WordNet

a lack of competence; "pointed out the insufficiencies in my report"; "juvenile offenses often reflect an inadequacy in the parents" (同)inadequacy
(pathology) inability of a bodily part or organ to function normally
lack of an adequate quantity or number; "the inadequacy of unemployment benefits" (同)inadequacy, deficiency
pertaining to respiration; "respiratory assistance"
a breathing device for administering long-term artificial respiration (同)inhalator

PrepTutorEJDIC

不十分な[点],不足;不適当,不向き
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

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/18 21:26:10」(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]

Type 1[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]

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]

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]

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]

^ ^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.

UpToDate Contents

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1. 高炭酸ガス血症を伴う急性呼吸不全を有する成人患者の評価、診断、および治療 the evaluation diagnosis and treatment of the adult patient with acute hypercapnic respiratory failure
2. 成人の急性呼吸不全への非侵襲的換気療法 noninvasive ventilation in acute respiratory failure in adults
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侵襲性機械的人工換気 invasive mechanical ventilation in acute respiratory failure complicating chronic obstructive pulmonary disease
4. 小児における急性および切迫呼吸不全に対する非侵襲的換気 noninvasive ventilation for acute and impending respiratory failure in children
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

Vitamin D and asthma: current perspectives.

Jiao J1, Castro M.
Current opinion in allergy and clinical immunology.Curr Opin Allergy Clin Immunol.2015 Aug;15(4):375-82. doi: 10.1097/ACI.0000000000000187.
PURPOSE OF REVIEW: To review the current evidence on the relationship between vitamin D and asthma.RECENT FINDINGS: The rising morbidity and tremendous socioeconomic burden of asthma have prompted efforts to seek modifiable environmental and nutritional factors that contribute to the asthma epidemic
PMID 26106827

Sleep and breathing disorders in myotonic dystrophy type 2.

Leonardis L1, Blagus R2, Dolenc Groselj L1.
Acta neurologica Scandinavica.Acta Neurol Scand.2015 Jul;132(1):42-8. doi: 10.1111/ane.12355. Epub 2014 Dec 11.
OBJECTIVES: In patients who exhibit myotonic dystrophy type 1 (DM1), sleep disorders and breathing impairments are common; however, in those with DM type 2 (DM2), limited studies on polysomnography (PSG) and none on phrenic compound motor action potential (CMAP) have been performed, which is the aim
PMID 25496235

Pneumomediastinum predicts early mortality in acute paraquat poisoning.

Zhou CY1, Kang X, Li CB, Li XH, Liu Y, Wang Z, Wang L, Wu T, Mohan C, Hu DY, Peng A.
Clinical toxicology (Philadelphia, Pa.).Clin Toxicol (Phila).2015 Jul;53(6):551-6. doi: 10.3109/15563650.2015.1046183. Epub 2015 Jun 13.
CONTEXT: In paraquat (PQ) poisoning, death often occurs after the appearance of pneumomediastinum (PM). However, the clinical features and eventual outcome of PM in PQ intoxication remains unclear.OBJECTIVE: We aimed to characterize PM following PQ poisoning and its prognostic value for predicting m
PMID 26072933

Japanese Journal

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International Heart Journal, 2017
NAID 130005797555

壊死性ミオパチーの臨床特徴と治療・予後

神経治療学 33(6), 627-632, 2017
NAID 130005630426

成人期に発症した急性リウマチ熱による弁破壊のために弁置換術を施行した1例

日本心臓血管外科学会雑誌 46(2), 79-83, 2017
NAID 130005548874

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★リンクテーブル★

リンク元	「呼吸不全」「呼吸障害」「ventilatory depression」「respiratory depression」「respiration disorder」
関連記事	「insufficiency」「respiratory」