BTS 25TH ANNIVERSARY

Hypercapnic respiratory failure

Hypercapnic respiratory failure: from the past to the future

John Shneerson

Correspondence to:
Dr John Shneerson, Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge CB23 8RE, UK; john.shneerson@papworth.nhs.uk

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The importance of non-invasive ventilation

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The first 150 words of the full text of this article appear below.

It seems surprising now, but the concept of respiratory failure is quite a recent development in respiratory medicine. Up until the middle of the 20th century, when chest physicians were dealing primarily with tuberculosis, it was virtually overlooked.¹ The principles of the biochemical control of respiration had only recently been demonstrated, arterial blood analysis was difficult and time-consuming, and the understanding of acid-base metabolism was primitive by modern standards. The work of Moran Campbell and his colleagues,² however, clarified the physiological basis of the clinical presentations of respiratory failure. The "blue bloater" who hypoventilated and developed right heart failure was contrasted with the "pink puffer" who suffered breathlessness but maintained a normal carbon dioxide tension and near normal oxygen tension. The adverse effect of supplemental oxygen of removing the hypoxic drive and exacerbating respiratory failure was recognised and controlled oxygen therapy using Venturi masks became established.

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This article has been cited by other articles:

• Wedzicha, J. A, Johnston, S. L (2008). Thorax update: October 2007-September 2008. Thorax 63: 1036-1037 [Full Text]