CASE PRESENTATION:

RESPIRATORY FAILURE
2 TO HCAP

PRESENTED BY: GROUP 2

Aramburo, Cristina

Binag, Lady Vi

Cabaldo, Jeanette

Diron, Anne

Eseo, Kirk Ivan

Kit, Alyssa

Lai, Kierstein

Largo, Nicole

Ledda, Richan

Samudio, John Carlo

Tomacruz, Samantha

Trabal, Thomas Charles

Uayan, Elaine Jean

INTRODUCTION:
Degenerative disc disease in the lumbar spine, or lower back particularly in the L4
-L5 refers to a syndrome in which a compromised disc causes low back pain (referred
to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg
(sciatica), numbness in dermatomes distribution and positive straight leg raising test.
Sciatic pain aggravates on standing, walking, bending, straining and coughing. Other
symptoms of lumbar disc degeneration are sensory disturbances in legs, claudication,
relief of pain when bending forward and weakness.
As we age, the water and protein content of the cartilage of the body changes. This
change results in weaker, more fragile, and thin cartilage. Because both the discs and
the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these
areas are subject to wear and tear over time (degenerative changes).

The disc itself does not have a blood supply, so if it sustains an injury it
cannot repair itself the way other tissues in the body can. An otherwise
insignificant injury to the disc can start a degenerative cascade whereby the
disc wears out thus causes various complications such as immobility leading
to respiratory complications as lungs are unable to expand properly.
The lungs can be affected after very short periods of immobility leading to
respiratory complications. Even a day or two the chest muscles become
weakened resulting in decreased lung expansion and shallow breathing.
Coughing an important protective function to clear the airways, becomes
weaker and less effective.

Secretions build up in the lungs, increasing the risk of pneumonia and later on will lead to
respiratory failure which results from inadequate gas exchange by the respiratory system, meaning
that the arterial oxygen, carbon dioxide or both cannot be kept at normal levels. A drop in the oxygen
carried in blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia

The prevalence of Degenerative Disk disease related respiratory complications is higher in men with
the percentage of 77% and 71 % in women ages from 50 years old and above. The highest
prevalence of an intervertebral space with degenerative disc disease is in L4 L5 about 75.8%. Age
and obesity were associated with the presence of degenerative disc disease in all regions.
In the case of the patient D.A, 74 years old, male, chief complain difficulty of breathing of two days
duration and admitted due to sepsis secondary to hospital acquired pneumonia and complicated UTI.

Patient was diagnosed with degenerative disc disease particularly in L4 and L5 and
experienced symptoms such as bilateral knee pain, and general body weakness,
leading to immobilization. Due to immobilization, the patient had a community
acquired pneumonia then was admitted to UERM hospital and it was resolved. Later
on, the patient had hospital acquired pneumonia at the same time with complicated
UTI. From complicated UTI, and the destruction of L4 and L5 it results to ascending
infection leading to the acute kidney injury then going to systemic circulation which
results to sepsis.

DEMOGRAPHIC DATA
Name: D.A
Gender: Male
Age: 74 years old
Status: Single
Occupation: Retired MMDA Officer
Nationality: Filipino
Address: Cubao, Quezon City
Religion: Catholic
Date of Birth: 08/01/1941
Admission Date and Time: 3/18/2016; 5:38PM
Chief Complaint: Difficulty of breathing for two days.

DEMOGRAPHIC DATA
Admitting Diagnosis: Sepsis secondary to hospital acquired pneumonia and complicated
UTI.
Past Health History:
Status post renal stones 1990s, AKI secondary post renal (BPH), sacral ulcer grade II; to
consider herniated disc L4-L5; sepsis secondary to complicated UTI.
Family History:
Patient D.A has a familial history of Hypertension, Diabetes Mellitus and Asthma.
Present Health History:
2 days prior to admission, patient was noted to have halak associated with shortness of
breath, decreased sensorium, and undocumented fever relieved by TSB. Persistence of
symptoms prompted consult at UERM.

ANATOMY AND PHYSIOLOGY

The Respiratory System
The respiratory system is made up of organs and tissues that help you breathe. The main parts of this
system are the airways, the lungs and linked blood vessels, and the muscles that enable breathing.

Figure A shows the location of the respiratory structures in the body. Figure B is an
enlarged view of the airways, alveoli (air sacs), and capillaries (tiny blood vessels). Figure
C is a closeup view of gas exchange between the capillaries and alveoli. CO2 is carbon
dioxide, and O2 is oxygen.

ANATOMY AND PHYSIOLOGY

Airways
The airways are pipes that carry oxygen-rich air to your lungs. They also carry carbon dioxide,
a waste gas, out of your lungs. The airways include your:

Nose and linked air passages (called nasal cavities)

Mouth

Larynx (LAR-ingks), or voice box

Trachea (TRA-ke-ah), or windpipe

Tubes called bronchial tubes or bronchi, and their branches

Air first enters your body through your nose or mouth, which wets and warms the air. (Cold, dry
air can irritate your lungs.) The air then travels through your voice box and down your
windpipe. The windpipe splits into two bronchial tubes that enter your lungs.
A thin flap of tissue called the epiglottis (ep-ih-GLOT-is) covers your windpipe when you
swallow. This prevents food and drink from entering the air passages that lead to your lungs.

ANATOMY AND PHYSIOLOGY

Except for the mouth and some parts of the nose, all of the airways have special hairs called
cilia (SIL-e-ah) that are coated with sticky mucus. The cilia trap germs and other foreign
particles that enter your airways when you breathe in air.
These fine hairs then sweep the particles up to the nose or mouth. From there, they're
swallowed, coughed, or sneezed out of the body. Nose hairs and mouth saliva also trap
particles and germs.
Lungs and Blood Vessels
Your lungs and linked blood vessels deliver oxygen to your body and remove carbon dioxide
from your body. Your lungs lie on either side of your breastbone and fill the inside of your
chest cavity. Your left lung is slightly smaller than your right lung to allow room for your
heart.
Within the lungs, your bronchi branch into thousands of smaller, thinner tubes called
bronchioles. These tubes end in bunches of tiny round air sacs called alveoli (al-VEE-uhleye).
Each of these air sacs is covered in a mesh of tiny blood vessels called capillaries. The
capillaries connect to a network of arteries and veins that move blood through your body.

ANATOMY AND PHYSIOLOGY

The pulmonary (PULL-mun-ary) artery and its branches deliver
blood rich in carbon dioxide (and lacking in oxygen) to the
capillaries that surround the air sacs. Inside the air sacs, carbon
dioxide moves from the blood into the air. At the same time, oxygen
moves from the air into the blood in the capillaries.
The oxygen-rich blood then travels to the heart through the
pulmonary vein and its branches. The heart pumps the oxygen-rich
blood out to the body.
The lungs are divided into five main sections called lobes. Some
people need to have a diseased lung lobe removed. However, they
can still breathe well using the rest of their lung lobes.

ANATOMY AND PHYSIOLOGY

Muscles Used for Breathing
Muscles near the lungs help expand and contract (tighten) the lungs
to allow breathing. These muscles include the:

Diaphragm (DI-ah-fram)

Intercostal muscles

Abdominal muscles

Muscles in the neck and collarbone area

The diaphragm is a dome-shaped muscle located below your lungs.

It separates the chest cavity from the abdominal cavity. The
diaphragm is the main muscle used for breathing.

ANATOMY AND PHYSIOLOGY

The intercostal muscles are located between your ribs. They also
play a major role in helping you breathe.
Beneath your diaphragm are abdominal muscles. They help you
breathe out when you're breathing fast (for example, during
physical activity).
Muscles in your neck and collarbone area help you breathe in when
other muscles involved in breathing don't work well, or when lung
disease impairs your breathing.

ANATOMY AND PHYSIOLOGY

What are the kidneys and what do they do?
The kidneys are two bean-shaped organs, each about the size of a
fist. They are located just below the rib cage, one on each side of
the spine. Every day, the two kidneys filter about 120 to 150 quarts
of blood to produce about 1 to 2 quarts of urine, composed of
wastes and extra fluid. The urine flows from the kidneys to the
bladder through two thin tubes of muscle called ureters, one on
each side of the bladder. The bladder stores urine. The muscles of
the bladder wall remain relaxed while the bladder fills with urine. As
the bladder fills to capacity, signals sent to the brain tell a person to
find a toilet soon. When the bladder empties, urine flows out of the
body through a tube called the urethra, located at the bottom of the
bladder. In men the urethra is long, while in women it is short.

ANATOMY AND PHYSIOLOGY

The urinary tract

ANATOMY AND PHYSIOLOGY

Why are the kidneys important?
The kidneys are important because they keep the composition, or
makeup, of the blood stable, which lets the body function. They

prevent the buildup of wastes and extra fluid in the body

keep levels of electrolytes stable, such as sodium, potassium,

and phosphate

make hormones that help

regulate blood pressure

make red blood cells

bones stay strong

ANATOMY AND PHYSIOLOGY

How do the kidneys work?
The kidney is not one large filter. Each kidney is made up of
about a million filtering units called nephrons. Each nephron
filters a small amount of blood. The nephron includes a filter,
called the glomerulus, and a tubule. The nephrons work
through a two-step process. The glomerulus lets fluid and
waste products pass through it; however, it prevents blood
cells and large molecules, mostly proteins, from passing. The
filtered fluid then passes through the tubule, which sends
needed minerals back to the bloodstream and removes
wastes. The final product becomes urine.

ANATOMY AND PHYSIOLOGY

Each kidney is made up of about a

million filtering units called
nephrons.

ANATOMY AND PHYSIOLOGY

Points to Remember

Every day, the two kidneys filter about 120 to 150 quarts of blood
to produce about 1 to 2 quarts of urine, composed of wastes and
extra fluid.

The kidneys are important because they keep the composition, or

makeup, of the blood stable, which lets the body function.

Each kidney is made up of about a million filtering units called

nephrons. The nephron includes a filter, called the glomerulus,
and a tubule.

The nephrons work through a two-step process. The glomerulus

lets fluid and waste products pass through it; however, it
prevents blood cells and large molecules, mostly proteins, from
passing. The filtered fluid then passes through the tubule, which
sends needed minerals back to the bloodstream and removes

PHYSICAL ASSESSMENT

SKIN and
NAILS

ASSESSMENT
Evenly colored skin tone, dry and warm to
touch. There is presence of peeling of the
skin on both upper and lower extremities
with poor skin tugor, presence of grade four
pitting edema, both upper and lower
extremities. There are four pressure sores
that are present. Pressure sore #1 is on
sacral medial; grade 3 with measurement of
5.6 x 3.7 cm. Pressure sore #2 is on gluteal
left side; grade 2 with measurement of 1.5 x
0.6 cm. Pressure sore #3 on malleolus
(right); necrotic and dry with measurement
of 1.5 x 1 cm and pressure sore #4 on
malleolus (left); grade 2 with measurement
of 2 x 2 cm. Nails are clean and intact.

ANALYSIS
A dry skin and
pressure sore are
present due to
prolonged
immobility.
Capilliary refill of
more than two
seconds and poor
skin tugor indicates
decrease
oxygenation in the
body system.
Presence of grade
four pitting edema
is due to decrease

PHYSICAL ASSESSMENT

HEAD AND
NECK

ASSESSMENT

Head is round with smooth skull

contour. Hard and smooth, no
tenderness upon palpation. No
bleeding and lesions noted.
Presence of white hair. Free from
lice. Facial features are
symmetrical. No swelling of lymph
nodes below the angle of the jaw
and along the sternocleidomastoid
muscle. No bruits heard upon
auscultation. Client has limited
range of motion of the neck.

ANALYSIS

Limited range of motion

of neck is due to muscle
atrophy and prolonged
immobility.

PHYSICAL ASSESSMENT

ASSESSMENT

ANALYSIS

EYES AND EARS Eyebrows are symmetrical in shape NORMAL

and eyelashes are similar in
quantity and distribution. Eye has
no redness, and tenderness
Eyeballs are feels firm. No edema
or tearing of the lacrimal sac.
Conjunctiva is moist and clear. Ears
are symmetrical in shape; external
auditory meatus is patent with no
drainage. Color of ear matches the
surrounding area and face, no
redness, nodules, swelling and
lesions noted. Hearing is intact and
able to recognized voices and

PHYSICAL ASSESSMENT

NOSE AND SINUSES

MOUTH

ASSESSMENT

Nose is straight, nares are

equal in size, and skin is
intact. No tenderness,
swelling upon palpation.
NGT is intact.
Lips are symmetrical, no
lesions, dry but moist
buccal mucosa. Patients
teeth are loose. Surface
of the tongue is smooth
and moist.

ANALYSIS

NORMAL

A dry lip is due to prolong

opening of the mouth
because of the
endotracheal tube.
Positive for dental carries.

PHYSICAL ASSESSMENT

RESPIRATORY

ASSESSMENT

ANALYSIS

Clients chest color is consistent

Assessment shows that
with the rest of the body. Sternum
client has been diagnosed
is in midline. Has tachypnea,
with HCAP.
positive labored breathing and used
of accessory muscles. Crackles are
heard on lower left lung upon
auscultation. Assisted with
mechanical ventilator with whining
therapy every after morning care
maintained with oxygen tank at one
liter per minute. Respiratory rate of
28 bpm. Presence of purulent
sputum greenish in color upon
suctioning thick in consistency.

PHYSICAL ASSESSMENT

CARDIOVASCULAR

GASTROINTESTINAL

ASSESSMENT

ANALYSIS

Good heart tone with no

NORMAL
abnormal sounds heard.
No murmurs or bruits
heard during auscultation
BP: 120/70 mmHg
PR: 86 bpm

No lesions, scars
NORMAL
observed on the
abdomen. Abdomen is
symmetric and flat.
Normo active bowel
sounds. Empty bladder is
not palpable or

PHYSICAL ASSESSMENT

RESPIRATORY

ASSESSMENT

ANALYSIS

Clients chest color is consistent

Assessment shows that
with the rest of the body. Sternum
client has been diagnosed
is in midline. Has tachypnea,
with HCAP.
positive labored breathing and used
of accessory muscles. Crackles are
heard on lower left lung upon
auscultation. Assisted with
mechanical ventilator with whining
therapy every after morning care
maintained with oxygen tank at one
liter per minute. Respiratory rate of
28 bpm. Presence of purulent
sputum greenish in color upon
suctioning thick in consistency.

PHYSICAL ASSESSMENT

URINARY

EXTREMITIES

ASSESSMENT

Foley catheter inserted and

attached to a Foley catheter
bag. Normal yellow urine color
passes through the bag in
minimal amounts
Extremities are symmetrical in
size and shape with limited
range of motion. Presence of
grade 2 pitting edema on shin
and ankle. No presence of
pedal pulses. Capillary refill
serum returns to normal less
than two seconds. No signs of
cyanosis noted

ANALYSIS

Monitor urinary output,

evaluate hydration status
and collection of urine
samples for diagnostic
procedures.
Pitting edema is associated
with acute kidney disorder

PHYSICAL ASSESSMENT

ASSESSMENT

NERVOUS SYSTEM No dizziness, tremor or seizure.

Hard to awaken. Limited motor
function. Numbness and
weakness in the lower
extremities
MUSCULOSKELET
AL

ANALYSIS

Numbness and weakness in

the legs is one of the sign
of herniated disc L4 - L5

Client has 1/5 muscle strength

Weak muscle tone and
of flexion and extension on both strength
upper and lower extremities.
Cant do the cross over hand
grip. Stiffness in trapezius, arm
and hand muscles. Forward
shoulder, downward scapular
rotation and increased kyphosis.

PATHOPHYSIOLOGY

LABORATORY RESULTS
TEST

RESULT

REFERENCE

75 umol/L
22 g/L

44 106 umol/L
38 50 g/L

Total Protein Mass

C

55 g/L

74 88 g/L

Globulin Mass C

33 g/L

36 38 g/L

Creatinine
Albmin Mass C

CHEMISTRY (MARCH 24, 2016)

INTERPRETATION AND
ANALYSIS
NORMAL
Reflects selective loss of
albumin from circulation,
as may occur with kidney
disease
Low total protein level
suggests a kidney
disorder
May reflect
overproduction of
globulins

LABORATORY RESULTS
TEST

RESULT

REFERENCE

INTERPRETATIO
N AND ANALYSIS

Sodium

136 mmol/L

135 155 mmol/L

NORMAL

Potassium

3.6 mmol/L

3.5 5.3 mmol/L

NORMAL

BLOOD CHEMISTRY (APRIL 2, 2016)

LABORATORY RESULTS
TEST

RESULT

Hemoglob
in Mass C

105

REFEREN
CE
140-160

INTERPRETATION AND ANALYSIS

Low Hb indicates anemia, recent

hemorrhage, or fluid retention, which
can cause hemodilution
Hematocri
30
40-54
Low Hct suggests anemia, hemodilution,
t
or massive blood loss
RBC
3.8
4.5-5.0
Low RBC count indicates anemia, fluid
overload, or hemorrhage
MCHC
34
32-37
NORMAL
MCH
27.5
27.5-33.2
NORMAL
MCV
79
80-94
Indicates RBCs are smaller than normal
(microcytic)
RDW
19.5
11-15
Indicates mixed population of small and
RBCs
COMPLETE BLOOD COUNT (APRIL 17,large
2016)

TEST
WBC
Differential
Count
Neutrophils
Lymphocytes
Eosinophils

Monocytes
Platelet
MPV

RESULT

REFERENCE

11.0

5-10

52
30
15

40-75
20-45
1-4

3
Normal
8.0

2-6
150-440
7.5-11.5

COMPLETE BLOOD COUNT (APRIL 17, 2016)

INTERPRETATION
AND ANALYSIS
Indicates presence
of infection

NORMAL
NORMAL
Indicates allergic
disorders /
infections / skin
diseases
NORMAL
NORMAL
NORMAL

DRUG ANALYSIS
Drug

MOA

Indication/ CI: Side

Effects
Clexane
A low moleculer
I:
-edema

weight heparin
patients with
-anemia
Classifica derivative that
acute illness
tion:
acceleratesformat who are at
Anticoag ion of antiincreased risk
ulants
thrombin IIIbecause of
thrombin complex decreased
and deactivates
mobility.
thrombin,

preventing
CI:
conversion of
Conditions with
fibrinogen to
high risk of
fibrin. Has higher uncontrolled
anti-factor Xa
hemorrhage
toantifactor IIa
including major
activity ratio.
bleeding

Nursing Responsibility:
- Monitor VS and assess for signs
of bleeding
-Give only by deep SC while lying
down
-Do not give IM
-Assess for Heparin product
hypersensitivity
-Document baseline hematologic
parameters, liver function, and
coagulation studies
-Report unusual bleeding, or
weakness
-Avoid OTC agents containing
aspirin
-Use an electronic razor to shave
-Use a bandage to prevent DVT

Drugs
Metropolol

Classificatio
n:
Beta2
Blocker

MOA
A selective
beta blocker
that
selectively
blocks beta1
receptors;
decreases
cardiac
output,
peripheral
resistance,
and cardiac
oxygen
consumption;
and
depresses
rennin
secretion.

I and CI
I:
-hypertension

CI:
-right
ventricular
failure
secondary to
pulmonary
hypertension.

SE
Dry skin,
pruritus, skin
eruptions.
Special
Senses: Dry
mouth and
mucous
membranes.

NI
Take apical pulse and BP before
administering drug. Report to
physician significant changes in
rate, rhythm, or quality of pulse
or variations in BP prior to
administration.
Monitor BP, HR, and ECG
carefully during IV
administration..

Lab tests: Obtain baseline and

periodic evaluations of blood
cell counts, blood glucose, liver
and kidney function.

Monitor I&O, daily weight;

auscultate daily for pulmonary
rales.

Withdraw drug if patient

presents symptoms of mental

DRUGS

MOA

CONTRAININDICATION DICATIONS
S
- To treat
- Contraindi
Clindamy Inhibits
serious
cated to
cin
protein
respirator
patient

synthesis in
y tract
hypersens
Classificat susceptible
infection
itive to
ion:
bacteria at the
caused by
drugs
Anti
level of 50S
pneumon - Use
Ineffectiv ribosomes
ococci
cautiously
e

- Infection
in patient
Bactericidal;
in skin
with renal
hinders or kills
and soft
or hepatic
susceptible
tissue
dse.
bacteria
injury

SIDE
EFFECTS

NURSING
RESPONSIBILITY

Severe skin reaction

that causes
blistering
and
peeling.

Assess for
patients
condition (V.S,
appearance of
the wound,
sputum)
Obtain specimen
for culture and
sensitivity prior
to initiating
therapy
Monitor peak
and through of
antibiotic
treatment
Assess patient
for
hypersensitivity

DRUGS

MOA

CONTRAIN
INDICATIO NS
DICATIONS
Lansopra Bind enzyme - Active
Hypersens
benign
zole
in presence
itivity to
hastric

of acidic
the drug
ulcer
Classifica gastric PH
- Prolonge
tion:

d ET and
PPI
Preventing
NGT
final
tube
transport of
hydrogen
ions to
gastric
lumen

SIDE
EFFECTS

NURSING
RESPONSIBILIT
Y
Dry mouth - Assess patient
routinely for
Peripheral
epigastric or
edema
abdominal
pain
- Administer
drug before
meals
- Report
headache and
worsening of
symptoms
- Oral care and
ice chips to
prevent
dryness of

NURSING CARE PLAN

PRIORITY #1
Assessment

Planni

Interventi

ng

on

Diagnosi

Rationale

Evaluation

Objective:

Ineffectiv After

Independe

Independent:

After 4hrs of

Clients chest color is consistent with the

e airway

4hrs of

nt:

to take

nursing

rest of the body. Sternum is in midline.

clearanc

nursing

elevate

advantage of

intervention

Has tachypnea, positive labored

e r/t

interven

head of

gravity

the client

breathing and used of accessory

retained

tion the

bed

decreasing

was able to

muscles. Crackles are heard on lower left secretion client

and

pressure on the maintain

lung upon auscultation. Assisted with

will be

change

diaphragm and

airway

mechanical ventilator with whining

able to

position

enhancing

patency

therapy every after morning care

maintai

Q2/PRN

drainage

maintained with oxygen tank at one liter

per minute. Respiratory rate of 28 bpm.

airway

Presence of purulent sputum greenish in

patency

color upon suctioning thick in

consistency.

NURSING CARE PLAN

PRIORITY #1
position head midline with flexion appropriate for

Intervention

age and condition

suction PRN
encourage deep breathing exercise
auscultate breath sounds and assess air
movement
observe for signs/symptoms of infection

Dependent:
Give expectorants/ bronchodilators as ordered

Collaborative:
Assist with procedure (endotracheostomy)

Rationale

to open/maintain airway in at-rest

or to compromised individual
to clear airway when secretion are
blocking airway

to maximize comfort

to ascertain status and note

progress
to identify infectious
process/promote timely
intervention

Collaborative:
to clear/maintain open airway

NURSING CARE PLAN PRIORITY #2

Assessment
Objective:

Diagnosis
Ineffective

Planning
Short term:

Clients chest color is consistent with the rest breathing pattern

After 2-3 hours of nursing

of the body. Sternum is in midline. Has

related to

intervention the client will

tachypnea, positive labored breathing and

hypoventilation as

be able to improve

used of accessory muscles. Crackles are

manifested by RR

pulmonary ventilation and

heard on lower left lung upon auscultation.

of 28 bpm and

oxygenation.

Assisted with mechanical ventilator with

crackles upon

whining therapy every after morning care

auscultation

Long term:

maintained with oxygen tank at one liter per

After 2-3days of nursing

minute. Respiratory rate of 28 bpm. Presence

intervention the client

of purulent sputum greenish in color upon

breathing pattern will

suctioning thick in consistency.

maintain as normal
respiratory rate.

NURSING CARE PLAN PRIORITY #2

Intervention

Rationale

Independent:

Independent:

Assessed respiratory rate and depth upon auscultation by the

lung

Noted muscles used for breathing and flaring of nostrils

Positioned client in proper body alignment(semi-fowlers)

Provided adequate rest

Provided physiotherapy

Suction airway as needed to clear secretions

Dependent:

Administered O2 as ordered at lowest concentration

Collaborative:

Administered O2 as ordered at lowest concentration

this signify an increase work of

breathing

this is for good lung excursion and

chest expansion

this prevent dyspnea resulting from

fatigue

NURSING CARE PLAN PRIORITY #2

Evaluation
Short term:
After 2-3 hours of nursing intervention the client was able to improved
pulmonary ventilation and oxygenation.

Long term:
After 2-3days of nursing intervention the client breathing pattern was
maintain into normal respiratory rate .

JOURNAL: RESPIRATORY
FAILURE
Respiratory failure occurs due mainly either to lung failure resulting in
hypoxemia or pump failure resulting in alveolar hypoventilation and
hypercapnia. Hypercapnic respiratory failure may be the result of
mechanical defects, central nervous system depression, imbalance of
energy demands and supplies and/or adaptation of central controllers.
Hypercapnic respiratory failure may occur either acutely, insidiously or
acutely upon chronic carbon dioxide retention. In all these conditions,
pathophyisiogically, the common denominator is reduced alveolar
ventilation for a given carbon dioxide production.
Acute hypercapnic respiratory failure is usually caused by defects in the
central nervous system, impairment of neuromuscular transmission,
mechanical defect of the ribcage and fatigue of the respiratory muscles.

JOURNAL: RESPIRATORY
FAILURE
The pathophysiological mechanisms responsible for chronic carbon dioxide retention are not
yet clear. The most attractive hypothesis for this disorder is the theory of natural wisdom.
Patients facing a load have two options, either to push hard in order to maintain normal
arterial carbon dioxide and oxygen tensions at the cost of eventually becoming fatigued and
exhausted or to breathe at lower minute ventilation, avoiding dyspnea, fatigue and
exhaustion but at the expense of reduced alveolar ventilation. Based on most recent work,
the favored hypothesis is that a threshold inspiratory load may exist, which, when exceeded,
results in injury to the muscles and, consequently, an adaptive response is elicited to
prevent and/or reduced this damage. This consists of cytokine production, which, in turn,
modulates the respiratory the respiratory controllers, either directly through the blood or
probably the small afferents or via the hypothalamic-pituitary-adrenal axis. Modulation of the
pattern of breathing, however, ultimately results in alveolar hypoventilation and carbon
dioxide retention.

REFERENCE:
Roussos, C., & Koutsoukou, A. (2003). Respiratory failure [Abstract]. European Respiratory
Journal, 3-14. Retrieved May 02, 2016.