Respiratory Failure

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THE RESPIRATORY SYSTEM COMPRISES THE UPPER RESPIRATORY TRACT, THE AIRWAYS AND THE LUNGS

The main diseases of the airways and lung are caused by infection and inflammation.
Exposure to environmental agents has an important role in causing disease, especially smoking and occupational exposure to dust.
Carcinoma of the lung is particularly feared because of its aggressive nature.
One consequence of severe disease of the respiratory system is impairment of oxygenation of blood, resulting in respiratory failure.

RESPIRATORY FAILURE IS DEFINED BY THE PRESENCE OF A LOW LEVEL OF BLOOD OXYGEN

Normal respiratory function maintains blood gases within physiological limits.
The normal PaO2 varies between 10.7 kPa and 13.3 kPa (80-100 mmHg), and the normal PaCO2 varies between 4.7 kPa and 6.0 kPa (35-45 mmHg).
Respiratory failure is defined as when the PaO2 falls below 8 kPa (60 mmHg)
There are two types of respiratory failure, which are defined according to whether blood carbon dioxide is also abnormal. In Type 1, PaO2 is low, but PaCO2 is within normal range.
In Type II, PaO2 is low, but PaCO2 is raised (above 6.7 kPa/50 mmHg).
There are several general causes of respiratory failure including failure of ventilatory drive, e.g. depression of respiratory centre; upper airways obstruction; diseases of lung preventing normal gas exchange; and mechanical impairment of ventilation, e.g. massive rib fracture, diseases of muscle.
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