[Acute respiratory failure concomitant with serious disease or injury].
BACKGROUND
Acute respiratory failure has an annual incidence of 20-75/100,000 and is the most common reason for admittance to an intensive care unit. A common cause is acute inflammatory changes in lung tissue. The article reviews clinical, etiological, pathophysiological and therapeutic aspects of acute respiratory failure, with an emphasis on failure secondary to proinflammatory processes.


METHODS
This paper is not based on a comprehensive literature review, but on the clinical and scientific experience of the author, literature from a private archive and a limited Medline search.


RESULTS
Acute respiratory failure can be precipitated by agents and/or trauma that damage the lungs directly. Serious infections and tissue damage located in other parts of the body can also cause respiratory failure. In these cases, the blood transports activated blood cells and proinflammatory agents to the lungs where they induce secondary tissue inflammation. The resulting respiratory failure is often serious. Mortality is in the range 30-50 %.


CONCLUSIONS
No specific treatment is available for secondary tissue inflammation; it usually resolves when the precipitating injuries or disease processes are healed. Positive pressure ventilation can prevent serious hypoxemia from causing additional damage to affected tissue. With modern treatment in an intensive care unit only 10-15 % of the deaths are caused by the respiratory failure per se, most deaths are caused by failure of several additional organs (multiorgan failure).
Opdahl
Helge
H
Nasjonalt kompetansesenter for NBC-medisin, Oslo universitetssykehus, Ullevål, 0407 Oslo, Norway. helge.opdahl@ulleval.no
D000208:Acute Disease; D003422:Critical Care / Q000379:methods; D006801:Humans; D055370:Lung Injury / Q000150:complications; D011014:Pneumonia / Q000150:complications; D011175:Positive-Pressure Respiration; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012138:Respiratory Therapy / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D014692:Ventilation-Perfusion Ratio