[Respiratory Insufficiency: State of the Art - Diagnosis and Therapy]

Abstract

The term "respiratory insufficiency" (RI) describes the inability of an organism to maintain the gas exchange between the ambient air and its peripheral organs. This causes a hypoxia and hypercapnia. The mechanisms that lead to RI are either an impaired gas exchange in the lung tissue or an alveolar hypoventilation caused by an insufficient ventilatory pump. Thus the RI is divided into a hypoxic or a hypercapnic RI. The diagnostic procedure for RI contains several examinations. One key aspect of the exploration is the identification of potential reversible and thus correctable reasons of the RI. The goal of the therapy is to maintain the oxygen supply for the peripheral organs and the elimination of CO₂. It covers supportive and causal therapeutic interventions. Wherever possible, therapy should resolve the cause of the RI. The non-invasive ventilation (NIV) is the therapy of choice in severe cases of a hypercapnic RI. It relieves the exhausted respiratory muscles and improves respiratory situation. It can be used for hypoxic RI as well, but frequently invasive ventilation is required. If NIV is not able to improve the patient's condition, invasive ventilation (IV) is applied.