WordNet

lack of success; "he felt that his entire life had been a failure"; "that year there was a crop failure"
loss of ability to function normally; "kidney failure"
an act that fails; "his failure to pass the test"
an unexpected omission; "he resented my failure to return his call"; "the mechanics failure to check the brakes"
a person with a record of failing; someone who loses consistently (同)loser, nonstarter, unsuccessful person
an event that does not accomplish its intended purpose; "the surprise party was a complete failure"
pertaining to respiration; "respiratory assistance"
a breathing device for administering long-term artificial respiration (同)inhalator

PrepTutorEJDIC

〈U〉(…における)『失敗』,不成功《+『in』+『名』(do『ing』)》 / 〈C〉失敗者,落後者;失敗した企て,不できなもの / 〈U〉〈C〉怠慢,不履行 / 〈U〉〈C〉(…の)不足,欠乏《+『of』+『名』》 / 〈U〉〈C〉(…の)破産《+『of』+『名』》 / 〈U〉(…の)『衰弱』,減退《+『in』(『of』+『名』》
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

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/27 18:23:47」(JST)

wiki en

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 partial pressure reference values are: oxygen PaO₂ more than 80 mmHg (11 kPa), and carbon dioxide PaCO₂ lesser than 45 mmHg (6.0 kPa). Classification into type I or type II relates to the absence or presence of hypercapnia respectively.

Types

Type 1

Type 1 respiratory failure is defined as a low level of oxygen in the blood (hypoxemia) without an increased level of carbon dioxide in the blood (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	decreased (< 60 mmHg (8.0 kPa))
P_aCO₂	normal or decreased (<50 mmHg (6.7 kPa))
P_A-aO₂	increased

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

Low ambient oxygen (e.g. at high altitude)
Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism)
Alveolar hypoventilation (decreased minute volume due to reduced respiratory muscle activity, e.g. in acute neuromuscular disease); this form can also cause type 2 respiratory failure if severe
Diffusion problem (oxygen cannot enter the capillaries due to parenchymal disease, e.g. in pneumonia or ARDS)
Shunt (oxygenated blood mixes with non-oxygenated blood from the venous system, e.g. right-to-left shunt)

Type 2

Hypoxemia (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 alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the buildup of carbon dioxide levels (P_aCO₂) that has been generated by the body but cannot be eliminated. 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 (Guillain-Barré syndrome,^[1] motor neuron disease)
Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.^[1]

Treatment

Mechanical ventilator

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

There is tentative evidence that in those with respiratory failure identified before arrival in hospital, continuous positive airway pressure can be useful when started before conveying to hospital.^[2]

References

^ ^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.
^ Bakke, SA; Botker, MT; Riddervold, IS; Kirkegaard, H; Christensen, EF (22 November 2014). "Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure: a systematic review of controlled studies.". Scandinavian journal of trauma, resuscitation and emergency medicine 22 (1): 69. doi:10.1186/s13049-014-0069-8. PMID 25416493.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人の急性呼吸不全における非侵襲的陽圧換気 noninvasive positive pressure ventilation in acute respiratory failure in adults
2. 急性呼吸窮迫症候群：臨床的特徴および診断 acute respiratory distress syndrome clinical features and diagnosis
3. 慢性閉塞性肺疾患（COPD）を合併した急性呼吸不全における機械的人工換気 mechanical ventilation in acute respiratory failure complicating copd
4. 挿管の判断 the decision to intubate
5. 妊娠中および周産期における急性呼吸不全 acute respiratory failure during pregnancy and the peripartum period

English Journal

Long-term survival and quality of life after intensive care for patients 80 years of age or older.

Andersen FH1, Flaatten H, Klepstad P, Romild U, Kvåle R.
Annals of intensive care.Ann Intensive Care.2015 Dec;5(1):53. doi: 10.1186/s13613-015-0053-0. Epub 2015 Jun 3.
BACKGROUND: Comparison of survival and quality of life in a mixed ICU population of patients 80 years of age or older with a matched segment of the general population.METHODS: We retrospectively analyzed survival of ICU patients ≥80 years admitted to the Haukeland University Hospital in 2000-2012.
PMID 26055187

Stimulating basal mitochondrial respiration decreases doxorubicin apoptotic signaling in H9c2 cardiomyoblasts.

Deus CM1, Zehowski C2, Nordgren K2, Wallace KB2, Skildum A2, Oliveira PJ3.
Toxicology.Toxicology.2015 Aug 6;334:1-11. doi: 10.1016/j.tox.2015.05.001. Epub 2015 May 18.
Doxorubicin (DOX) is currently used in cancer chemotherapy, however, its use often results in adverse effects highlighted by the development of cardiomyopathy and ultimately heart failure. Interestingly, DOX cardiotoxicity is decreased by resveratrol or by physical activity, suggesting that increase
PMID 25997894

Japanese Journal

Sivelestat併用術前化学療法によって治療しえた呼吸不全を伴うG-CSFおよびIL-6産生膀胱腫瘍の1例

松崎恭介,奥見雅由,岸本望,矢澤浩治,宮川康,内田欽也,野々村祝夫
泌尿器科紀要 59(7), 443-447, 2013-07-00
… Marked leukocytosis and respiratory distress with pleural effusion appeared. … Neoadjuvant systemic chemotherapy was performed along with use of steroid and sivelestat, which ameliorated the respiratory distress. …
NAID 120005308132

受傷後短時間で著明な血小板減少を来したマムシ咬傷の1例

上田晃志郎,瀬山厚司,尼崎陽太郎,平田健,井口智浩,守田知明
山口医学 62(2), 105-109, 2013-05-01
… In the clinical course, respiratory failure and acute renal failure appeared. … Her respiratory and renal failure improved after a month treatmens. … Multiple organ failure was caused without an anti-mamushi venom. …
NAID 120005246413

Related Pictures

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★リンクテーブル★

リンク元	「呼吸不全」「ventilatory depression」「respiratory depression」
関連記事	「failure」「respiratory」

「呼吸不全」

Respiratory failure
Classification and external resources
Specialty	Pulmonology, Intensive care medicine
ICD-10	J96
ICD-9-CM	518.81
DiseasesDB	6623
eMedicine	med/2011
MeSH	D012131