Summary
Differentials
Common
- COPD
- Multilobar pneumonia
- Foreign body aspiration
- Drug use (narcotics, alcohol, sedatives, anesthetics)
- Oxygen therapy in COPD
- CNS infarction or hemorrhage
- Head trauma
- CNS infection
- Hypoventilation syndrome in obesity
- Pleural effusion
- Pneumothorax
- Obesity
- Kyphoscoliosis
- Hypokalemia
- Hypophosphatemia
- Inadequate mechanical ventilation
Uncommon
- Cardiogenic pulmonary edema
- Acute lung injury/acute respiratory distress syndrome
- Pulmonary fibrosis
- Status asthmaticus
- Laryngospasm
- Angioedema
- Primary alveolar hypoventilation
- Empyema
- Hemothorax
- Flail chest
- Scleroderma
- Ankylosing spondylitis
- Fibrothorax
- Hypothyroidism
- Paralytic agents and organophosphates
- High cord trauma/lesions (above C4)
- Guillain-Barre syndrome
- Multiple sclerosis
- Myasthenia gravis
- Muscular dystrophy
- Amyotrophic lateral sclerosis
- Polymyositis and dermatomyositis
- Phrenic nerve trauma
- Tetanus
- Botulism
- Poliomyelitis
- Sepsis
- Fever/malignant hyperthermia
- Insufflation of CO₂ into body cavity (e.g., laparoscopic surgery)
Contributors
Authors
Rajiv Dhand, MD
Professor of Medicine
Department of Medicine
University of Tennessee Graduate School of Medicine
Knoxville
TN
Disclosures
RD declares that he has received grants/contracts from Mylan/Theravance and Viatris. RD receives royalties from UpToDate and Taylor and Francis. RD has been a consultant for Verona Pharma and is a member of the American Association for Respiratory Care Clinical Practice Guidelines for Aerosol Therapy. RD has received drugs from Theravance and Viatris for research in clinical trials.
Ghassan Jamal Wadi, MBBS
Pulmonary and Critical care fellow
Department of Medicine
University of Tennessee Graduate School of Medicine
Knoxville
TN
Disclosures
GJW declares that he has no competing interests.
Acknowledgements
Dr Rajiv Dhand and Dr Ghassan Jamal Wadi would like to gratefully acknowledge Dr M. Bradley Drummond and Dr Eddy Fan, previous contributors to this topic.
Disclosures
MBD declares that he has no competing interests. EF has received fees from MC3 Cardiopulmonary and ALung Technologies, Baxter, Getinge, Inspire, Vasomune, and Zoll Medical.
Peer reviewers
Guy Soo Hoo, MD, MPH
Director
Intensive Care Unit
West Los Angeles VA Healthcare Center
Clinical Professor of Medicine
Geffen School of Medicine
UCLA
Los Angeles
CA
Disclosures
GSH declares that he has no competing interests.
Harman Paintal, MBBS
Division of Pulmonary and Critical Care Medicine
Veterans Affairs Palo Alto Health Care System (VAPAHCS)
Palo Alto
CA
Disclosures
HP declares that he has no competing interests.
Patrick J. Neligan, MA, MB BCh, FCARCSI, FJFICM
Consultant in Anaesthesia and Intensive Care
Galway University Hospitals
Senior Lecturer in Anaesthesia
National University of Ireland
Galway Department of Anaesthesia and Intensive Care
University College Hospitals
Galway
Ireland
Disclosures
Not disclosed.
References
Key articles
British Thoracic Society. BTS guideline for oxygen use in adults in healthcare and emergency settings. May 2017 [internet publication].Full text
British Thoracic Society. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Mar 2016 [internet publication].Full text
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD: 2025 report. 2024 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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