Respiratory Failure

Abstract

Respiratory failure, which is defective gas exchange in the lung, is frequently seen in the casualty department and the medical and surgical wards of the district general hospital. The respiratory failure may be the dominating factor of the patient’s illness and the primary reason for hospital admission. On the other hand acute respiratory failure may not be obvious and is diagnosed only after systematic examination and investigation of a surgical or injured patient. The natural history* of acute respiratory failure is very variable; from a transient disturbance of gas exchange without symptoms to a progressive and life-threatening illness. The role of the intensive care unit is three-fold. Firstly, to investigate and treat selected patients; secondly, to provide intensive observation of patients who have a high risk of developing acute respiratory failure; lastly, th.e educational role of teaching the early recognition, treatment and prevention. Since the majority of patients admitted to an ICU have acute respiratory failure of some degree, the causes, diagnosis and treatment are outlined in this early chapter. The beginner should take heart that only a meagre knowledge of respiratory physiology is required to practice general intensive care. The great advances in our knowledge of respiratory physiology have, as yet, found only very limited application at the bedside of the acutely ill patient. The reader who is interested to study the applied physiology is referred to the excellent monographs by Nunn (1971) and West (1974).

Anoxaemia not only stops the machine, but wrecks the machinery. J. S. Haldane