Potentially life-threatening emergency
Respiratory failure
Alerts and Notices
Synopsis
Respiratory failure may be classified as an acute, severe, sudden-onset medical emergency, or as chronic, which develops over a period of time and necessitates long-term treatment. Chronic respiratory failure occurs in association with chronic obstructive pulmonary disease (COPD) or chronic drug- or alcohol-induced respiratory suppression. Broadly, respiratory failure is also classified into 4 major classes based on the underlying etiology of the condition.
Type I respiratory failure is characterized by hypoxemia-damaged lung tissue. Several mechanisms cause such severe hypoxemia, including ventilation perfusion mismatch (pulmonary edema, pulmonary embolism, or chronic lung disease), right-to-left shunting (acute respiratory distress, pneumonia, edema, or congenital heart defect), or diffusion impairment (interstitial lung diseases).
Type II respiratory failure, or ventilation failure, is characterized by hypercapnia, high levels of carbon dioxide in the circulating blood, or respiratory acidosis, which can be fatal if untreated. Possible underlying causes include pre-existing chronic lung conditions (COPD, asthma, cystic fibrosis, etc), impaired central respiratory drive (traumatic or drug-related), neuromuscular diseases (myopathies, myasthenia gravis, Guillain-Barré syndrome), spinal cord injury, sepsis, diabetic ketoacidosis, or hyperthermia.
Type III respiratory failure involves perioperative atelectasis secondary to low functional residual capacity. This can result in hypoxia, hypercarbia, or both. It can be prevented with pulmonary toileting and effective pain management for postoperative patients.
Type IV occurs following intubation and recovery from hypoperfusion-related injury or shock.
Depending on the root cause of respiratory failure, treatments include treating the causative disease, oxygen therapy, mechanical ventilation, and tracheostomy.
Codes
ICD10CM:J96.90 – Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
SNOMEDCT:
409622000 – Respiratory failure
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Creating a differential for the underlying etiology of respiratory failure depends on the type of respiratory failure and patient history of possible contributing causes. A general differential should include the following:Pulmonary:
- Asthma, COPD, emphysema
- Pulmonary infection – pneumonia, bronchitis, respiratory syncytial virus
- Bronchopulmonary dysplasia (in premature neonates) – risk for acute respiratory distress with any respiratory infection
- Bronchiectasis
- Traumatic injury to chest wall or lungs – flail chest, diaphragmatic rupture
- Pneumothorax, hemothorax, pleural effusion
- Central nervous system depression – opioid overdose, trauma
- Neuromuscular disease – myasthenia gravis, Guillain-Barré syndrome, Lambert-Eaton myasthenic syndrome, amyotrophic lateral sclerosis, polio, myopathies
- Intracranial hypertension
- Central nervous system infection
- Pulmonary embolism
- Cardiogenic pulmonary edema – result of acute decompensated heart failure
- Congenital heart defect
- Sepsis – secondary to pneumonia, urinary tract infection, and other infectious causes
- Anaphylaxis
- Transfusion-related acute lung injury
- Acute pancreatitis
- Hypothyroidism
- Botulism
- Organophosphate poisoning
- Obesity
- Kyphosis, scoliosis
- Scleroderma
- Systemic lupus erythematosus
- High-altitude pulmonary edema – history of travel to high-altitude area
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:05/07/2019
Last Updated:05/07/2019
Last Updated:05/07/2019