Acute respiratory failure: back to the roots!
Hypoxic respiratory failure is one of the most commonest disorders leading to intensive care unit (ICU) admission and also a common reason for the deterioration of patients already treated in the ICU. It is a very serious condition associated with significant mortality [1, 2]. In recent decades, research and scientific attention has focused nearly exclusively on the pathophysiology and treatment of established causes of hypoxic respiratory failure such distress syndrome (ARDS) [1, 2]. Therefore, our diagnostic approach to patients with hypoxic respiratory failure has remained both largely unchanged and poorly validated. This is a dilemma because diagnostic uncertainty is very common. The severity of disease and the requirement for immediate ventilatory support often limit our ability to obtain a detailed patient history and physical examination. Chest X-ray is helpful but also associated with important limitations .
KeywordsIntensive Care Unit Chronic Obstructive Pulmonary Disease Respiratory Failure Acute Respiratory Distress Syndrome Brain Natriuretic Peptide
Unable to display preview. Download preview PDF.
- 4.Lefebvre A, Kural-Menasche S, Darmon M, Thiery G, Feugeas JP, Schlemmer B, Azoulay E (2008) Use of N-terminal pro-B-type natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure. Intensive Care Med DOI 10.1007/s00134-008-1000-4Google Scholar
- 9.Karmpaliotis D, Kirtane AJ, Ruisi CP, Polonsky T, Malhotra A, Talmor D, Kosmidou I, Jarolim P, de Lemos JA, Sabatine MS, Gibson CM, Morrow D (2007) Diagnostic and prognostic utility of brain natriuretic peptide in subjects admitted to the ICU with hypoxic respiratory failure due to noncardiogenic and cardiogenic pulmonary edema. Chest 131:964-971PubMedCrossRefGoogle Scholar
- 10.Abroug F, Ouanes-Besbes L, Nciri N, Sellami N, Addad F, Hamda KB, Amor AB, Najjar MF, Knani J (2006) Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease. Diagnostic performance of biomarkers. Am J Respir Crit Care Med 174:990–996CrossRefGoogle Scholar
- 12.Grasso S, Leone A, De Michele M, Anaclerio R, Cafarelli A, Ancona G, Stripoli T, Bruno F, Pugliese P, Dambrosio M, Dalfino L, Di Serio F, Fiore T (2007) Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med 35:96-105PubMedCrossRefGoogle Scholar
- 13.The Task Force on Acute Heart Failure of the European Society of Cardiology. Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, Hasin Y, Lopez-Sendon J, Mebazaa A, Metra M, Rhodes A, Swedberg K (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J 26:384–416PubMedCrossRefGoogle Scholar