Patients typically present with respiratory symptoms (i.e., dyspnea, cough, hemoptysis, sputum production, and wheezing) however, symptoms from other organ systems (i.e., chest pain, decreased appetite, heartburn, fever, and significant weight loss) are important. Loss of smell and/or exposure to sick people or unprotect contact with individuals with coronavirus infection (COVID-19) is essential in suspecting COVID-19 illness and associated respiratory failure, particularly in high-risk patients (older patients, men, and morbidly obese). Respiratory failure is a syndrome with a myriad of etiologies therefore, a thorough history and physical examination are required to narrow the differential diagnosis. The inability to ventilate can occur if any of the components mentioned above of the respiratory pump fails. Respiratory pump failure: The respiratory pump is comprised of the chest wall, the pulmonary parenchyma, the muscles of respiration, as well as the central and peripheral nervous systems. The two main paradigms responsible for hypercapnia respiratory failure are either manifested by "won't breathe" due to a central drive issue or "can't breathe" as a result of a peripheral neuromuscular defect, resistive loading (narrow airway) or restrictive defect that lead to hypoventilation and hypercapnia. Depending on the cause of respiratory failure, the partial pressure of oxygen (PaO2) may be normal or decreased. While decreased VA is the most common reason for the respiratory failure of hypercapnia, increased CO2 production is a very rare reason. Īlveolar ventilation (VA) is the product of minute ventilation (VE) and the ratio of dead space (VD) to tidal volume (Vt) (VA = VE x ). The relationship between minute ventilation and CO2 production in response to exercise can be affected by age and pregnancy. In general, according to the modified alveolar ventilation equation, the PaCO2 level is proportionally related to the rate of CO2 production (VCO2) and inversely associated with the rate of CO2 elimination (i.e., alveolar ventilation) (PaCO2 =VCO2 /VA). Hypercapnic respiratory failure is defined as an increase in arterial carbon dioxide (CO2) (PaCO)> 45 mmHg with a pH < 7.35 due to respiratory pump failure and/or increased COproduction. A thorough understanding of respiratory failure is crucial to managing this disorder. If either type of respiratory failure is not identified and addressed early, it will become life-threatening and lead to respiratory arrest, coma, and death. The approach to adult patients with suspected respiratory failure (both hypercapnia and hypoxic), as well as the diagnosis and treatment of acute and chronic respiratory failure, are discussed in this article. Respiratory failure can be classified based on chronicity (i.e., acute, chronic, and acute on chronic). Type 2 respiratory failure occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia. The inability of the respiratory system to perform either or both of these tasks results in respiratory failure. Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia. Specifically, the respiratory system provides oxygen and removes carbon dioxide from the body. The respiratory system allows gas exchange between the environment and the body, facilitating the process of aerobic metabolism.
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