Acute Respiratory Failure Imposed on Chronic Lung Disease

Abstract

A 68-year-old woman was seen in the emergency room with severe shortness of breath and dyspnea that had worsened over the previous 48 hours and had not responded to albuterol (Proventil), theophylline (Theo-Dur), and oxygen therapy, at home. Wheezing, a prolonged expiratory phase, and cough productive of mucopurulent sputum were obvious on examination. Analysis of arterial blood confirmed acute respiratory failure, with PaCO2 > 70 torr, severe hypoxemia, and anemia. Consequently, the patient was intubated and mechanically ventilated. A chest radiograph was taken soon after intubation and is shown in Figure 1.