hypoxemia, with or without hypercapnia, which is referred to as respiratory failure. Therefore, there are many causes of respiratory failure, and some diseases are indeed contagious, such as SARS, H1N1, and H3N2. However, other causes, such as tumors or pulmonary embolism, are generally not contagious.

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Written by Wei Shi Liang
Intensive Care Unit
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The earliest clinical symptoms of respiratory failure

The clinical symptoms of respiratory failure mainly manifest as hypoxemia and carbon dioxide retention. Looking at their clinical manifestations, mild hypoxia may not show any clinical symptoms. As the severity of the disease increases, there can be signs of increased respiratory drive, such as rapid breathing or difficulty breathing, along with symptoms of sympathetic nervous system activation, such as anxiety and sweating. Hypoxemia can cause dilation of peripheral arteries and constriction of veins, leading to an increased heart rate, or even severe arrhythmias. Furthermore, considering the clinical manifestations of carbon dioxide retention, they are directly related to the levels of carbon dioxide in the body, mainly depending on the rate of occurrence. Clinically, this primarily affects myocardial contractility, the contractile ability of respiratory muscles, and increases in intracranial blood flow. In mild to moderate cases, it can stimulate the respiratory center causing increased and shallow breathing, but in severe cases, it may suppress the respiratory center.

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Written by Peng Miao Yun
Internal Medicine
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Respiratory failure is a disease.

Respiratory failure is a condition caused by severe impairment of lung ventilation and gas exchange functions due to various reasons, leading to ineffective gas exchange. This results in hypoxia in the body, accompanied by either retention or non-retention of carbon dioxide, thereby causing a clinical syndrome of physiological and metabolic disorders. The causes of respiratory failure include diseases of the lung tissue, respiratory tract disorders, pulmonary vascular diseases, and cardiovascular and cerebrovascular diseases, among other factors, all of which can lead to respiratory failure.

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Written by Li Qiang
Intensive Care Unit
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Precursors of respiratory failure

Respiratory failure can be a very acute condition, or it may evolve gradually due to chronic diseases. The basic precursors of respiratory failure generally include hypoxia or hypercapnia. In the early stages of hypoxia, patients may experience excitement or irritability, characterized by rapid breathing and possibly sweating due to the effort of breathing. Symptoms include accelerated breathing and hypoxia; the patient’s lips may also turn blue. If the level of carbon dioxide increases, once past the initial period of excitement and as the hypoxia worsens, the person may become listless. Gradually, their consciousness may become unclear, manifesting as drowsiness or possibly even coma.

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Written by Peng Miao Yun
Internal Medicine
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How to administer oxygen for respiratory failure

If patients with respiratory failure undergo oxygen therapy, it is necessary to choose different therapy plans based on the type of respiratory failure. In the case of Type I respiratory failure, there is simply a lack of oxygen. For Type II respiratory failure, there is not only a lack of oxygen but also an accumulation of carbon dioxide. Therefore, for Type I respiratory failure, the oxygen flow can be higher, over five liters per minute, and the patient can continuously receive oxygen without causing significant side effects. However, for Type II respiratory failure, it is essential to control the oxygen flow at a low rate, under three liters per minute, otherwise, it may lead to other complications.