From the Guidelines
Yes, you can get type 2 respiratory failure (T2RF) without having had type 1 respiratory failure (T1RF) first, as T2RF can develop gradually due to chronic conditions that cause progressive respiratory muscle weakness or lung damage. This can occur in patients with neuromuscular diseases (NMD) or chest wall disorders (CWD), where respiratory impairment generally parallels disease progression 1. In some cases, diaphragm involvement precedes locomotor disability, leading to presentation with acute on chronic hypercapnia, which is characteristic of certain conditions like acid maltase deficiency and amyotrophic lateral sclerosis variety of motor neurone disease. Some key points to consider include:
- Sleep disordered breathing may arise from a combination of respiratory muscle weakness and upper airway obstruction, leading to nocturnal hypoventilation that gradually spills over into daytime hypercapnia 1.
- Bulbar dysfunction can render voluntary cough less effective and make effective non-invasive ventilation (NIV) more difficult to achieve, requiring higher expiratory positive airway pressure (EPAP) to overcome upper airway obstruction 1.
- The use of NIV in patients with NMD and CWD who present with acute hypercapnic respiratory failure (AHRF) can improve outcomes and quality of life, even if they present initially in severe respiratory failure 1.
- Minor infections, such as coryza, can provoke progressive hypercapnia in patients with NMD/CWD, and NIV should be considered in any breathless or acutely unwell patient with these conditions before respiratory acidosis develops 1.
From the Research
Can you get t2rf without t1rf
- There are no direct research papers to assist in answering this question, as the provided studies do not discuss the relationship between t1rf and t2rf.
- However, study 2 discusses acute type two respiratory failure (AT2RF) and its treatment with high flow nasal therapy (HFNT), but it does not mention the relationship between t1rf and t2rf.
- The other studies 3, 4, 5, 6 focus on pain management, fracture risk, and bone healing, and do not provide relevant information on this topic.
Possible Relationship between t1rf and t2rf
- Since there is no direct evidence, it is unclear if t2rf can occur without t1rf.
- Study 2 suggests that AT2RF can be treated with HFNT, but it does not discuss the underlying causes or relationships between different types of respiratory failure.
- Further research would be needed to determine if t2rf can occur independently of t1rf, as the provided studies do not provide sufficient information on this topic.