We review the pathogenesis of hypercapnic respiratory failure, emphasizing the interrelationship between respiratory muscle dysfunction and abnormal pulmonary gas exchange. Although dysfunction in the gas-exchange region of the lungs (alveolar-capillary area) is commonly the initiating event of respiratory failure, failure of the respiratory muscles figures importantly in the final development of hypercapnic respiratory failure from ventilation-perfusion mismatch. Respiratory muscle dysfunction contributes to this failure when muscle fatigue occurs, which it can do as a result of a decrease in the maximum force the muscles are capable of generating or an increase in the force required to sustain ventilatory demands. Theoretically, there are two ways to treat hypercapnic respiratory failure: decrease the demand for ventilation, or increase the ventilation.
DerenneJP, MacklemPT, RoussosCH. The respiratory muscles: Mechanics, control, and pathophysiology, Part III. Am Rev Respir Dis1978;118:581–601.
2.
KelsenSG, RaoL, CherniackNS, GotheB, AltoseMD. Respiratory adjustments to ventilatory loading in chronic obstructive pulmonary disease. Am Rev Respir Dis1979;119:159–164.
3.
RochesterDF. Respiratory disease: Attention turns to the air pump. Am J Med1980;68:803–805.
4.
MacklemPT. Respiratory muscles: The vital pump. Chest1980;78:753–758.
5.
MurrayJF. The normal lung: The basis for diagnosis and treatment of pulmonary disease. Philadelphia: WB Saunders, 1976.
6.
PontoppidanH, GeffinB, LowensteinE.Acute respiratory failure in the adult, Part I. N Engl J Med1972;287:690–696.
7.
WestJB. Ventilation-perfusion relationships. Am Rev Respir Dis1977;116:919–943.
8.
RobinED, LamanDP, GorisML, TheodoreJ.A shunt is (not) a shunt is (not) a shunt. Am Rev Respir Dis1977;115:553–557.
9.
DantzkerDR, BrookCJ, DehartP, LynchJP, WegJG. Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Respir Dis1979;120:1039–1052.
10.
WestJB. Causes of carbon dioxide retention in lung disease. N Engl J Med1979;284:1232–1236.
11.
HopewellPC, MurrayJF. The adult respiratory distress syndrome. Annu Rev Med1976;27:343–356.
12.
BergofskyEH. Respiratory failure in disorders of the thoracic cage. Am Rev Respir Dis1979;119:643–669.
13.
BlackLF, HyattRE. Maximal static respiratory pressures in generalized neuromuscular disease. Am Rev Respir Dis1971;103:641–650.
14.
DerenneJP, MacklemPT, RoussosCH. The respiratory muscles: Mechanics, control, and pathophysiology, Part I. Am Rev Respir Dis1978;118:119–133.
15.
de TroyerA, HeilpornA.Respiratory mechanics in quadriplegia. The respiratory function of the intercostal muscles. Am Rev Respir Dis1980;122:591–600.
16.
RoussosC, FixleyM, GrossD, MacklemPT. Fatigue of inspiratory muscles and their synergic behavior. J Appl Physiol1979;46:897–904.
17.
LeithDE, BradleyM.Ventilatory muscle strength and endurance training. J Appl Physiol1976;41:508–516.
18.
GibsonGJ, PrideNB, Newsom DavisJ, LohLC. Pulmonary mechanics in patients with respiratory muscle weakness. Am Rev Respir Dis1977;115:389–395.
19.
NewmanJH, NeffTA, ZiporinP.Acute respiratory failure associated with hypophosphatemia. N Engl J Med1977;296:1101–1103.
20.
RoussosCS, MacklemPT. Diaphragmatic fatigue in man. J Appl Physiol1977;43:189–197.
21.
RochesterDP, BraunNMT. The respiratory muscles. Basics of RD1978;6:20–25.
22.
DriverAG, LeBrunM.Iatrogenic malnutrition in patients receiving ventilatory support. JAMA1980;244:2195–2196.
23.
EdwardsRT. The diaphragm as a muscle. Am Rev Respir Dis1979;119:81–84.
24.
LevisonH, CherniackRM. Ventilation cost of exercise in chronic obstructive pulmonary disease. J Appl Physiol1968;25:21–27.
25.
Newsom DavisJ.The diaphragm and neuromuscular disease. Am Rev Respir Dis1979;119:115–117.
26.
MortolaJP, Sant'ambrogioG.Mechanics of breathing in tetraplegics. Am Rev Respir Dis1979;119:131–134.
27.
GilbertR, AshutoshK, AuchinclossJH. Clinical value of observations of chest and abdominal motion in patients with pulmonary emphysema. Am Rev Respir Dis1979;119:155–158.
28.
RochesterDF, BraunNM, AroraNS. Respiratory muscle strength in chronic obstructive pulmonary disease. Am Rev Respir Dis1979;119:151–154.
GrossD, LaddHW, RileyEJ, MacklemPT, GrassinoA.The effect of training on strength and endurance of the diaphragm in quadriplegia. Am J Med1981;68:27–34.
31.
BelmanMJ, MittmanC.Ventilatory muscle training improves exercise capacity in chronic obstructive pulmonary disease patients. Am Rev Respir Dis1980;121:273–280.
32.
RochesterDF, BraunNMT, LaineS.Diaphragmatic energy expenditure in chronic respiratory failure. Am J Med1977;63:223–232.
33.
RoizenMF, FeeleyTW. Pancuronium bromide. Ann Intern Med1978;88:64–68.
34.
SharpJT, DrutzWS, MolsanT, FosterJ, MachnachW.Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis1980;122:201–211.
