Acute respiratory failure implies the inability of the respiratory system to meet the oxygenation, ventilation, or metabolic requirements of the patient.([FOOTNOTE=Gurka, D.P., Balk, R.A. “Acute Respiratory Failure”. Critical Care Medicine (Third Edition). Parillo, J.E., Dellinger, R.P. 2008, Pages 773-794 (38).],[ANCHOR=],[LINK=])
Common risk factors are smoking, alcohol abuse, airway obstruction, COPD, cardiac failure and obesity. Patients with acute respiratory failure may present symptoms like shortness of breath, anxiety, confusion, tachypnea, cardiac dysfunction, and cardiac arrest symptoms.
Lynn and Curry([FOOTNOTE=Lynn LA, Curry JP. Patterns of unexpected in-hospital deaths: a root cause analysis. Safety in Surgery 2011, 5:3],[ANCHOR=],[LINK=]) identified three distinct physiological pathways leading to respiratory failure and unexpected in-hospital deaths.
Hypercapnic failure, the second physiological pathways leading to Acute Respiratory Failure, is the inadequate ventilation to clear carbon dioxide. Its main causes include opioid usage, sedation and brain injury.
And the third physiological pathways leading to Acute Respiratory Failure is Arousal Failure (sleep disordered breathing): recurring apnoeas and/or shallow breathing during sleep, mainly caused by either obstructive sleep apnoea, central sleep apnoea or Cheyne-Stokes respiration.
Respiratory compromise (RC) is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death, but in which specific interventions (enhanced monitoring and/or therapies) might prevent or mitigate this decompensation.
The treatment of acute respiratory failure is aimed at supporting the respiratory system in oxygenating and removing carbon dioxide from the blood and tissues, while simultaneously controlling or removing the underlying cause of the failure. Invasive ventilatory support may cause significant complications like cardiac failure and lung infections. Therefore supplemental oxygen delivery, noninvasive ventilatory support and mechanical ventilation serve as bridging treatments and should be employed to support respiration while treating the underlying cause.