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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Respiratory Failure


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
518.81 - Respiratory Failure
518.83 - Chronic Respiratory Failure
518.84 - Acute and Chronic Respiratory Failure; Acute on Chronic Respiratory Failure

Related Terms

  • Extrapulmonary Respiration Failure
  • Respiratory Distress

Overview

Respiratory failure is a general term that describes the respiratory system's inability to effectively exchange carbon dioxide and oxygen, a critical function that oxygenates the body's tissues and organs and removes carbon dioxide from arterial blood. Almost any condition that affects breathing or the lungs can lead to respiratory failure. The cause can originate within the lungs (intrapulmonary) or outside the lungs (extrapulmonary).

Respiratory failure is commonly classified as either acute or chronic. Acute respiratory failure occurs when the lungs cannot meet the body's metabolic demands. It is a medical emergency in which the individual is hospitalized and almost always intubated. Chronic respiratory failure results in chronically low oxygen levels and/or chronically high carbon dioxide levels. It can often be treated less urgently than the acute type, and individuals may not necessarily need to be hospitalized.

Incidence and Prevalence: The incidence depends on the underlying condition.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Causes of acute respiratory failure include dysfunction of the lung structure (parenchyma), pneumonia, fluid accumulation (pulmonary edema), acute respiratory distress syndrome (ARDS), pulmonary embolism, and chest wall trauma.

Chronic respiratory failure is caused by lung conditions such as emphysema, asthma, bronchitis, bronchiectasis, bronchiolitis, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis; diseases or conditions that paralyze respiratory muscles such as muscular dystrophy or spinal cord injury; autoimmune neuromuscular diseases such as myasthenia gravis; structural defects of the chest wall caused by kyphoscoliosis or severe injury; genetic disorders such as cystic fibrosis; conditions that depress the respiratory center such as sleep apnea and extreme obesity; and extrapulmonary conditions such as polio, Guillain-Barré syndrome, polymyositis, and amyotrophic lateral sclerosis.

Advanced age is a primary risk factor for respiratory failure.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may include shortness of breath (dyspnea), cough, sputum production, bluish discoloration of the skin (cyanosis), restlessness, anxiety, confusion, headache, and generalized fatigue. Respiratory rate (the number of breaths per minute) may be increased or less commonly, decreased. The individual may have had a previously diagnosed condition involving the lungs. Symptoms may have developed suddenly or appeared after a cold, viral infection, or other illness.

Physical exam: Listening through a stethoscope (auscultation) may reveal abnormal breath sounds, irregular heart rhythm (arrhythmia), and lack of bowel sounds in the abdomen. A neurological exam may indicate impaired sensory and motor function. If the individual is suffering from ventilation fatigue, the chest may heave when breathing, indicating overworking of the ventilatory muscles.

Tests: Laboratory tests include routine blood chemistries and hematologic (blood) evaluation. Pulmonary function tests (PFT) will be ordered to help diagnose lung conditions. Arterial blood gases (ABG) will be ordered to measure oxygen and carbon dioxide levels and evaluate the gas exchange function of the lungs. Chest x-rays may be done, as well as sputum cultures, to evaluate lung conditions and/or underlying infection. A flexible, lighted fiberoptic instrument (bronchoscope) may be passed through the trachea and into the lungs to examine the bronchial area for possible obstruction. Organ systems will be evaluated to help determine the underlying cause or the possible effects on organs from the respiratory failure.

Source: Medical Disability Advisor



Treatment

The initial goal of treatment is to assure that enough oxygen is getting to body organs. Supplemental oxygen therapy may be necessary to improve oxygenation. Many individuals can use noninvasive ventilation such as a nasal mask. In acute cases, however, invasive interventions may be required. If intubation is required, an oral or nasal tube (endotracheal tube [ETT]) is passed through the nose or mouth into the trachea to deliver a carefully controlled amount of oxygen. Mechanical ventilation (respirator), continuous positive airway pressure (CPAP), or supportive breathing (positive end expiratory pressure [PEEP]) can be used to support ventilation. Sedation is necessary in many individuals to relieve restlessness and anxiety that occur when breathing is compromised. Cardiac function must be stabilized; drug therapy may be necessary to maintain cardiac function, especially if low blood oxygen (hypoxemia) is present. Fluid balance must be maintained to avoid compromising kidneys or other vital organs by the accumulation of fluids and to reduce the work of the heart and lungs in removing excess fluid.

Treatment is aimed eliminating the underlying cause, promoting adequate gas exchange, reducing the workload of the lungs, and preventing multiple organ damage due to impaired oxygenation. According to the primary cause of respiratory failure, drug therapy to facilitate removal of secretions (expectorants) and dilate airways (bronchodilators) may be administered either intravenously or through inhalation (mechanical ventilation). Antibiotics may be given to treat or prevent infections.

If respiratory failure is due to obstruction of the airflow, the cause must be corrected. Treatment may include forced coughing (chest physical therapy), suctioning, and respiratory or physical therapy. Frequent changing of position is usually recommended as well. If there is no relief, a flexible light source with camera (fiberoptic bronchoscopy) is passed down the trachea and into the bronchi to identify and remove the obstruction.

Source: Medical Disability Advisor



Prognosis

If respiratory failure is due to an airway obstruction, removal of the obstruction usually restores effective ventilation. When due to abnormal lung function the outcome may depend on the underlying cause, the degree of hypoxemia or abnormally high levels of carbon dioxide in the blood (hypercarbia), and the degree of organ dysfunction as a result of insufficient oxygenation. Respiratory distress may progress rapidly from tissue hypoxia to respiratory arrest and death.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Critical Care Internist
  • Pulmonologist

Source: Medical Disability Advisor



Rehabilitation

Individuals with respiratory failure require occupational, physical, and respiratory therapy. All therapies begin in the hospital with occupational and physical therapy continuing after discharge.

Respiratory therapy addresses improving lung function and decreasing risk for the buildup of lung secretions. For individuals with COPD, respiratory therapists teach individuals pursed lip breathing to increase the airflow to the lungs. Individuals may also use a device that measures and displays the amount of air inspired (incentive spirometer) to help motivate deeper breathing. Individuals also learn to produce an effective cough through techniques such as huffing, in which air is forcefully breathed out while the mouth is open. Positions that relieve shortness of breath are also demonstrated, such as leaning forward while sitting with the arms resting on the thighs.

For individuals with continued shortness of breath, occupational therapy addresses fatigue or discomfort that may occur during activities of daily living. Individuals learn to use equipment such as a shower chair to decrease the energy expended during bathing or a long-handled sponge to decrease the amount of forward bending. Energy conservation techniques may be taught to ease the activities of daily living such as meal preparation. Tasks are broken up into smaller components to make them more manageable.

Physical therapy addresses decreased endurance, strength, and range of motion. Individuals learn to stretch shoulder and chest muscles to promote normal posture that in turn improves respiration. Individuals perform strengthening exercises of the arms, legs, and upper back to improve overall endurance and improve posture. Individuals also learn abdominal breathing exercises to strengthen the diaphragm. Aerobic activities such as walking on a treadmill or riding a stationary bicycle further increase endurance. Individuals learn to rate the amount of energy they expend by using a scale to rate perceived exertion from "very, very light" to "very, very hard." This helps individuals stay within safe exercise parameters as advised by their physicians. A pulse oximeter may also be used to help monitor blood oxygen levels to assure that a sufficient level is maintained.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Respiratory failure may cause an inadequate supply of oxygen to the tissues (hypoxia) of major organ systems. Hypoxia in the heart muscle causes chest pain (angina pectoris) and heart rhythm irregularities (arrhythmias). Hypoxia of the brain may initially cause confusion, dizziness, and uncoordinated movements. If the condition persists, it can progress to unconsciousness and death. Severe hypoxia may lead to complete absence of oxygen in a tissue (anoxia). If prolonged, anoxia may result in tissue death, organ system failure, and death.

Individuals on ventilators are at risk for deep vein thrombosis, pulmonary embolism, gastritis and ulcers, bed sores (decubitus ulcers), and infections acquired in the hospital (nosocomial infections). The ventilator itself introduces risk for damage to the lung, acute respiratory alkalosis, hypotension, and ventilator-associated pneumonia.

Up to 26% of individuals with acute respiratory failure will progress to acute respiratory distress syndrome (ARDS), which has higher morbidity and mortality (Rubenfeld).

Source: Medical Disability Advisor



Factors Influencing Duration

Severity of symptoms, underlying cause of the condition, effectiveness of treatment, or any complications may influence length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations must be determined on an individual basis depending on job requirements.

Risk, capacity, and tolerance will generally depend on the underlying cause of the respiratory failure. Review of the "Risk" section in the topic Chronic Obstructive Pulmonary Disease (COPD) may be useful.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a history of intrapulmonary disorders such as pulmonary fibrosis, COPD, emphysema, bronchiectasis, asthma, bronchiolitis, bronchitis, or pulmonary embolism? History of genetic disorders such as cystic fibrosis? History of extrapulmonary conditions such as myasthenia gravis, muscular dystrophy, polio, Guillain-BarrĂ© syndrome, polymyositis, or amyotrophic lateral sclerosis?
  • Has individual experienced drug overdose, inhalation of toxic gases, near drowning, or burns?
  • Does individual complain of dyspnea, cough, cyanosis, restlessness, anxiety, confusion, headache, and generalized fatigue?
  • Were PFT and ABG performed? Were chest x-ray, blood chemistry, and sputum culture done?
  • Was the underlying cause of the respiratory failure determined?

Regarding treatment:

  • If there was an obstruction of airflow, how was it corrected?
  • Did individual require fiberoptic bronchoscopy to identify and remove the obstruction?
  • Did individual receive oxygen via a nasal cannula or was intubation required?
  • Was the use of positive pressure mechanical ventilation required?
  • Were antibiotics, expectorants, and/or bronchodilators used?
  • Was sedation required to relieve restlessness and anxiety?
  • Were respiratory, physical, and/or occupational therapy recommended?
  • Did treatment restore adequate air exchange?

Regarding prognosis:

  • Did individual obtain prompt treatment for respiratory failure?
  • What was the underlying cause for respiratory failure and how was it treated? Is additional treatment required to adequately control the underlying cause?
  • Has individual participated in respiratory, occupational, and/or physical therapy as prescribed?
  • Has the lack of oxygen affected other organs such as the heart or brain? If so, how severely were these organs damaged?
  • If individual required mechanical ventilation, have complications occurred such as deep vein thrombosis, pulmonary embolism, gastritis and ulcers, decubitus ulcers, or infections?
  • Did the ventilator cause damage to the lung (barotrauma), hypotension, or ventilator-associated pneumonia?
  • Have complications occurred as a result of respiratory failure or treatment? How will complications be treated and what is the expected outcome with treatment?
  • How will individual's daily activities be affected?

Source: Medical Disability Advisor



References

Cited

Rubenfeld, G. D. , et al. "Incidence and Outcomes of Acute Lung Injury." New England Journal of Medicine 353 (2005): 1685-1693.

Source: Medical Disability Advisor