How to grade respiratory failure

Written by Li Qiang
Intensive Care Unit
Updated on November 07, 2024
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Respiratory failure is generally not graded; instead, it is classified into types. There are two types, Type I and Type II. Type I is characterized by an oxygen tension lower than 60 mmHg, at which point, there is no increase in carbon dioxide, and the carbon dioxide level is normal. Type II respiratory failure is when the oxygen tension is below 60 mmHg, accompanied by an increase in carbon dioxide, which is then termed Type II respiratory failure. Regarding respiratory failure, it is classified by type and not by severity grade. This means that once it meets these criteria, it is referred to as respiratory failure, and at this point, some emergency treatments to improve low oxygen levels are necessary. Therefore, respiratory failure is generally not graded into mild, moderate, or severe degrees. It is only differentiated into different types. Of course, there are different severity levels in respiratory failure, but we generally do not apply a specific degree of severity.

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Causes of Respiratory Failure

Respiratory failure is relatively common in clinical practice and is frequently seen in critical respiratory conditions. The causes of respiratory failure most often arise from diseases of the respiratory and circulatory systems, such as chronic obstructive pulmonary disease, acute exacerbation of asthma, severe pneumonia, severe pulmonary tuberculosis, diffuse pulmonary fibrosis, pulmonary edema, pneumoconiosis, pulmonary embolism, various causes of heart failure, pulmonary hypertension, severe pneumothorax, and substantial pleural effusion, among others. These can all lead to respiratory failure. Therefore, if respiratory distress occurs clinically and respiratory failure is suspected, it is crucial to conduct prompt examinations and actively manage the condition.

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Written by Li Tao
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What is acute respiratory failure?

Respiratory failure refers to the severe dysfunction in pulmonary ventilation and gas exchange in the respiratory system caused by various reasons under normal conditions. This dysfunction leads to ineffective gas exchange during respiration, resulting in hypoxia in the body and retention of carbon dioxide, thereby causing a series of physiological and metabolic disorders. Typically, under resting conditions at sea-level atmospheric pressure, respiratory failure is defined when arterial oxygen tension falls below 60 mmHg, accompanied by carbon dioxide retention, with carbon dioxide tension exceeding 50 mmHg, or without an increase in carbon dioxide tension. It is categorized into acute respiratory failure and chronic respiratory failure.

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Written by Peng Miao Yun
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Principles of oxygen therapy for respiratory failure

Patients with respiratory failure undergoing oxygen therapy should be treated differently depending on the type of respiratory failure. If it is Type I respiratory failure, it is simply hypoxia without accompanying carbon dioxide retention. Our oxygenation principle can provide slightly higher oxygen flow, with an oxygen flow rate exceeding 5 liters per minute. However, if it is Type II respiratory failure, which comes with severe carbon dioxide retention, it requires continuous low-flow oxygenation. This type of respiratory failure is often caused by chronic pulmonary diseases. Because if high-flow oxygen is provided, the peripheral chemoreceptors' response to hypoxia will decrease in the short term, which will exacerbate respiratory suppression, leading to increased carbon dioxide retention and worsening the condition. Therefore, for Type II respiratory failure, low-flow continuous oxygen should be provided, with an oxygen flow rate controlled below 3 liters per minute.

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Causes of CO2 retention in respiratory failure

Respiratory failure manifests as hypoxia and the retention of carbon dioxide. The main cause of carbon dioxide retention is pathological changes in the respiratory system, such as chronic obstructive pulmonary disease with respiratory failure, status asthmaticus, pulmonary heart disease, lung cancer, etc. Some neuropathies that cause paralysis of the respiratory muscles can lead to respiratory dysfunction, resulting in the retention of carbon dioxide in the body, affecting normal cellular metabolism, causing disturbances in acid-base balance and nervous system function, and posing life-threatening conditions. The most important pathogenic mechanism causing carbon dioxide retention in these diseases is still inadequate alveolar ventilation.

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What are the symptoms of respiratory failure?

Respiratory failure is a common critical condition in clinical settings. At the stage of respiratory failure, patients often experience severe discomfort and pain. Common symptoms include difficulty breathing, with many patients showing obvious respiratory distress, often needing to sit upright to breathe, profuse sweating, and an inability to continue normal activity. Additionally, cyanosis can occur, indicating very severe hypoxia. Symptoms of pulmonary encephalopathy, such as mental confusion, convulsions, and agitation, may also appear. In severe cases, patients may even fall into a coma. Hence, at the stage of respiratory failure, patients suffer considerably.