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Chronic respiratory failure – pathophysiology
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Mafalda Vanzeller, Marta Drummond, João Carlos Winck
The diagnosis of chronic respiratory failure begins with clinical suspicion of its presence. The clinical signs and symptoms may be few or no findings other than a complaint of mild dyspnoea. Nevertheless, the majority of patients present with important respiratory symptoms like severe dyspnoea, wheezing, chest tightness, etc. Typically, CRF patients have increased minute ventilation requirements due to an increasing dead-space fraction, so tachypnoea is a frequent sign of the respiratory condition as is muscle fatigue, inducing the use of accessory muscles. Cyanosis (either central or peripheral) and digital and nail clubbing are other identifiable signs of CRF. Neurologic manifestations include restlessness, anxiety, confusion, seizures or coma. Asterixis may be seen with severe hypercapnia. Common cardiovascular findings include tachycardia and a variety of arrhythmias.
Acid–base disturbances
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
The blood findings in a respiratory acidosis are as follows. PCO2 is always raised.In acute respiratory failure: – pH is low,– [HCO3−] is high-normal or slightly raised.In chronic respiratory failure: – pH is near normal or low, depending upon chronicity (allowing time for compensation to occur),– [HCO3−] is raised.
Long-term non-invasive ventilation in patients with chronic obstructive pulmonary disease (COPD): 2021 Canadian Thoracic Society Clinical Practice Guideline update
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Marta Kaminska, Karen P. Rimmer, Douglas A. McKim, Mika Nonoyama, Eleni Giannouli, Debra L. Morrison, Colleen O’Connell, Basil J. Petrof, François Maltais
Chronic hypercapnic respiratory failure is a devastating consequence of severe chronic obstructive pulmonary disease (COPD).1,2 Chronic hypercapnia in COPD generally indicates advanced disease with limited survival, carrying a 1-year mortality rate of 17-30%.3–7 The course of chronic hypercapnic respiratory failure is often characterized by bouts of acute-on-chronic respiratory failure that require repeated hospital admissions,3,4,6–8 often in an intensive care unit. The in-hospital mortality in 1016 patients admitted with COPD exacerbations and hypercapnic respiratory failure (partial pressure of carbon dioxide in arterial blood [PaCO2] ≥ 50 mm Hg) was 11%; corresponding rates after 180 days and 2 years were 33% and 49%, respectively.9 Hospital readmission is also a common occurrence after an index hospitalization for COPD. Data from the United States suggest that approximately 20% of patients with COPD are readmitted within 30 days; COPD was the most common reason for these readmissions while respiratory failure was present in 12%.10
Pharmacological strategies for smoking cessation in patients with chronic obstructive pulmonary disease: a pragmatic review
Published in Expert Opinion on Pharmacotherapy, 2021
Sabina Antonela Antoniu, Ioana Buculei, Florin Mihaltan, Radu Crisan Dabija, Antigona Carmen Trofor
COPD is a chronic airways and systemic inflammatory disease, with tobacco smoking recognized as the major risk factor. Characterized by progressive respiratory symptoms such as dyspnea and chronic cough and by constant aggravation of airflow limitation which is well established at the time of symptoms onset, the end stage of the disease is associated with chronic respiratory failure and with a limited therapeutic effectiveness for conventional therapies. In smokers with COPD, smoking cessation is the only intervention demonstrated to be able to reduce the decline of the lung function on a long-term basis, as shown by The Lung Health Study [1]. In this seminal study, nicotine gum was used for stopping smoking. Subsequent studies using other pharmacological approaches for smoking cessation demonstrated their efficacy in inducing sustained abstinence. This paper reviews in a pragmatic manner the available therapies for smoking cessation interventions and discusses the particular aspects of their use in COPD.
Pathophysiology of respiratory failure in patients with osteogenesis imperfecta: a systematic review
Published in Annals of Medicine, 2021
S. Storoni, S. Treurniet, D. Micha, M. Celli, M. Bugiani, J. G. van den Aardweg, E. M. W. Eekhoff
Respiratory failure is a major cause of death in patients with Osteogenesis Imperfecta, one of the most common inherited connective tissue disorders. Acute or chronic respiratory failure has been correlated to the severity of the OI disease [14,15,17]. However, the underlying mechanism and pathophysiology have received relatively little attention. Little is known about whether and how OI can affect intrapulmonary tissues beyond its known effect on the thoracic skeleton. Research and treatment for OI have almost been exclusively focussed on fracture prevention, correction of bone deformities while other complications, such as hearing loss, dental problems, and pain relief are rarely addressed. Respiratory problems seem to receive particular attention only at a late stage when they have become a clinical problem. As a result, to date, there are no established international protocols for follow-up pulmonary surveillance or treatment of pulmonary manifestations in patients with OI.