From the Guidelines
Respiratory insufficiency is characterized by symptoms such as breathlessness at rest or during talking, inability to count to 15 in a single breath, use of accessory respiratory muscles, increased respiratory or heart rate, and abnormal arterial blood gas or pulse oximetry measurements, as noted in a 2019 study published in Nature Reviews Neurology 1.
Key Symptoms
The symptoms of respiratory insufficiency can vary, but common signs include:
- Shortness of breath (dyspnea) that worsens with physical activity or when lying flat
- Rapid, shallow breathing
- Use of accessory muscles in the neck and chest to breathe
- Fatigue, weakness, and confusion or altered mental status due to inadequate oxygen delivery to the brain
- Persistent cough, wheezing, and chest tightness
- Tachycardia (rapid heart rate) in severe cases
Diagnostic Criteria
A study published in Nature Reviews Neurology in 2019 1 highlights the importance of early identification of patients at risk of respiratory failure, using tools such as the Erasmus GBS Respiratory Insufficiency Score (EGRIS) prognostic tool.
Monitoring and Assessment
Regular assessment of respiratory function is crucial, including measurement of vital capacity, maximum inspiratory and expiratory pressure, and usage of accessory respiratory muscles, as recommended in a 2019 study published in Nature Reviews Neurology 1.
Clinical Considerations
It is essential to monitor patients for swallowing and coughing difficulties, autonomic dysfunction, and cardiovascular risk factors, especially during the recovery phase, as noted in a 2019 study published in Nature Reviews Neurology 1. The most critical aspect of managing respiratory insufficiency is early recognition and intervention, as delayed treatment can lead to severe consequences, including respiratory failure and death, as emphasized in a 2009 study published in the Journal of Allergy and Clinical Immunology 1.
From the FDA Drug Label
Dyspnea, bronchitis, and bronchospasm were the most common lower respiratory adverse reactions Additional adverse reactions reported include coughing, sputum increased, and respiratory disorder The symptoms of respiratory insufficiency are dyspnea, bronchitis, bronchospasm, coughing, sputum increased, and respiratory disorder 2
From the Research
Symptoms of Respiratory Insufficiency
The symptoms of respiratory insufficiency can be categorized into two main types: hypoxic and hypercapnic respiratory insufficiency.
- Hypoxic respiratory insufficiency is characterized by a lack of oxygen in the blood, which can lead to symptoms such as:
- Shortness of breath
- Dyspnea (difficulty breathing)
- Hypoxaemia (reduced arterial oxygen tension)
- Hypercapnic respiratory insufficiency is characterized by an excess of carbon dioxide in the blood, which can lead to symptoms such as:
- Hypercapnia (increased arterial carbon dioxide tension)
- Respiratory acidosis
- Hypoventilation
Causes of Respiratory Insufficiency
Respiratory insufficiency can be caused by a variety of factors, including:
- Airflow limitation
- Parenchymal abnormalities
- Dysfunction of the respiratory pump
- Chronic obstructive pulmonary disease (COPD)
- Acute exacerbations of COPD
Diagnostic Procedures
The diagnostic procedure for respiratory insufficiency involves several examinations, including:
- Identification of potential reversible and correctable reasons for the respiratory insufficiency
- Measurement of arterial oxygen and carbon dioxide tensions
- Assessment of respiratory function using techniques such as spirometry and lung volume measurements 3, 4
Treatment Options
Treatment options for respiratory insufficiency depend on the underlying cause and severity of the condition.
- Non-invasive ventilation (NIV) is often used to treat hypercapnic respiratory insufficiency
- Long-term oxygen therapy (LTOT) can improve survival in patients with severe hypoxaemia
- Invasive ventilation (IV) may be required in severe cases of respiratory insufficiency 4, 5
- Dyspnea can be managed using a variety of interventions, including pacing activities, breathing techniques, and inducing the relaxation response 6, 7