Skip to main content
SpringerLink
Log in

Ventilatory Failure: An Overview

  • Conference paper
Book cover Ventilatory Failure

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 15))

Abstract

Ventilatory failure is defined as a state or condition in which the partial pressure of carbon dioxide in arterial blood (PaCO2) is consistently elevated. It is generally accepted that the normal range of PaCO2 is 35 to 45 torr, in the awake subject at or near sea level. Therefore, one would not make a diagnosis of ventilatory failure unless the PaCO2 were consistently above 45 torr. The acceptable upper limit of PaCO2 might be higher during sleep, and lower if the person lived at altitude. Another way to think about ventilatory failure is to consider how much effort is required to maintain a normal, metabolically appropriate PaCO2. Thus, a state of ventilatory failure can also be said to exist if a patient can maintain an acceptable PaCO2 only with extreme dyspnea, or with mechanical ventilatory assistance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Braun NMT, Arora NS, Rochester DF (1982) The force-length relationship of the normal human diaphragm. J Appl Physiol 53:405–412

    PubMed  CAS  Google Scholar 

  2. Farkas GA, Decramer M, Rochester DF, De Troyer A (1985) Contractile properties of intercostal muscles and their functional significance. J Appl Physiol 59:528–535

    PubMed  CAS  Google Scholar 

  3. De Troyer A, Estenne M (1988) Functional anatomy of the respiratory muscles. Clin Chest Med 9:175–193

    PubMed  Google Scholar 

  4. Rochester DF, Farkas GA, Lu J-Y (1987) Contractility of the in situ human diaphragm: assessment based on dimensional analysis. In: Sieck GS, Gandevia SC, Cameron WE (eds) Respiratory muscles and their neuromotor control. Neurology and Neurobiology, Vol. 26, Alan R. Liss, New York, pp 327–336

    Google Scholar 

  5. Druz WS, Sharp JT (1981) Activity of the respiratory muscles in upright and recumbent humans. J Appl Physiol 51:1552–1561

    PubMed  CAS  Google Scholar 

  6. Collett PW, Perry C, Engel LA (1985) Pressure-time product, flow and oxygen cost of resistive breathing in humans. J Appl Physiol 58:1263–1272

    Article  PubMed  CAS  Google Scholar 

  7. Bellemare F, Grassino A (1982) Effect of pressure and timing on human diaphragm fatigue. J Appl Physiol 53:1190–1195

    Article  PubMed  CAS  Google Scholar 

  8. Killian KJ, Jones NL (1988) Respiratory muscles and dyspnea. Clin Chest Med 9:237–248

    PubMed  CAS  Google Scholar 

  9. Von Euler C (1983) On the central pattern generator for the basic breathing rhythmicity. J Appl Physiol 55:1647–1659

    Google Scholar 

  10. Sears TA (1990) Central rhythm and pattern generation. Chest 97:45S-51S

    Article  PubMed  CAS  Google Scholar 

  11. Cherniack NS (1990) The central nervous system and respiratory muscle coordination. Chest 97:52S-57S

    Article  PubMed  CAS  Google Scholar 

  12. Milic-Emili J, Grassino AE, Whitelaw WA (1981) Measurement and Testing of Respiratory Drive. In: Hornbein TF (ed) Regulation of breathing, Vol. 17, Lung Biology in Health and Disease, Lenfant C (ed), Marcel Dekker, New York, pp 675–743

    Google Scholar 

  13. Gilbert R, Auchincloss JH Jr, Brodsky J, Boden W (1972) Changes in tidal volume, frequency and ventilation induced by their measurement. J Appl Physiol 33:252–254

    PubMed  CAS  Google Scholar 

  14. Hirsch JA, Bishop B (1982) Human breathing patterns on mouthpiece or face mask during air, CO2 or low O2. J Appl Physiol 53:1281–1290

    PubMed  CAS  Google Scholar 

  15. Tobin MJ, Chadha TS, Jenouri G, Birch SJ, Gazeroglu HB, Sackner MA (1983) Breathing patterns 1. Normal subjects. Chest 84:202–205

    Article  PubMed  CAS  Google Scholar 

  16. Loveridge B, West P, Anthonisen NR, Kryger MH (1984) Breathing patterns in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 130:730–733

    PubMed  CAS  Google Scholar 

  17. Hussain SNA, Sinkus G, Roussos C (1985) Respiratory muscle fatigue: a cause of ventilatory failure in septic shock. J Appl Physiol 58:1802–1808

    Google Scholar 

  18. Boczkowski J, Dureuil B, Branger C, et al (1988) Effects of sepsis on diaphragmatic function in rats. Am Rev Respir Dis 138:260–265

    PubMed  CAS  Google Scholar 

  19. Drew JS, Farkas GA, Pearson RD, Rochester DF (1988) Effects of a chronic wasting infection on skeletal muscle size and contractile properties. J Appl Physiol 64:460–465

    PubMed  CAS  Google Scholar 

  20. Kelly SM, Rosa A, Field S, Coughlin M, Shizgal HM, Macklem PT (1984) Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy. Am Rev Respir Dis 130:33–37

    PubMed  CAS  Google Scholar 

  21. Aubier M, Murciano D, Lecocguic Y, et al (1985) Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med 313:420–424

    Article  PubMed  CAS  Google Scholar 

  22. Janssens S, Decramer M (1989) Corticosteroid-induced myopathy and the respiratory muscles. Report of two cases. Chest 95:1160–1162

    Article  PubMed  CAS  Google Scholar 

  23. Braun NMT, Arora NS, Rochester DF (1983) Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax 38:616–623

    Article  PubMed  CAS  Google Scholar 

  24. Goldring RM, Turino GM, Heinemann HO (1971) Respiratory-renal adjustments in chronic hypercapnia in man. Am J Med 51:772–784

    Article  PubMed  CAS  Google Scholar 

  25. Wolkove N, Altose MD, Kelsen SG, Cherniack NS (1980) Respiratory control abnormalities in alveolar hypoventilation. Am Rev Respir Dis 122:163–167

    PubMed  CAS  Google Scholar 

  26. Gorini M, Spinelli A, Ginanni R, Duranti R, Gigliotti F, Scano G (1990) Neural respiratory drive and neuromuscular coupling in patients with chronic obstructive pulmonary disease (COPD). Chest 98:1179–1186

    Article  PubMed  CAS  Google Scholar 

  27. Decramer M, Demedts M, Rochette F, Billiet L (1980) Maximal respiratory pressures in obstructive lung disease. Bull Europ Physiopath Resp 16:479–490

    CAS  Google Scholar 

  28. Bellemare F, Grassino A (1983) Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J Appl Physiol 55:8–15

    PubMed  CAS  Google Scholar 

  29. O’Neill S, McCarthy DS (1983) Postural relief of dyspnoea in severe chronic airflow limitation: relationship to respiratory muscle strength. Thorax 38:595–600

    Article  PubMed  Google Scholar 

  30. Rochester DF, Braun NMT (1985) Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 132:42–47

    PubMed  CAS  Google Scholar 

  31. Oliven A, Kelsen SG, Deal EC Jr, Cherniack NS (1985) Respiratory pressure sensation. Relationship to changes in breathing pattern and PCO2 during acute increase in airway resistance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 132:1214–1218

    PubMed  CAS  Google Scholar 

  32. Martinez FJ, Couser JI, Celli BR (1990) Factors influencing ventilatory muscle recruitment in patients with chronic airflow obstruction. Am Rev Respir Dis 142:276–282

    PubMed  CAS  Google Scholar 

  33. Oliven A, Supinski GS, Kelsen SG (1986) Functional adaptation of diaphragm to chronic hyperinflation in emphysematous hamsters. J Appl Physiol 60:225–231

    PubMed  CAS  Google Scholar 

  34. Similowski T, Yan S, Gauthier AP, Macklem PT, Bellemare F (1990) Contractile properties of the human diaphragm during chronic hyperinflation. Am Rev Respir Dis 141: A166

    Google Scholar 

  35. Supinski GS, Kelsen SG (1982) Effect of elastase-induced emphysema on the force-generating ability of the diaphragm. J Clin Invest 70:978–988

    Article  PubMed  CAS  Google Scholar 

  36. Farkas GA, Roussos C (1983) Diaphragm in emphysematous hamsters: sarcomere adaptability. J Appl Physiol 54:1635–1640

    PubMed  CAS  Google Scholar 

  37. Sharp JT, Goldberg NB, Druz WS, Fishman HC, Danon J (1977) Thoracoabdominal motion in chronic obstructive pulmonary disease. Am Rev Respir Dis 115:47–56

    PubMed  CAS  Google Scholar 

  38. Cohen C, Zagelbaum G, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Am J Med 73:308–316

    Article  PubMed  CAS  Google Scholar 

  39. Tobin MJ, Guenther SM, Perez W, et al (1987) Konno-Mead analysis of rib cage-abdominal motion during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 135:1320–1328

    PubMed  CAS  Google Scholar 

  40. Roussos C, Fixley M, Gross D, Macklem PT (1979) Fatigue of the inspiratory muscles and their synergic behaviour. J Appl Physiol 46:897–904

    PubMed  CAS  Google Scholar 

  41. Tobin MJ, Perez W, Guenther SM, Lodato RF, Dantzker DR (1987) Does rib cage-abdominal paradox signify respiratory muscle fatigue? J Appl Physiol 63:851–860

    PubMed  CAS  Google Scholar 

  42. Ward ME, Eidelman D, Stubbing DG, Bellemare F, Macklem PT (1988) Respiratory sensation and pattern of respiratory muscle activation during diaphragm fatigue. J Appl Physiol 65:2181–2189

    PubMed  CAS  Google Scholar 

  43. O’Donnell DE, Sanii R, Anthonisen NR, Younes M (1987) Effect of dynamic airway compression on breathing pattern and respiratory sensation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 135:912–918

    PubMed  Google Scholar 

  44. Pourriat JL, Lamberto C, Hoang PH, Fournier JL, Vasseur B (1986) Diaphragmatic fatigue and breathing pattern during weaning from mechanical ventilation in COPD patients. Chest 90:703–707

    Article  PubMed  CAS  Google Scholar 

  45. Sassoon CSH, Te TT, Mahutte CK, Light RW (1987 Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135:107–113

    PubMed  CAS  Google Scholar 

  46. Tobin MJ, Perez W, Guenther SM, et al (1986) The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 134:1111–1118

    PubMed  CAS  Google Scholar 

  47. Lisboa C, Moreno R, Fava M, Ferretti R, Cruz E (1985) Inspiratory muscle function in patients with severe kyphoscoliosis. Am Rev Respir Dis 132:48–52

    PubMed  CAS  Google Scholar 

  48. Kafer ER (1976) Idiopathic scoliosis. Gas exchange and the age dependence of arterial blood gases. J Clin Invest 58:825–833

    Article  PubMed  CAS  Google Scholar 

  49. Arora NS, Rochester DF (1979) Respiratory muscle function in obesity and obesity-hypoventilation syndrome. Clin Research 27:394

    Google Scholar 

  50. Esau SA, Bellemare F, Grassino A, Permutt S, Roussos C, Pardy RL (1983) Changes in relaxation rate with diaphragmatic fatigue in humans. J Appl Physiol 54:1353–1360

    PubMed  CAS  Google Scholar 

  51. Mador MJ, Acevedo FA (1991) Effect of inspiratory muscle fatigue on breathing pattern during inspiratory resistive loading. J Appl Physiol 70:1627–1632

    PubMed  CAS  Google Scholar 

  52. Efthimiou J, Fleming J, Spiro SG (1987) Sternocleidomastoid muscle function and fatigue in breathless patients with severe respiratory disease. Am Rev Respir Dis 136:1099–1105

    Article  PubMed  CAS  Google Scholar 

  53. Murciano D, Boczkowski J, Lecocguic Y, Milic Emili J, Pariente R, Aubier M (1988) Tracheal occlusion pressure: A simple index to monitor respiratory muscle fatigue during acute respiratory failure in patients with chronic obstructive pulmonary disease. Ann Intern Med 108:800–805

    PubMed  CAS  Google Scholar 

  54. Truwit JD, Lamb VJ, Marini JJ (1989) Validation of a technique to assess maximal inspiratory pressure in poorly cooperative patients. Am Rev Respir Dis 139:A98

    Google Scholar 

  55. Adams JM, Farkas GA, Rochester DF (1988) Vagal afferents, diaphragm fatigue and inspiratory resistance in the anesthetized dog. J Appl Physiol 64:2279–2286

    Article  PubMed  CAS  Google Scholar 

  56. Ferguson GT, Irvin CG, Cherniack RM (1990) Relationship of diaphragm glycogen, lactate, and function to respiratory failure. Am Rev Respir Dis 141:926–932

    PubMed  CAS  Google Scholar 

  57. Sampson MG, Grassino A (1983) Neuromechanical properties in obese patients during carbon dioxide rebreathing. Am J Med 75:81–90

    Article  PubMed  CAS  Google Scholar 

  58. Burki NK, Baker RW (1984) Ventilatory regulation in eucapnic morbid obesity. Am Rev Respir Dis 129:538–543

    PubMed  CAS  Google Scholar 

  59. Baydur A (1991) Respiratory muscle strength and control of ventilation in patients with neuromuscular disease. Chest 99:330–338

    Article  PubMed  CAS  Google Scholar 

  60. Sorli J, Grassino A, Lorange B, Milic-Emili J (1978) Control of breathing in patients with chronic obstructive lung disease. Clin Sci Molec Med 54:295–304

    CAS  Google Scholar 

  61. Javaheri S, Blum J, Kazemi H (1981) Pattern of breathing and carbon dioxide retention in chronic obstructive lung disease. Am J Med 71:228–234

    Article  PubMed  CAS  Google Scholar 

  62. Parot S, Miara B, Milic-Emili J, Gautier H (1982) Hypoxemia, hypercapnia and breathing pattern in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 126:882–886

    PubMed  CAS  Google Scholar 

  63. Tobin MJ, Chadha TS, Jenouri G, Birch SJ, Gazeroglu HB, Sackner MA (1983) Breathing patterns 2. Diseased subjects. Chest 84:286–294

    Article  PubMed  CAS  Google Scholar 

  64. Loveridge B, West P, Kryger MH, Anthonisen NR (1986) Alteration in breathing pattern with progression of chronic obstructive pulmonary disease. Am Rev Respir Dis 134:930–934

    PubMed  CAS  Google Scholar 

  65. Aubier M, Murciano D, Fournier M, Milic-Emili J, Pariente R, Derenne JP (1980) Central respiratory drive in acute respiratory failure of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 122:191–199

    PubMed  CAS  Google Scholar 

  66. Younes M (1990) Load responses, dyspnea and respiratory failure. Chest 97:59S-68S

    PubMed  CAS  Google Scholar 

  67. Jabour ER, Rabil DM, Truwit JD, Rochester DF (1991) Evaluation of a new weaning index, based on inspiratory effort, gas exchange, and tidal volume. Am Rev Respir Dis (in press)

    Google Scholar 

Download references

Authors
  1. D. F. Rochester
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. St. Paul-Ramsey Medical Center, 640 Jackson Street, St. Paul, MN, 55101-2595, USA

    J. J. Marini

  2. Department of Critical Care, Evangelismos Hospital, 45, Ipsilandou Street, Athens, 11521, Greece

    C. Roussos

Rights and permissions

Reprints and permissions

Copyright information

© 1991 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Rochester, D.F. (1991). Ventilatory Failure: An Overview. In: Marini, J.J., Roussos, C. (eds) Ventilatory Failure. Update in Intensive Care and Emergency Medicine, vol 15. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84554-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-84554-3_1

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-84556-7

  • Online ISBN: 978-3-642-84554-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation