critical care medicine
Overview of Respiratory Arrest
Etiology of Respiratory Arrest
Respiratory arrest (and impaired respiration that can progress to respiratory arrest) can be caused by Airway obstruction Decreased respiratory effort Respiratory muscle weakness Obstruction may involve the Upper airway Lower airway Upper airway obstructionmay occur in infants<3 months, who are usually nose breathers and thus may have upper airway obstruction secondary to nasal blockage. At all ages, loss of muscular tone with decreased consciousness may cause upper airway obstruction as the posterior portion of the tongue displaces into the oropharynx. Other causes of upper airway obstruction include Blood Mucus Vomitus Foreign body Spasm of the vocal cords Edema of the vocal cords Pharyngolaryngeal or tracheal inflammation (eg, Epiglottitis , Tumor Trauma Patients with congenital developmental disorders (eg, Down Syndrome (Trisomy 21) , Lower airway obstructionmay result from Aspiration Bronchospasm Airspace filling disorders (eg, Overview of Pneumonia , Drowning None Decreased respiratory effort reflects central nervous system (CNS) impairment due to one of the following: Central nervous system disorder Adverse medication or illicit drug effect Metabolic disorder that affect the brain stem (eg, Overview of Stroke , infection, tumor) can cause hypoventilation. Disorders that increase intracranial pressure usually cause hyperventilation initially, but hypoventilation may develop if the brain stem is compressed. include opioids and sedative-hypnotics (eg, barbiturates, alcohol; less commonly, benzodiazepines). Combinations of these drugs further increase the risk of respiratory depression ( Etiology references ). Usually, an overdose (iatrogenic, intentional, or unintentional) is involved, although a lower dose may decrease effort in patients who are more sensitive to the effects of these drugs (eg, older patients, deconditioned patients, patients with chronic respiratory insufficiency or obstructive sleep apnea). Respiratory arrest due to illicit drug use especially ) may cause serious breathing difficulties in patients using opioids or other drugs that depress the CNS (eg, Sedatives ), older patients, or patients who have underlying respiratory impairment such as patients with Metabolic disordersthat cause CNS depression due to severe hypoglycemia or hypotension ultimately compromise respiratory effort. Weakness may be caused by Respiratory muscle fatigue Neuromuscular disorders can occur if patients breathe for extended periods at a minute ventilation exceeding about 70% of their maximum voluntary ventilation (eg, because of severe Metabolic Acidosis or hypoxemia). include spinal cord injury, neuromuscular diseases (eg, Myasthenia Gravis , 1.Izrailtyan I, Qiu J, Overdyk FJ, et al: Risk factors for cardiopulmonary and respiratory arrest in medical and surgical hospital patients on opioid analgesics and sedatives.PLoS One13(3):e019455, 2018. doi: 10.1371/journal.pone.0194553 2.Khanna AK, Bergese SD, Jungquist CR, et al: Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: An international prospective, observational trial.Anesth Analg131(4):1012-1024, 2020. doi:10.1213/ANE.0000000000004788 3.Lee LA, Caplan RA, Stephens LS, et al: Postoperative opioid-induced respiratory depression: A closed claims analysis.Anesthesiology122: 659–665, 2015. doi: 10.1097/ALN.0000000000000564 