Diffuse alveolar hemorrhage-induced respiratory failure

This case study discusses the management of type I respiratory failure (RF) secondary to diffuse alveolar-induced acute lung injury. Type I RF occurs with ventilation-perfusion mismatch resulting in inadequate oxygenation. Arterial oxygen saturation is usually less than 90% despite supplemental fraction of inspired oxygen (FIO(2)) greater than 60%. Type I RF may occur as a result of injury to the lung parenchyma caused by infection, toxins, pulmonary edema, pulmonary hemorrhage, aspiration of gastric contents, and respiratory distress syndrome. Whatever the inciting element, the typical pathophysiology of type I RF involves damage to the alveolar-capillary membrane causing an inflammatory cascade of events. The extent of lung injury determines its severity as well as management. Invasive mechanical ventilation support is required in most cases, but when the patient is hemodynamically stable and lung injury is mild or moderate, noninvasive positive pressure ventilation may provide adequate ventilation support. Despite the ventilation type chosen, management requires a multidisciplinary team approach and a high level of care.