How is postoperative
respiratory failure defined? What are the two main types of acute respiratory
failure?
Postoperative respiratory failure is defined as the need for continued mechanical ventilation
beyond 48 hours after surgery, or the need for reintubation and mechanical
ventilation after extubation.
There are two categories of respiratory
failure: hypox-emic or type I (usually with a low or normal PCO2)
and hypercapnic or type II. Hypoxemia is discussed in detail in the next
section. Hypercapnia is caused by either ineffective minute ventilation or,
much less commonly, excessive carbon dioxide (CO2) production (e.g.,
malignant hyperthermia or overzealous carbohydrate feeding). Ineffective
ventilation may result from a low respiratory rate (e.g., opioid effect), a low
tidal volume (e.g., neuromuscular weakness or splinting from pain), or an
increase in physiologic dead-space (e.g., COPD, pulmonary embolus, acute
respiratory distress syndrome, or shock).
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