Chronic Hypercapneic Respiratory Failure

From Anvita Health Wiki

Contents 1 Etiology 2 Pathology 3 Clinical-manifestations 4 Laboratory 5 Diagnostic-procedures 6 Management 7 More General Terms 8 References

Etiology

• COPD
• neuromuscular disease

• myasthenia gravis
• amyotrophic lateral sclerosis ( ALS)
• multiple sclerosis

• chest wall skeletal disorders - kyphoscoliosis
• obesity

Pathology

• patients with respiratory muscle weakness, obesity, & disorders of ventilatory control, 1st hypoventilate during rapid-eye-movement sleep

Clinical-manifestations

• nighttime awakenings with dyspnea
• increasing fatigue or daytime sleepiness
• may be symmetric muscle weakness
• lungs may be clear to auscultation

Laboratory

• arterial blood gas

• increased pCO2
• respiratory acidosis with metabolic compensation

• chem7

• anion gap normal
• increased serum bicarbonate compensatory to hypercapnia

Diagnostic-procedures

• pulmonary function testing

• maximum inspiratory effort
• maximum expiratory effort
• if normal or near normal, suspect disorder of ventilatory control

• polysomnography

• nocturnal hypoventilation suspected
• daytime sleepiness, nocturnal awakening, morning headaches

Management

• most patients benefit from BiPap (exception is COPD)

More General Terms

• respiratory failure
• chronic lung disease

References

1. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006

chronic hypercapneic respiratory failure