chronic hypercapneic respiratory failure
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Etiology
- COPD
- neuromuscular disease
- chest wall skeletal disorders - kyphoscoliosis
- obesity
Pathology
- decreased ventilatory drive
- patients with respiratory muscle weakness, obesity, & disorders of ventilatory control, 1st hypoventilate during rapid-eye-movement sleep
Clinical manifestations
- nighttime awakenings with dyspnea
- orthopnea
- 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
- vital capacity with changes in position
- helpful for assessing role of neuromuscular weakness [1]
- maximum inspiratory effort & maximum expiratory effort
- polysomnography
- nocturnal hypoventilation suspected
- daytime sleepiness, nocturnal awakening, morning headaches
Management
- COPD patients benefit from CPAP
- most patients benefit from BiPap (exception is COPD)
- nocturnal non-invasive positive pressure ventilation is the usual initial method of respiratory assistance[1]
- improves quality of life
- delays progression of respiratory failure in patients with neuromuscular disease[1][2]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 14, 17, 19. American College of Physicians, Philadelphia 2006, 2015, 2022
- ↑ 2.0 2.1 Ambrosino N, Carpene N, Gherardi M. Chronic respiratory care for neuromuscular diseases in adults. Eur Respir J. 2009 Aug;34(2):444-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19648521