RESPIRATORY FAILURE

Respiratory failure is a clinical condition that happens when the respiratory system fails to maintain its
main function, which is gas exchange, in which PaO2 is lower than 60 mmHg and/or PaCO2 higher than
50 mmHg.

Respiratory failure is classified according to blood gases abnormalities into type 1 and type 2.

Type 1 - (hypoxemic) respiratory failure has a PaO2 < 60 mmHg with normal or subnormal PaCO2.
Hypoxemic respiratory failure means that you don’t have enough oxygen in your blood, but your levels
of carbon dioxide are close to normal.

PATHO: Type I respiratory failure involves low oxygen, and normal or low carbon dioxide levels. Occurs
because of damage to lung and this lung damage prevents adequate oxygenation of the blood
(hypoxaemia); however, the remaining normal lung is still sufficient to excrete the carbon dioxide being
produced by tissue metabolism (This involves transport of oxygen from the lung to the tissues by means
of the circulation of blood). This is possible because less functioning lung tissue is required for carbon
dioxide excretion than is needed for oxygenation of the blood.

Signs and symptoms of RF Type I (Hypoxemia) include:

 Dyspnea, irritability
 Confusion, fits, somnolence
 Tachycardia, arrhythmia
 Tachypnea
 Cyanosis

Type 2 - (hypercapnic) respiratory failure has a PaCO2 > 50 mmHg. Hypoxemia is common, and it is due
to respiratory pump failure. Hypercapnic respiratory failure means that there’s too much carbon dioxide
in your blood, and near normal or not enough oxygen in your blood.

PATHO: Type II respiratory failure involves low oxygen, with high carbon dioxide (pump failure). It occurs
when alveolar ventilation is insufficient to excrete the carbon dioxide being produced. The most
common cause is chronic obstructive pulmonary disease (COPD). Inadequate ventilation is due to
reduced ventilatory effort, or inability to overcome increased resistance to ventilation – it affects the
lung as a whole, and thus carbon dioxide accumulates.

Signs and symptoms of RF Type II (Hypercapnia) include [4]:

 Change of behavior
 headache
 Coma
 Warm extremities
 Astrexis
 Papilloedema

ATELECTASIS

Atelectasis means that lung sacs cannot inflate properly, which means your blood may not be able to
deliver oxygen to organs and tissues. It is when the alveoli collapse of one or more areas in the lung.
When air sacs become deflated because of atelectasis, they cannot inflate properly or take in enough air
and oxygen. If enough of the lung is affected, your blood may not receive enough oxygen, which can
cause health problems.

PATHO: When you breathe in, your lungs fill up with air. This air travels to air sacs in your lungs (alveoli),
where the oxygen moves into your blood. The blood delivers the oxygen to organs and tissues
throughout your body.

ARDS

Acute respiratory distress syndrome, or ARDS, is an inflammatory lung injury that happens when fluids
build up in small air sacs (called alveoli) in the lungs. ARDS prevents the lungs from filling up with air and
causes dangerously low oxygen levels in the blood (hypoxemia).

Fluid leaks from small blood vessels and collects in tiny air sacs in your lungs so they can’t fill with
enough air. Because of this, your blood can’t pick up the oxygen it needs to carry to the rest of your
body. Organs such as your kidneys or brain might not work the way they should or might shut down.