2. Explain the classification of the respiratory failure?

Respiratory failure is a failure of the respiratory system in the exchange of O2

and CO2 gases and is still a problem in medical management. Practically, respiratory
failure is defined as PaO2 <60 mmHg or PaCO2> 50 mmHg.

1) Type I Respiratory Failure (oxygenation failure, arterial hypoxemia)

Type I respiratory failure is characterized by partial abnormally low arterial O2 pressure.
Perhaps this is caused by any abnormality that causes low intrapulmonary perfusion ventilation from
right to left characterized by low partial pressure of arterial O2 (PaO2 <60 mmHg when inhaling ambient
air).
Signs and symptoms:
 Dyspnea, Cyanosis
 Confused, somnolen
 Tachycardia, arrhythmia
 The use of muscle aids breathing
 Recession of the use of intercostal muscles
 Polycythemia

Causes of type 1 respiratory failure (oxygenase failure):

 Adult Respiratory Distrees Syndrome (ARDS)
 Asthma
 Lung edema
 Chronic Obstructive Pulmonary Disease (COPD)
 Intertisisal fibrosis
 Pneumonia
 Lung embolism
 Pneumothorax
 Pulmonary hypertension
2) Type II Respiratory Failure (ventilation failure: arterial hypercapnea)
Type II respiratory failure is caused by any abnormality that decreases Central
Respiratory drive, affects the transmission of signals from CNS, or impedes the ability
of the respiratory muscles to develop lung and chest. Type II respiratory failure is
characterized by an increase in the partial pressure of abnormal arterial CO2 (PaCO2>
46 mmHg), and is followed simultaneously by a decrease in PaO2 - PaO2 that remains
unchanged.
Signs and symptoms:
 Increased cerebral blood flow and cerebrospinal fluid pressure
 Headache
 Asterixis
 Papyledema
 Warm extremities, pulse decreases
 Acidosis (respiratory and metabolic)
 ↓ pH, ↑ lactic acid

Causes of type II respiratory failure:

a) Abnormalities concerning the Central Ventilatory Drive, which is a respiratory
control or respiratory drive located in the medulla of the brain stem.
 Infarction or brain hemorrhage
 Supratentorial emphasis on the brain stem
 Drug overdoses, narcotics, Benzodiazepines, anesthetic agents, etc.

b) Abnormalities concerning the transmission of signals to the muscles of respiration

 Myastania Gravis
 Amytropic lateral sclerosis
 Guillain Barre Syndrome
 Spinal Cord Injury
  Multiple Sclerosis
 Residual paralysis (muscle paralysis)

c) Abnormalities in the respiratory muscles and chest wall

 Muscual dystrophy
 Polymyositis
 Flail Chest

Respiratory failure can also be distinguished based on the cause of trauma or

non-trauma.
a) Failure of breath due to trauma, including:
Pneumothorax, Hemothorax, Hydropneumothorax, Foreign body obstruction,
Flail chest, brain infarction or bleeding, suppression of the supratentorial period
in the brain stem
b) Respiratory failure due to non-trauma, among others:
Effusion, asthma, pneumonia, vascular disease, myastania gravis, Guillain
barre syndrome, muscular dystrophy, polymyositis, and others.
Referensi :

1. Nemaa PK. Respiratory Failure. Indian Journal of Anaesthesia,47(5):360-6

2. Deliana, Anna dkk. 2013. Indikasi Perawatan Pasien dengan Masalah Respirasi
di Instalasi Perawatan Intensif. J Respir Indo Vol. 33, No. 4.