What are the different types of respiratory failure, including examples?

From the Guidelines

Respiratory failure can be classified into four main types: Type 1 (hypoxemic) respiratory failure, Type 2 (hypercapnic) respiratory failure, acute respiratory failure, and chronic respiratory failure, with management depending on the underlying cause and including oxygen therapy, ventilatory support, and treating the underlying condition. The different types of respiratory failure include:

• Type 1 (hypoxemic) respiratory failure, which involves low blood oxygen levels without carbon dioxide retention, commonly seen in pneumonia, pulmonary edema, and acute respiratory distress syndrome (ARDS) 1
• Type 2 (hypercapnic) respiratory failure, which features both low oxygen and high carbon dioxide levels, occurring in conditions like COPD exacerbations, severe asthma attacks, and drug overdoses 1
• Acute respiratory failure, which develops rapidly over minutes to hours, as in cases of pulmonary embolism or severe pneumonia 1
• Chronic respiratory failure, which develops slowly over time, as seen in progressive COPD or neuromuscular disorders 1 Some key points to consider in the management of respiratory failure include:
• The use of high-flow nasal oxygen (HFNO) as a potential treatment option for patients with hypoxemic respiratory failure, which may result in a large reduction in all-cause mortality and a modest reduction in hospital-acquired pneumonia 1
• The importance of prompt recognition and treatment of respiratory failure, as it can rapidly progress to respiratory arrest and death if not properly managed 1
• The need to individualize treatment based on the underlying cause of respiratory failure, with options including oxygen therapy, ventilatory support, and medications such as bronchodilators for COPD or antibiotics for pneumonia 1

From the Research

Types of Respiratory Failure

• Hypoxemic respiratory failure: defined by Pao2 less than 60 mm Hg or SaO2 less than 88% 2
• Hypercapnic respiratory failure: defined by Paco2 ≥ 45 mm Hg and pH less than 7.35 2
• Hypoxemic-hypercapnic (global) respiratory failure: a combination of hypoxemic and hypercapnic respiratory failure, resulting from multiple factors such as reduced ventilation and increased dead space 3

Causes of Hypercapnic Respiratory Failure

• Mechanical defects 4
• Central nervous system depression 4
• Imbalance of energy demands and supplies 4
• Adaptation of central controllers 4
• Chronic obstructive pulmonary disease (COPD) 5, 6
• Obesity hypoventilation syndrome (OHS) 5
• Acute respiratory distress syndrome (ARDS) 6

Examples of Hypercapnic Respiratory Failure

• Acute exacerbation of COPD (AECOPD) 5, 6
• Acute respiratory distress syndrome (ARDS) 6
• Obesity hypoventilation syndrome (OHS) 5
• Overlap syndrome 5

Diagnosis and Management

• Diagnosis is based on clinical presentation and laboratory examination of blood gases and acid-base balance 3
• Non-invasive ventilation is used to establish normocapnia in the absence of contraindications 5, 3
• Mechanical ventilation procedures should be selected based on the predominant pathophysiological component 5
• Extracorporeal CO2 removal (ECCO2R) may be necessary in severe cases 5, 6