WordNet

pertaining to respiration; "respiratory assistance"
a breathing device for administering long-term artificial respiration (同)inhalator
loss of the ability to move a body part (同)palsy

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呼吸の,呼吸作用の,呼吸のための
《米》人工呼吸装置 / (一般に)マスク;防毒マスク
(体の)麻痺(まひ),中風 / (…の)停滞《+『of』+『名』》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/10 11:52:54」(JST)

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Respiratory failure is inadequate gas exchange by the respiratory system, with the result that levels of arterial oxygen, carbon dioxide or both cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. The normal reference values are: oxygen PaO₂ greater than 80 mmHg (11 kPa), and carbon dioxide PaCO₂ less than 45 mmHg (6.0 kPa). Classification into type I or type II relates to the absence or presence of hypercapnia respectively.

Types[edit source | edit]

Type 1[edit source | edit]

Type 1 respiratory failure is defined as hypoxia without hypercapnia, and indeed the P_aCO₂ may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs. The basic defect in type 1 respiratory failure is failure of oxygenation characterized by:

P_aO₂	low (< 60 mmHg (8.0 kPa))
P_aCO₂	normal or low (<50 mmHg (6.7 kPa))
P_A-aO₂	increased

This type of respiratory failure is caused by conditions that affect oxygenation such as:

Parenchymal disease (V/Q mismatch)
Diseases of vasculature and shunts: right-to-left shunt, pulmonary embolism
Interstitial lung diseases: ARDS, pneumonia, emphysema.

Type 2[edit source | edit]

Hypoxia (PaO2 <8kPa) with Hypercapnia (PaCO2 >6.0kPa).

The basic defect in type 2 respiratory failure is characterized by:

P_aO₂	decreased (< 60 mmHg (8.0 kPa))
P_aCO₂	increased (> 50 mmHg (6.7 kPa))
P_A-aO₂	normal
pH	decreased

Type 2 respiratory failure is caused by inadequate ventilation; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide levels (P_aCO₂) that has been generated by the body. The underlying causes include:

Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis).
Neuromuscular problems (GB syndrome.,^[1] myasthenia gravis, motor neurone disease)
Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.^[1]

Causes[edit source | edit]

Chest X-ray showing ARDS

Pulmonary dysfunction
- Asthma
- Emphysema
- Chronic Obstructive Pulmonary Disease
- Pneumonia
- Pneumothorax
- Pulmonary contusion^[2]
- Hemothorax
- Acute Respiratory Distress Syndrome (ARDS) is a specific and life-threatening type of respiratory failure.
- Cystic Fibrosis
Cardiac dysfunction
- Pulmonary edema
- Cerebrovascular Accident
- Arrhythmia
- Congestive heart failure
- Valve pathology
Other
- Fatigue due to prolonged tachypnoea in metabolic acidosis
- Intoxication with drugs (e.g., morphine, benzodiazepines, alcohol) that suppress respiration.
- Neurological Disease
- Toxic Epidermal Necrolysis
- Jameson's Mamba bite

Treatment[edit source | edit]

Mechanical Ventilator

Emergency treatment follows the principles of cardiopulmonary resuscitation. Treatment of the underlying cause is required. Endotracheal intubation and mechanical ventilation in severe respiratory failure ( PaO2 less than 50 mmHg ) required. Respiratory stimulants such as doxapram may be used, and if the respiratory failure resulted from an overdose of sedative drugs such as opioids or benzodiazepines, then the appropriate antidote such as naloxone or flumazenil will be given.

References[edit source | edit]

^ ^a ^b Burt, Christiana C.; Arrowsmith, Joseph E. (1 November 2009). "Respiratory failure". Surgery (Oxford) 27 (11): 475–479. doi:10.1016/j.mpsur.2009.09.007.
^ Johnson SB (2008). "Tracheobronchial injury". Seminars in Thoracic and Cardiovascular Surgery 20 (1): 52–57. doi:10.1053/j.semtcvs.2007.09.001. PMID 18420127.

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English Journal

Nutritional and metabolic support in patients with amyotrophic lateral sclerosis.

Muscaritoli M, Kushta I, Molfino A, Inghilleri M, Sabatelli M, Rossi Fanelli F.SourceDepartment of Clinical Medicine, Sapienza, University of Rome, Rome, Italy.
Nutrition (Burbank, Los Angeles County, Calif.).Nutrition.2012 Oct;28(10):959-66. Epub 2012 Jun 5.
Amyotrophic lateral sclerosis (ALS) is the most common form of progressive motor neuron disease and the most devastating neurodegenerative disorder. ALS is characterized by progressive paralysis and respiratory failure leading to death within 3 to 5 years after its onset. Protein-energy malnutrition
PMID 22677356

Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients.

Jurado J, Javidfar J, Newmark A, Lavelle M, Bacchetta M, Gorenstein L, D'Ovidio F, Ginsburg ME, Sonett JR.SourceDivision of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
The Annals of thoracic surgery.Ann Thorac Surg.2012 Sep;94(3):974-82. Epub 2012 Jun 28.
BACKGROUND: An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results.METHODS: This is an institutional review board-a
PMID 22748641

Japanese Journal

くも膜下出血と左横隔神経麻痺を合併した Churg-Strauss 症候群の1例

清水郷子,大庭ひろみ,島田裕之,井上幸久,神靖人,吉村信行
日本呼吸器学会雑誌 = The journal of the Japanese Respiratory
NAID 10029695026

気管分岐部まで二股状に伸展した縦隔内甲状腺腫の1切除例

阿部勇人,池田晋悟,日野春秋,星野竜広,横田俊也,羽田圓城
日本呼吸器外科学会雑誌 = The journal of the Japanese Association for Chest Surgery 25(5), 518-521, 2011-07-15
症例は61歳男性．血痰を主訴に近医受診し当科紹介となった．胸部CTでは，甲状腺左葉から連続して縦隔内に伸展し気管を右方に圧排しながら気管分岐部まで達する腫瘍が認められた．穿刺吸引細胞診で腺腫様甲状腺腫と診断できたため，手術は左頸部襟状切開に胸骨正中切開を加え甲状腺左葉とともに切除した．腫瘍は15.5×7.5cmであり，気管を食道とともに右側へ圧排し二股状に分かれ，一方は気管背側に回り込んで気管分岐 …
NAID 10029125737