Pulmonary failure symptoms in children. Respiratory failure in children

In violation of the gas balance of the blood, a pathology of the respiratory system develops. She is called respiratory failure. You can normalize the imbalance by increased work of the respiratory system. This leads to the development of shortness of breath. The basis of the process of respiratory failure is that an insufficient amount of oxygen enters the human body. At the same time, a large amount of carbon dioxide accumulates, leading to oxygen depletion of important organs of vital activity.

In the international classification of diseases, ICD-10 is designated: J96 Respiratory failure, not classified elsewhere.

Causes of respiratory failure

Violation of the functionality of any organs of the human body can trigger the development of pulmonary insufficiency. Problems with the respiratory apparatus may occur as a result of mechanical damage to organs in the human body, due to the development of infectious processes. To the violation of the normal functioning of the respiratory system can lead to:

• the consequences of various diseases associated with the respiratory tract, leading to their narrowing, these include: asthma, laryngeal edema, cystic fibrosis;
• hit of a foreign object in the bronchial system;
• damage to lung tissue caused by inflammation of the alveoli, fibrosis, tumors, burns, abscess;
• impaired circulation, accompanied by pulmonary embolism;
• heart defects;
• decreased muscle activity, lethargy;
• bad habits: drinking alcohol, drugs, smoking;
• obesity;
• injuries of the ribs and spine, as well as their pathology;
• severe blood anemia;
• blood loss, transfer of complex operations;
• lesions of the central nervous system of any manifestations;
• violation of blood pressure;
• infectious diseases;
• a change in the balance of thyroid hormones.

Classification of respiratory failure

The disease is classified depending on the mechanism of occurrence and development. It happens:

• parenchymal;
• ventilation;
• mixed.

The parenchymal form is a significant violation of the oxygen saturation of the blood in the lungs, leading to hypoxemia. It manifests itself in the process of progression: pneumonia, pulmonary edema, alveolitis.

Ventilation respiratory failure acts as a history of hypercapnia, muscle weakness in the respiratory system, mechanical damage to the chest, and obesity. It is classified into subspecies:

• centrifugal (the respiratory process is inhibited as a result of a brain injury, ischemia, poisoning with drugs (alkaloids), etc.);
• neuromuscular (disruption of the spinal cord leads to an imbalance in the conduct of a nerve impulse to the respiratory muscles, polio, respiratory muscle disease);
• thoracodiaphragmatic (kyphoscoliosis causes difficulty in the work of the chest, limited diaphragm, arthritis);
• bronchopulmonary (pulmonary) (the work of the respiratory tract is impaired, the extensibility of the alveoli and the respiratory surface are reduced).

The mixed stage of pathology is the result of a combination of the first two forms.

Depending on the duration of the disease, the following stages are distinguished:

• sharp;
• chronic.

Acute respiratory failure is dangerous for humans. The development of the disease occurs in a short period of time: from several minutes to several hours or days. It is accompanied by a violation of the movement of blood through the vessels. The severe condition of the patient with an acute form of respiratory failure requires immediate medical intervention and emergency treatment. The acute stage often occurs on the basis of the already present chronic form of the disease.

Chronic respiratory failure can last from several months to several years. Long pathological processes in the lungs lead to improper functioning of the respiratory and circulatory systems. The main reason for the manifestation of the acute form is hyperventilation, which ensures oxygen saturation of the blood. The body adapts to the condition due to increased hemoglobin in the blood.

Severity of respiratory failure

There are three degrees of severity of the disease.

• I degree: shortness of breath is absent or manifests itself intermittently. Possible manifestation of tachycardia, cyanosis. In some cases, pallor of the skin of the face appears.
• II degree: there is a pronounced shortness of breath, rapid pulse. Behavior becomes restless, the state of the body is lethargic, inhibited.
• III degree: the patient's condition is serious. Irregular breathing is observed, followed by shortness of breath. The patient's condition is inhibited, bluish areas of the skin are visible.

By compensatory mechanisms distinguish:

• compensated respiratory failure;
• decompensated respiratory failure.

Respiratory failure in children

The development of the disease in childhood most often appears as a result of acute and chronic diseases of the lungs and respiratory diseases. Poisoning, neurotoxicosis, traumatic brain injuries also lead to respiratory failure. In childhood, pulmonary failure develops faster than in adult patients. This pattern is due to weak work of the muscles of the respiratory organs, insufficient development of tissue fibers in the lungs and bronchi, and a high located diaphragm. All this explains the smaller than in adults, the depth of breathing in children. Good ventilation is provided by rapid breathing.

The oxygen demand in children is much higher than in adults, since at this age the metabolism is faster. The need for oxygen is great in the presence of pathology. Hypoxemia in a short period develops into hypoxia and impaired normal function of some internal organs.

Respiratory failure in newborns develops into a respiratory distress syndrome. Statistics show that pathology affects 14% of newborn babies in the world. Factors of pulmonary failure:

• surfactant deficiency;
• quality defect of surfactant;
• inhibition and destruction;
• immaturity of the structure of lung tissue.

The appearance of the disease in newborns is facilitated by:

• prematurity;
• infections
• fetal hypoxia;
• maternal diabetes;
• great blood loss during childbirth;
• hemorrhage;
• hyperoxia
• the birth of a second child during childbirth.

What is the danger of pulmonary failure?

The disease is very dangerous for humans. The condition is threatening the life and health of the patient. If you do not immediately carry out emergency therapy, then this threatens a fatal outcome for the patient. With prolonged treatment and progression of the chronic stage of the disease, there is a risk of developing right ventricular chronic insufficiency. Pathology develops due to the lack of the necessary amount of oxygen to the heart muscle. Pulmonary hypertension may develop as a result of alveolar hypoxia. A decrease in the function of the right ventricle or its complete absence leads to the development of the pulmonary heart. Thus, stagnation of blood occurs in the vessels of a large circle.

Possible complications:

• Pulmonary embolism and fibrosis develop in the lungs. Complications arise after mechanical ventilation.
• In the cardiovascular system appears: pulmonary heart, hypotension, decreased cardiac output, arrhythmia, myocardial infarction.
• In the gastrointestinal tract, there is a risk of bleeding, intestinal obstruction, diarrhea.
• From the side of the nervous system appear: psychosis, muscle weakness, coma.
• Possible occurrence: bedsores, abscesses, sepsis, urinary tract infections.
• There is a risk of kidney failure, disturbances in the water-electrolyte balance, and damage to the gallbladder.

The patient's quality of life is reduced, nutrition is disturbed due to mental disorders and parenteral feeding.

In acute respiratory failure, there is a high risk of cardiac arrest and patient death.

Which doctors should I contact?

There are frequent cases when a child has acute respiratory failure. This is due to the carelessness of parents who overlooked their baby. Children often swallow small toys and objects, which subsequently interfere with normal breathing. The first symptoms are: cyanotic skin, persistent cough and hoarseness. In such cases, you need to immediately call an ambulance. It is strictly forbidden to extract the item yourself, this can lead to serious consequences.

The causes of respiratory failure in children can be many. But, one way or another, all cases of the manifestation of the disease are dangerous for the child. Having noticed the first signs of a manifestation of pathology, you should call the local pediatrician or emergency care.

Adult patients may seek the help of a physician. A pulmonologist can detect the development of a disease in the initial stages of its manifestation. In critical situations, you need to call an ambulance.

Symptoms

The symptoms of respiratory failure are based on various manifestations of oxygen deficiency in the cells and tissues of the body or external changes occurring in the body due to a decrease in the activity of the respiratory system. The existing symptoms of respiratory failure can be divided into primary, which are directly changes that cause the disease itself, for example, a lack of oxygen supply to the cell tissue. Secondary symptoms are a manifestation of primary changes, for example, shortness of breath resulting from a disturbed supply of oxygen to organs. Often, according to external symptoms, diagnosis is possible when the signs are divided into two groups of factors, caused in one case by a lack of oxygen in the cells of the body; in the second - with the manifestation of signs of a chronic nature of respiratory failure.

Signs of respiratory failure caused by a lack of oxygen in the cells of the body:

Changes in the shape of the nails and fingers, which for the nails take a more round and convex appearance, associated with the manifestation of friability of structures, due to the high content of carbon dioxide in the blood and low oxygen content in it. In the case of the fingers, the manifestation of signs of respiratory failure consists in increasing the width and height of the last phalanx of the fingers due to the same reason.

The manifestation of frequent breathing of low intensity refers to signs of respiratory failure and is a symptom of a decrease in lung volume. As a result, in order to fill the cells with oxygen, as in the case of a healthy organism, the respiratory system has to perform a greater number of inspiration-expiration cycles in an equal amount of time.

Manifestations of excessive fatigue associated with the loss of muscle ability to perform the amount of work normal for a healthy body over an extended period.

Symptoms of primary respiratory failure - associated with disruption of the central nervous system, caused by hypoxia in the body and leading to such secondary symptoms of the disease as shortness of breath (having serious manifestations during wakefulness and even in a dream), insomnia, nausea, chronic headaches, increased frequency heart pulsations.

Respiratory failure, in addition to the above symptoms and signs, is defined as a series of changes in the organs and structures of the body. Changes associated with respiratory failure manifest themselves as a result of hypoxia and are determined in the process of diagnosis. The diagnosis of respiratory failure must be defined as the mandatory presence of two conditions in the disease: problems with the organs of the respiratory system and lack of oxygen in the cells and tissues of the body.

Symptoms of acute respiratory failure with a worsening condition of a latently sick person is manifested in the inclusion in the scope of damage to the organs of the cardiovascular, nervous system, digestive system and respiratory system. A clear symptom of acute respiratory failure is the action of the compensation mechanism on the principle of providing either a respiratory cycle or a circulation cycle. Symptoms of the acute form of respiratory failure also include the manifestation of cyanosis of the organs, due to a decrease in oxygen pressure in the blood of arterial type below 60 mm. Hg When symptoms of multiple organ failure, which is also a symptom of acute respiratory failure, are achieved, the effects of euphoria, falling into a coma with a critical value of central nervous system hypoxia may occur.

With a decrease in oxygen pressure in the blood to a mark less than 45 mm Hg development of disorders of the neurological type is noted, which is preceded by a state of decreased activity of consciousness and the possible occurrence of seizures of body parts. Deterioration of the patient's condition after determining the symptoms of acute form of respiratory failure, expressed in multiple organ failure, may indicate the wrong methods of the chosen therapy and pose a risk of death.

Cyanosis with respiratory failure manifests itself in a change in the color of the skin with the acquisition of either a pale shade or signs of cyanosis. Cyanosis in respiratory failure manifests itself in the process of lowering blood circulation pressure in the arterial system to 60 mm Hg. This phase, inherent in acute respiratory failure, is accompanied by an increase in heart rate and a decrease in blood pressure values. Cyanosis in respiratory failure is a sign of an insufficient amount of oxygen in the blood of arteries and is expressed in varying degrees of change in the cyanotic color of the skin integuments, which characterize the degree of damage to organs by the disease.

Edema usually begins to manifest itself in the later stages of the disease and is a symptom of chronic respiratory failure. Along with edema, the most common symptoms inherent in chronic respiratory failure are the development of cyanosis of the diffuse type, activation of the muscles of the respiratory system, activation of blood circulation, manifested in tachycardia and shortness of breath.

Other symptoms of chronic respiratory failure are:

• A change in the appearance of the chest (manifested as a result of traumas and injuries of a mechanical type), while the chest cell itself becomes more rounded, and the ribs are located in a more horizontal position. These changes in the body are elements of the compensatory mechanism and relate to symptoms of chronic respiratory failure.
• Shortness of breath as a symptom of chronic respiratory failure can occur in two types of abnormalities. The so-called expiratory cycle consists in increasing the expiratory time during the respiratory cycle, and in the inspiratory phase the cycle shifts toward increasing inspiratory time. With a mild form of chronic respiratory failure, the manifestation of one of two types of shortness of breath will be a consequence of previous physical exertion. In severe forms of the disease, even the patient’s transition from a sitting position to an upright standing will be accompanied by the occurrence of one of the two described types of shortness of breath.
• The next symptom of chronic respiratory failure is the vibration of the wings of the nose, which is explained by a partial lack of patency in the airways, in which the wings of the nose join the breathing cycle. They act on the principle of expansion during the inspiration cycle and subsidence in the exhalation phase. Outwardly, it resembles an attempt to capture a greater volume of air during one respiratory cycle.

In children, the symptoms of respiratory failure exhibit the same symptoms as in adults, however, they are characterized by milder forms of the disease. The highest incidence of symptoms of respiratory failure was noted in newborns who had a difficult birth process or were born prematurely.

Diagnostics

In case of respiratory failure, the gas composition of the blood is not properly filled, or it is compensated by the overstrain of the external respiration apparatus.

At the first stage of the diagnosis of respiratory failure, doctors collect a patient's history to find out the possible causes that led to the pathology. Examining the patient, they check the respiratory rate, look at the participation of other muscle groups in the respiratory process, and also look for cyanosis of the skin.

Later, functional samples are taken (spirometry, fluid flow metering), which are necessary for the study and evaluation of lung ventilation. This procedure also includes the establishment of lung capacity, respiratory rate per minute, air velocity inside the respiratory system, etc.

When diagnosing respiratory failure, the doctor must prescribe a laboratory analysis of the gas composition of the blood, which shows the amount of oxygen and carbon dioxide in the arterial blood (PaO2 and PaCO2), as well as its alkaline-acid state.

Signs of respiratory failure

Respiratory failure is different and differs in form of severity, mechanism of occurrence, rate of development. Accordingly, depending on the type of pathology, it manifests itself in different ways. Common signs that you should pay attention to are:

• dyspnea;
• increased heart rate;
• fainting
• cyanosis of the skin (cyanosis);
• nausea;
• morning migraines;
• lethargic, drowsy state in the morning and waking at night, insomnia;
• short-term memory loss;
• low pressure.

The first five symptoms from the list are signs of acute chronic failure.

Cyanosis in respiratory failure appears due to reduced gas exchange in the lungs and appears in the form of a purple tint of the mucous membranes and skin.

Reduced oxygen in the blood - hypoxemia characteristic of respiratory failure - is the cause of cutaneous cyanosis. With hypoxemia, tachycardia and moderate low blood pressure are also observed. If the oxygen pressure (PaO2) decreases to 55 mm Hg. Art., memory loss may occur; if below 30 mm RT. Art. - loss of consciousness.

With a high content of carbon dioxide - hypercapnia - the patient has tachycardia and sleep disturbance. A person suffers from migraine, morning sickness. A sharp increase in CO2 pressure can cause intracranial pressure, leading to cerebral edema.

Weakness and fatigue of the muscles of the respiratory system is manifested by an increase in respiratory rate (BH). BH with an indicator of 25 and above once a minute is a sign of fatigue of the muscles of the respiratory tract.

A decrease in BH to 12 times per minute suggests that respiratory arrest is possible in the near future. Shortness of breath is interpreted by the patient as a lack of air. It is observed both in the process of performing physical activities, and at rest.

How to determine the diagnosis of respiratory failure

When establishing a diagnosis of respiratory failure, the following methods are used:

• A physical examination is the general name of the methods that a doctor uses when examining a patient for the first time. These include a full examination of the chest, in which the doctor searches for blueness of the skin, determines the amplitude of inspiration and exhalation and the very shape of the chest; palpation, which allows you to determine whether axillary and subclavian lymph nodes are enlarged, which is typical for respiratory failure; pulse measurement, etc.
• Spirometry is a way to study external respiration using tools. It is quite effective for diagnosis, as it allows you to accurately and objectively check the level of activity of the respiratory system. As a rule, this is the main method for diagnosing chronic respiratory failure, as it estimates the rate of its progression. Spirometry shows the vital capacity of the lungs, the Tiffno index, the maximum expiratory volume in the first second, and so on.
• Blood gas analysis. The determination of the gas composition of the blood in case of respiratory failure is prescribed by doctors in 100% of cases, since this analysis is highly informative and accurate and at the same time it is easy to perform. When checking the blood for gas composition, the patient is put on a finger a spectrophotometric sensor that reads the PaO2 value, that is, the degree of blood oxygenation. The device issues data in percent. Patients should not be afraid of this procedure - it does not take much time and is completely painless. It can be carried out by absolutely everyone, since it does not have any medical or other contraindications.

Other more complex methods are also used to diagnose respiratory failure. However, their appointment is carried out strictly individually and depends on the initial examination of the doctor.

If you increasingly notice shortness of breath, migraines and a sluggish state of the body, including loss of consciousness, consult a doctor immediately and in no case do self-medication! Only a specialist is able to accurately diagnose the cause of your ailments, which can be signs of respiratory failure.

Treatment

The essence of acute respiratory failure therapy is:

• normalization and further maintenance of lung function, which consists in saturating the blood with oxygen;
• therapy of the underlying disease that caused respiratory failure (pneumonia, gas accumulation in the pleura, chronic bronchitis, etc.);
• normalization of airway patency.

If the patient has severe oxygen starvation, then first of all doctors usually prescribe oxygen therapy (oxygen treatment). Oxygen inhalation during oxygen therapy is dosed. In this case, doctors carefully monitor the patient's condition.

If the patient is in a conscious state, then oxygen is supplied to him through a special mask or nasal catheter. If the patient is in a coma, then air is supplied to him through the endobronchial tube or through artificial ventilation of the lungs.

In parallel with this, doctors usually do everything to improve lung function. For this purpose, antibiotics, drugs that relieve spasm from the bronchi, agents that help to thin the sputum in the lungs and its elimination, massage the chest area, exercise therapy, ultrasonic inhalation, etc. can be used.

At the same time, doctors carry out aspiration of the bronchi, which consists in removing sputum from the bronchi with the help of a special device.

If a patient with acute respiratory failure has an increase in pressure in the heart, which has led to an increase in its departments on the right, then doctors can recommend diuretics to their patients.

After this, the treatment of respiratory failure is aimed at eliminating the factors that provoked it.

First aid for acute respiratory failure

Before the emergence of an ambulance, a patient with an attack of acute respiratory failure urgently needs to do artificial mouth-to-mouth or mouth-to-nose artificial respiration.

Extremely carefully it is necessary to carry out lung ventilation in children of any age. So, children of any age with artificial respiration are allowed to blow air into the nose and mouth at the same time. At the same time, in young children, the likelihood of a head tipping over should be considered. In infants, the neck is short and thick, it is very easy to break.

When performing artificial respiration, children should not inhale the entire amount of air, since at this age lung tissue can rupture due to excess oxygen.

The algorithm for assisting children with respiratory failure:

• put the child on a hard and even surface;
• after that, it is recommended to place a roller rolled up from clothes under the shoulders;
• then the child’s head slightly tilts back, and the chin rises;
• all airways must be cleaned of mucus and foreign objects using fingers or a special suction;
• after that, a gauze napkin is placed on the mouth and nose of the baby;
• then you need to take a breath and place your face over the face of the child so that the nose and mouth are as tightly connected as possible;
• oxygen is inhaled into the nose and mouth of the infant. His chest should be slightly raised. The age of the child should be taken into account (the younger the child, the less oxygen is required);
• stop the procedure and wait until the chest of the baby is completely lowered;
• these actions must be repeated until the child begins to breathe on his own, or until the ambulance arrives.

The technique of first aid for respiratory failure in adults is not fundamentally different.

It is worth noting that first aid methods for respiratory failure may vary slightly depending on how much the pathology manifests itself.

So, in case of acute respiratory failure of the 1st degree, it is enough for the patient to go into a room with good ventilation and take off his tight-fitting clothes.

If the patient has acute respiratory failure of the 2nd degree in combination with subcompensation, then the patient, in addition to the previous actions, must perform respiratory drainage. To do this (if this is a child), you can turn it over in a crib, tap on the chest or squeeze it rhythmically.

If the patient feels better, he still needs to see a doctor as soon as possible. Patients with an acute attack of respiratory failure are often placed in intensive care, since this condition is dangerous to the patient's life.

To alleviate symptoms as soon as possible, doctors can inject bronchodilators into a patient’s vein or muscle, the function of which is to eliminate spasms in the respiratory system.

To quickly provide relief from respiratory failure, the patient can be given expectorant medications in tablets, or inhalation sprays. If a young child has respiratory failure, he can be aspirated with a catheter, which is inserted through the oral cavity.

If the patient’s respiratory failure is caused by pulmonary edema, he is advised to take a semi-sitting position and lower his legs from the bed, or simply lift the pillow onto the bed so that he can lean on it. After this, the patient should take a diuretic (in severe cases, diuretics are administered intravenously).

Elimination of the cause of pathology

In order to identify the cause of chronic respiratory failure, patients are often hospitalized, where they undergo a series of examinations. Treatment of respiratory failure should be carried out only after a thorough diagnosis.

Most often, to eliminate the cause of the pathology, they are prescribed:

• antibacterial agents. Antibiotics in the shortest possible time can help if the cause of the pathology is a bacterial damage to the respiratory system. As a rule, this method is used for acute bronchitis, pneumonia or suppuration;
• thrombotic drugs. These funds are used to destroy blood clots in blood vessels. These drugs may be required if the cause of the disease is obstruction of the arteries or blood vessels of the lungs. As a rule, doctors with these drugs give injections;
• detoxification. These funds are used in order to neutralize any substances in the patient's body. For example, with botulism, a botulinum toxoid can be used, etc.

Often eliminating the cause of respiratory failure is simply not possible. However, measures can be taken to timely eliminate diseases that can cause pathology.

To ensure constant patency in the respiratory system, doctors usually prescribe for regular use agents that thin the sputum and dilate the bronchi. For this, treatment with folk remedies is ideal. However, before using any decoctions, the patient must always consult a doctor. In addition, it is recommended to constantly perform breathing procedures and suck out sputum.

Mode

Patients with respiratory failure for a speedy recovery must necessarily observe a special regimen, which primarily includes reducing the number of physical exertion. This is due to the fact that physical exercises do not allow tissues of the body to get enough oxygen. Any physical exercise in patients with respiratory failure can trigger an exacerbation of the disease.

In addition, it is recommended that patients with respiratory failure quit smoking and purify the air they breathe as often as possible. So, dust particles or cigarette smoke at any time can provoke a spasm of the bronchi, which will entail a sharp deterioration.

In addition, toxic substances from the air contribute to sclerotic processes, which can cause a decrease in the volume of the respiratory system.

Therapeutic diet

Intensive care for respiratory failure must necessarily be combined with a therapeutic diet. Thus, the patient will be able to prevent the transition of an acute disease into a chronic form, as well as some other complications.

Among the basic principles of nutrition for respiratory failure can be identified:

• variety of diet;
• the use of proteins and fats of animal origin in large quantities;
• the use of vegetables and fruits with a high content of vitamins and minerals;
• additional intake of dietary supplements with vitamins and minerals in the composition;
• food intake should be in small portions 5-7 times a day;
• avoid or limit as much as possible the consumption of products that can cause increased gas formation in the intestine;
• the use of salt in respiratory failure is also recommended to be reduced.

Physiotherapeutic treatment

Physiotherapy, as a rule, is used in small courses in order to significantly improve the well-being of the patient in a short period of time. The choice of treatment method largely depends on the cause of the pathology.

So, if the patient has a bronchiectatic disease, then doctors usually prescribe a chest massage or exercise therapy.

Thus, the patient's lungs and bronchi can be cleansed of pus faster. For the same purpose, inhalations of certain drugs can be used.

Patients with respiratory failure are strongly advised to visit resorts or motels near which there is a sea. Even tuberculosis patients recover quickly thanks to the sea air.

Radical treatment

One of the fastest and most effective treatments for chronic respiratory failure is a lung transplant. However, this treatment method has significant drawbacks, among which one can single out the complexity of the operation and a very high price.

Medication

The drugs used for respiratory failure depend on the form in which it is expressed. An acute and chronic form is distinguished depending on the kind and duration of the course of the disease.

Means and drugs used in acute respiratory failure are divided into several groups:

• Anti-infective drugs.
• Anesthetics.
• Cardiac stimulants.
• Muscle relaxants.

Antibiotics are needed to prevent the spread of infection. Respiratory failure can be caused by various factors, but most of them can be associated with an infectious nature. In this case, a course of antibiotics is prescribed.

Painkillers used in acute respiratory failure are often used to reduce pain resulting from respiratory failure, as well as to facilitate the transfer of physiotherapy used to relieve acute respiratory failure.

The funds used in acute respiratory failure, stimulating the work of the heart, increase blood pressure and prevent the heart rate from straying due to the occurrence of pathology.

Muscle relaxants help reduce the need for the body to consume normal amounts of oxygen. They contribute to muscle relaxation, due to which the metabolic rate in the body decreases, metabolic processes are much slower and the body cells do not need a large amount of oxygen. This gives time to restore respiratory function. In addition, the drugs used for acute respiratory failure of this type relax the muscles and prevent their movement, so as not to interfere with the assistance and further breathing with the help of a tube or breathing apparatus.

In addition, if acute respiratory failure has arisen as a result of some other disease, it is necessary to simultaneously treat this disease, for example, a brain disease or damage to the respiratory center, neurology (botulism or myasthenia gravis prevents the signal from the nervous system to the muscles of the respiratory system).

Among the drugs for respiratory failure used in the subsequent treatment of acute and chronic forms, there are:

• Bronchodilators.
• Adrenomimetics.
• Beta-adrenoreceptor agonists.
• Corticosteroids.
• Respiratory stimulants.
• Sedatives.
• Mucolytic drugs.

The use of bronchodilators is effective in the treatment of diseases of chronic respiratory failure. They expand the volume of the bronchi, thereby increasing the amount of air consumed and the amount of oxygen that saturates the blood. Due to the large number of side effects, they should be taken under the supervision of a doctor, who must prescribe tests to determine the effectiveness of the treatment.

Adrenomimetics stimulate the work of important muscle groups. Due to this, the heart rate and blood pressure increase. The smooth muscles of the walls of the blood vessels and bronchi relax, the lumen in the bronchi increases, which removes the obstacle in the way of the air filling the lungs. The most popular drug of this type is Isadrine. It performs all of the above functions equally, but at the same time causes severe tremor and tachycardia. For people with heart disease and cardiac arrhythmia, such a drug is contraindicated.

Beta-adrenergic agonists act only on beta2-adrenergic receptors. They increase the air flow rate and are most effective for inhalation use. Among these drugs for respiratory failure, terbutaline is used. It can be taken orally, in the form of subcutaneous injections and inhaled. The latter application, as shown by practical research, is most effective. Also, Salbutamol, Berodual, Isoetarin (depending on the individual tolerance of the components by the patient) can be prescribed as a similar drug. When using these drugs, you need to correctly calculate the dosage. A sign of too high a dose of the drug is tremor of the extremities and tachycardia. In the event of such violations, it is necessary to reduce the dose of the drug.

Corticosteroids help restore the sensitivity of beta-adrenergic receptors in the treatment of severe forms of chronic respiratory failure, most often due to bronchial asthma. Among them, Dexamethasone, Methylprednisolone, Prednisolone, Hydrocortisone are distinguished. The drugs are listed in increasing order of the necessary dose to relieve symptoms of respiratory failure. The effectiveness of these drugs has been proven only with asthma. In other cases, the listed drugs are usually not prescribed to patients.

When respiratory functions are impaired due to medication, such as analgesics or narcotic substances, respiratory stimulants are prescribed. They are also prescribed for Pickwick syndrome. Among respiratory stimulants, Progesterone, Naloxone, Doxapram, Theophylline are distinguished. They have an effect on the nervous system, which sends impulses to the respiratory muscles, on the part of the brain that is responsible for breathing, stimulate the contraction of the diaphragm.

Sedatives are important because they balance the tissue's need for oxygen and the delivery of oxygen to them. This is important, because with an increase in the respiratory rate, the tissue demand for oxygen can increase proportionally, and this process must be controlled with medication. In hospitals, Haloperidol or Sibazon is more often used.

Mucolytic drugs thin the mucus that accumulates in the bronchi and prevents the development of pneumatic processes. In hospitals, acetylcysteine \u200b\u200bis administered intravenously to prevent such diseases.

The listed drugs should be used in the complex treatment of respiratory failure under the strict supervision of doctors. All drugs should be used in the recommended dosage for individual purposes.

Folk remedies

Respiratory failure is characterized by the inability to provide the body with oxygen through the respiratory system due to the pathological process. Depending on the duration of respiratory failure, distinguish between acute and chronic form. The acute form lasts for several minutes or hours. In the treatment of this form, it is important to provide prompt assistance so that the patient does not die. The chronic form lasts for many years and can be treated with traditional medicine.

The principle of alternative treatment is based on the removal of edema of the respiratory system. Such medications help to eliminate sputum and mucus from the bronchi, and also help to relax and relieve muscle spasm.

Alternative recipes for chronic respiratory failure

• Mix 100 grams of honey, juice of one lemon and 10 minced cloves of garlic until smooth. Close the resulting mixture in a jar and insist for at least 1 week in a dark, cool place. Take one teaspoon in the morning on an empty stomach, dissolving the resulting consistency in the mouth for one minute.
• To prepare elderberry tincture yourself at home, you need 150 grams of ripe elderberry and the same amount of alcohol. Berries must be thoroughly washed, dried and added to alcohol. Close the container tightly and remove for 5 days. Take such a tincture in the form of drops, diluting with water. It is better to take drops at night, 25 drops at a time.
• If respiratory failure has occurred due to stagnation of mucus in the bronchi. To improve its separation and stimulate output, it is recommended to take warm milk with carrot juice. To do this, peeled carrots need to be ground with a blender and squeeze the resulting juice. Half a glass of such juice must be mixed with the same amount of warm milk. Divide the glass into three doses and drink during the day.
• Onion-honey juice is made in a similar way. Chop the onion in a blender and squeeze the juice. 5 tbsp. tablespoons of juice should be mixed with the same amount of honey and take a teaspoon three times a day.
• To remove the muscle tone of the bronchi, an infusion of onion roots in milk is taken. The roots of 3 bulbs must be cut off, washed and filled with 150 ml of hot milk. Leave for one day, then take a tablespoon up to 5 times a day.

Such natural recipes will help relieve unpleasant symptoms that have arisen as a result of respiratory failure quickly and effectively.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

When doctors say "respiratory failure," they mean that the respiratory system, which includes the oral and nasal cavities, larynx, trachea, bronchi, and lungs, cannot provide the blood with the necessary amount of oxygen or is unable to remove excess carbon dioxide from the blood. This condition occurs when one or more of the mechanisms by which oxygen enters the blood or CO2 is removed from the blood is disrupted.

The human body has a rather complicated structure, and it has various ways by which it maintains the parameters necessary to ensure life (this includes oxygen supply). And if one pathway begins to “overlap,” the body immediately opens and expands the “workaround” called “compensatory mechanisms”. When they solve a situation, chronic failure develops (in this case, chronic respiratory failure). When the disease develops so quickly that the compensation does not even have time to form, the insufficiency is called acute and carries an immediate threat to life.

Below we will look at how, even before the arrival of the doctor, to understand what caused respiratory failure and how to help. Because in many cases saving lives by 80-90% depends on the literacy of the actions of relatives of the victim.

Briefly about oxygen transport

In this section, we will follow the path by which oxygen from the air enters the bloodstream. The respiratory system is conditionally divided into 2 parts:

Dead space

This is the name of most of the respiratory system, in which there is no contact of the inhaled air with the blood. It is conditionally divided into anatomically dead space, which includes:

• Nasal cavity. Serves for the primary purification and warming of the air. Even if it is completely blocked (due to edema or swelling), respiratory failure does not develop.
• Oral cavity and pharynx. The oral cavity is not intended for breathing, since there is no warming and purification of air. But due to their direct communication in the form of a pharynx, it can also be used for breathing. On the border of the oral cavity and pharynx, as well as in the pharynx itself, there is a ring of lymphoid tissue (tonsils), which is a barrier to the passage of foreign substances from the air and food. If the tonsils or their surrounding tissue develop inflammation, and they increase in volume. If the degree of their increase is so great, they block the path to air - respiratory failure develops.
• The larynx is the entrance to the trachea. Above it is a cartilaginous structure - the epiglottis, and in the larynx itself there are vocal cords. Inflammation, accompanied by swelling of the mucosa, as well as a tumor of these structures block the path to air. Respiratory failure develops.
• A trachea is a cartilage tube between the larynx and bronchi. It rarely develops such a significant edema that will block the path of the inhaled air, but with the development of the tumor, chronic respiratory failure forms here.
• The bronchial tree to the bronchioles is the tube into which the trachea is divided. They, branching, gradually become smaller and lose their cartilage base (bronchioles do not contain cartilage in the wall at all). The edema or tumor develops in a larger bronchus, the more air does not reach the greater part of the lung, the greater the severity of respiratory failure. There are processes, such as chronic bronchitis or bronchial asthma, which affect all bronchi at once, causing respiratory failure.

There is also a functional dead space - sections of the respiratory system, in which gas exchange also does not occur. This is anatomically dead space, plus those areas of the lungs where the air reaches, but in which there are no blood vessels. Normally, there are few such sites.

Departments in which ventilation takes place

These are the final sections of the lungs - the alveoli. These are original "bags" with a thin wall into which air enters. On the other side of the wall is a blood vessel. Due to the difference in oxygen pressure, it penetrates through the wall of the alveoli and the wall of the vessel, falling directly into the blood. If the wall of the alveoli becomes edematous (with pneumonia), it grows with connective tissue (pulmonary fibrosis) or the vessel wall undergoes pathological changes, and respiratory failure develops. The same process occurs when a fluid appears between the wall of the alveoli and the vessel (interstitial pulmonary edema).

It turns out that the main gas exchange occurs at the level of the alveoli. Therefore, if in case of respiratory failure oxygen is introduced directly into the blood, bypassing all the airways, this will save a person’s life. This allows the method of membrane oxygenation, but it requires special equipment, which is purchased by a small number of hospitals. It is used mainly for severe degrees of parenchymal respiratory failure (for example, pneumonia, pulmonary fibrosis, respiratory distress syndrome) - when the lung tissue does not fulfill its function.

Breath control

Although a person can speed up or slow down his own breathing by the power of thought, it is a self-regulating process. The center of respiration is located in the medulla oblongata, and if this accumulation of nerve cells does not give a command that an inhalation should take place (exhalation is considered a passive process, inevitably following an inhalation), no willpower will help to do it.

The regulator of the respiratory center is not oxygen, but CO2. It is an increase in its concentration in the blood that activates more frequent breathing. It happens like this: the level of carbon dioxide increases in the blood and immediately rises in the cerebrospinal fluid. Cerebrospinal fluid washes the entire brain - both the brain and the spinal cord. The signal that there is more CO2 is immediately captured by special medulla receptors, and it gives the command to breathe more often. The team goes along the fibers that are part of the spinal cord, and reach its III-V segments. From there, the impulse is transmitted to the respiratory muscles: located in the intercostal spaces (intercostal) and the diaphragm - the main respiratory muscle.

The diaphragm is a muscular plate stretched between the lower ribs by a dome and delimiting the chest cavity from the abdominal cavity. When it contracts, it shifts the abdominal organs up and down, as a result, negative pressure appears in the chest cavity, and it “pulls” the lungs along, causing them to straighten. Intercostal muscles help to expand the chest even more: they pull the ribs down and forward, expanding the chest in the lateral and anteroposterior directions. But without a diaphragm, by the efforts of the intercostal muscles alone, normal oxygen saturation of the blood will not work.

When the respiratory muscles contract, the size of the chest increases, and the resulting negative pressure pulls the thin and elastic lungs along, causing them to expand and fill with air. Lungs are “wrapped” in a thin “film” in 2 layers. This is a pleura. Normally, between its two layers there should be nothing - neither air, nor liquid. When they get there, the lungs are compressed and can no longer properly straighten. This is respiratory failure.

If the ingress of air (pneumothorax) or fluid (hydrothorax) into the pleural cavity occurs in large numbers or continues, not only the lung is compressed: the overflowing “container” also presses the adjacent heart and large vessels, preventing them from contracting normally. In this case, cardiovascular is attached to respiratory failure.

Oxygen balance indicators

• hemoglobin level: its norm is 120-140 g / l. It is estimated that each molecule binds 1.34 grams of oxygen. It is determined by a general blood test;
• saturation of hemoglobin with oxygen, that is, the ratio of the amount of oxygenated hemoglobin (oxyhemoglobin) to the total number of these molecules. Normally, oxygen saturation is 95-100% and depends on the oxygen content in the inhaled gas mixture. So, if a person breathes 100% oxygen (this is possible only in hospitals or specialized ambulances and only when using special equipment), the saturation of hemoglobin with oxygen is higher. In atmospheric air, the oxygen content is approximately 21%. If a person is indoors with a low oxygen content, hemoglobin will be very poorly saturated with oxygen. This indicator is determined by the analysis, which is called "blood gases" and is given from the artery and veins.
• partial pressure of oxygen in arterial blood, that is, a separate pressure of this particular gas on the walls of the vessel. The higher the oxygen pressure, the better the blood is saturated with it. Normally, the partial pressure of oxygen in arterial blood is 80-100 mm Hg. If this indicator is reduced, a diagnosis of respiratory failure is made. The indicator for the analysis of blood gases is determined.

To understand the processes occurring in the body, it is important for doctors to know not only how much oxygen is contained in arterial, that is, saturated O2 blood, but also:

• how it will be delivered to the tissues (this already depends on the cardiovascular system);
• how the tissues will use it (calculated by the oxygen content in the venous blood and data on the work of the heart).

By deviation from the norm of the last two indicators, compensation for respiratory failure is judged (how much the heart will pump blood faster and tissues more effectively “use” oxygen from the blood). It also happens that a person develops symptoms that are the same as with respiratory failure, but pathology of the respiratory tract is not detected. Then the definition of oxygen delivery to tissues and their assimilation by them is important for diagnosis.

Causes of respiratory failure - acute and chronic

There is such a classification that divides respiratory failure into 2 types:

1. Ventilation. It arises due to a huge number of reasons not related to lung tissue damage.
2. Pulmonary. It is associated with lung damage in the normal state of the ventilation departments (functional dead space).

There is a second division of respiratory failure into:

• hypoxemic, which occurs with insufficient partial pressure of oxygen in the blood;
• hypercapnic, when high pressure of carbon dioxide is noted in the blood, that is, it is clear that CO2 is not sufficiently excreted.

The first classification is used for treatment at the initial stage of the provision of specialized medical care. The second - to correct the state of blood gases a little later, after clarifying the diagnosis and performing urgent measures in relation to the patient.

Consider what the main causes can cause ventilation and pulmonary forms of respiratory failure.

Causes of Ventilation Failure

This condition can be both hypoxemic and hypercapnic. It arises due to a large number of reasons.

Impaired brain regulation of respiration. This can happen due to:

• insufficient blood supply to the respiratory center. This is a form of acute respiratory failure. It develops either a sharp decrease in blood pressure (with blood loss, any form of shock), as well as with a shift in the structures of the brain in the cranium (with a brain tumor, its injury or inflammation);
• lesions of the central nervous system without displacement of the brain into the natural openings of the skull. In this case, acute respiratory failure develops with meningitis, meningoencephalitis, strokes, and chronic - with brain tumors;
• traumatic brain injury. When cerebral edema occurs due to a malfunction of the respiratory center, it is acute respiratory failure (ARF). If 2-3 months have passed after the injury, and there is a violation of adequate oxygen metabolism, it is chronic respiratory failure (CRF);
• overdoses of drugs that suppress the respiratory center: opiates, sleeping pills and sedatives. So develops ONE;
• primary lack of air in the alveoli. This is a hypercapnic form of CDN, caused, for example, by an extreme degree of obesity (Pickwick syndrome): when a person is unable to breathe often and deeply.

Violation of the impulses to the respiratory muscles due to:

a) damage to the spinal cord. With his injury or inflammation, ONE develops;

b) disorders of the spinal cord or nerve roots, along which there are impulses to the respiratory muscles. So, with polyradiculoneuritis (damage to several roots of the spinal nerves), the development of inflammation of the spinal cord, inflammation of the nerves that go to the respiratory muscles develops ONE. If a tumor slowly grows in the spinal cord - CDN.

Neuromuscular disorders due to:

• erroneous administration of drugs that relax all muscles, including the respiratory muscles (these drugs are called muscle relaxants and are used for anesthesia, after which a person is transferred to breathing apparatus). This is an acute respiratory failure;
• poisoning with organophosphorus compounds (for example, dichlorvos). This is also acute respiratory failure;
• myasthenia gravis - fast fatigability of the striated muscles, which also include the respiratory muscles. Myasthenia gravis causes ONE;
• myopathies - non-inflammatory diseases of muscles, including respiratory, when their strength and motor activity decrease. Thus, both acute and chronic forms of respiratory failure can develop;
• tearing or excessive diaphragm relaxation. Calls ONE;
• botulism, when botulinum toxin ingested with food is absorbed into the bloodstream, and then into the nervous system, where it blocks the passage of an impulse from nerves to muscles. Botulinum toxin acts on all nerve endings, but ONE causes in severe cases associated with its ingestion in large quantities. Sometimes ODN can develop with late treatment of a person with botulism for medical help;
• tetanus, when a tetanus toxin that enters (usually through a wound) causes paralysis of the striated muscles, including the respiratory muscles. Calls ONE.

Violations of the normal anatomy of the chest wall:

• with open pneumothorax, when air enters the pleural cavity through the wound of the chest wall, causing ONE;
• with floating rib fractures, when a fragment of the rib is formed that is not connected with the spine, and it usually moves freely in the direction opposite to the movement of the chest. If one rib is damaged, a CDN occurs, if several ribs are damaged at once, one ODN;
• kyphosis (bending by the bulge back to the back) of the spine in its thoracic region, which restricts the movement of the chest during inspiration and causes CDN;
• pleurisy - the accumulation of inflammatory fluid and / or pus between the pleura sheets, which, like pneumothorax, limits the expansion of the lungs. Acute pleurisy causes ONE;
• chest deformities - congenital, resulting from rickets, injuries or surgeries. This limits the movement of the lungs, causing CID.

Airway disorders at the level of anatomically dead space (obstructive respiratory failure)

It arises due to:

• laryngospasm - muscle contraction at the level of the larynx, which occurs in response to a lack of calcium in the body of a child under 3 years old, with the development of pneumonia, diseases of the larynx, trachea, pharynx, pleura, inhalation of toxic gases, fear. This causes ONE;
• foreign bodies entering the trachea or bronchi. If the closure of the trachea or large bronchi causes acute respiratory failure, when assistance needs to be provided in a few minutes, then the closure of smaller bronchi may not be so acute;
• laryngostenosis - narrowing of the lumen of the larynx. It can develop against the background of infectious diseases or as a result of a foreign body entering the larynx, in response to which a spasm of its muscles occurs, which does not let the foreign object go further (ONE). Laryngostenosis can also cause HDN when it occurs due to laryngeal tumors or squeezing it from the outside by an enlarged thyroid gland or tumors of the soft tissues of the neck;
• narrowing of the lumen of the bronchi with asthma, bronchitis, when swelling of the mucous membrane of the bronchi occurs. In acute bronchitis and exacerbation of bronchial asthma, in some cases, ODN develops, while chronic bronchitis and the interictal period in bronchial asthma is the cause of HDN;
• narrowing of the lumen of the bronchi due to the accumulation of a large amount of mucus in them (for example, with cystic fibrosis). Provoke CDN;
• narrowing of the lumen of the bronchi as a result of bronchospasm, the cause of which are allergens and infectious agents. This disease is accompanied by ONE;
• bronchiectasis, when as a result of chronic inflammation or congenital features of the bronchi they expand, pus accumulates in them. Causes the formation of CDN.

Causes of pulmonary DN

These types of respiratory failure do not cause the accumulation of carbon dioxide in the blood, but an insufficient supply of oxygen. Provoke the development of ONE. The main pulmonary causes are:

1. Pneumonia, when inflammatory fluid accumulates in the alveoli of a separate site (s) and individual walls of the alveoli swell, as a result of which oxygen cannot enter the bloodstream. Causes acute respiratory failure.
2. Respiratory distress syndrome - damage to the lungs as a result of trauma, pneumonia, inhalation (aspiration) of fluids, adipose tissue in the vessels of the lungs, inhalation of radioactive gases and aerosols. As a result, sweating of the inflammatory fluid occurs in the lungs, after a while some of the inflammatory changes stop, but in some departments the lung tissue is replaced by connective tissue.
3. Pulmonary fibrosis is a replacement for normal connective lung tissue. The larger the changed departments, the worse the condition.
4. Pulmonary edema - sweating fluid into the alveoli (alveolar edema) or into the lung tissue between the vessels and alveoli (interstitial edema), as a result of which oxygen delivery to the blood is significantly impaired.
5. Lung injury. In this case, the penetration of oxygen from the alveoli into the blood becomes impossible in some area due to damage to blood vessels and impregnation of lung tissue with blood.
6. Embolism of the branches of the pulmonary artery, that is, blockage of the branches of the artery, which carries blood from the heart to the lungs, fat, air, blood clots, tumor cells, foreign bodies. As a result, large or smaller sections of the lungs stop receiving blood supply, respectively, much less oxygen enters the bloodstream.
7. Atelectasis, that is, the decline of the lungs and turning them off from gas exchange. The reasons may be compression of the lung with fluid in the pleura, obstruction of the bronchus, violation of the mechanical ventilation technique, when some part of it is not ventilated.

Signs of ONE

Symptoms of acute respiratory failure are:

• rapid breathing. In adults - more than 18 per minute, in children - above the age norm;
• the inclusion in the act of breathing of the auxiliary respiratory muscles. It becomes noticeable retraction of the intercostal spaces, places above the collarbone, the wings of the nose swell;
• increased heart rate above 90 beats per minute, due to intoxication, arrhythmia may begin;
• feeling of lack of air;
• asymmetrical movements of the chest can be noticed;
• discoloration of the skin: the skin becomes pale, and the lips, nasolabial triangle become cyanotic, the fingers get the same color;
• with severe respiratory failure, loss of consciousness is observed; before this, inadequate behavior, delirium can be observed;
• feeling of panic, fear of death.

The severity of respiratory failure is determined by such indicators as respiratory rate, level of consciousness, level of partial pressure of O2 and CO2 in arterial blood. To determine the partial pressure of gases, it is necessary to perform an analysis of gases from arterial blood, which requires time and related equipment. Therefore, for a faster diagnosis, the “saturation” indicator is used, which is determined using a pulse oximeter device. The sensor of this device is a clothespin, inside which is an infrared emitter. The sensor is put on the finger of a person and in a matter of seconds it allows you to judge the degree of oxygen saturation of capillary blood.

Allocate 4 degrees

• Breathing is quickened to 25 per minute, and the heart rate reaches 100-110 beats per minute. The person is conscious, adequate, feels a lack of air, slight blueing of the lips may be noted. Oxygen saturation 90-92%, partial pressure CO2 50-60 mm Hg when breathing in normal air.
• Respiratory rate - 30-35 per minute, pulse - 120-140 per minute, blood pressure rises. The skin is cyanotic, covered with cold, sticky sweat. A person is restless or inhibited, may be euphoric. Saturation is reduced to 90-85%, the partial pressure of CO2 is 60-80 mm Hg.
• Breathing shallow, 35-40 per minute, pulse - 140-180 per minute, blood pressure is reduced. The skin is earthy, the lips are cyanotic. The person is inadequate, inhibited. Saturation is reduced to 80-75%, the partial pressure of CO2 is 80-100 mm Hg.
• A hypoxic coma develops here, that is, a person is unconscious, and he cannot be awakened. Pulse - 140-180 per minute, respiratory rate depends on brain damage: it can be more than 40 per minute or less than 10 per minute. Saturation is reduced to 75% and lower, and the partial pressure of CO2 is more than 100 mm Hg.

Depending on the severity, doctors will assist the person. If in the first degree, while the examination and clarification of the causes of ARF are ongoing, the person is allowed to breathe moistened oxygen with the help of a face mask (while the content of oxygen supplied will be no more than 40%, while it contains 20.8% in the air). At stages 2-4, the patient is injected into anesthesia in order to transfer him to hardware respiration using an artificial ventilation apparatus.

In addition to the symptoms of the respiratory failure itself, a person has signs that tell the doctor the reason for the development of this serious condition:

• if the symptoms of ONE develop after a traumatic brain injury, there is likely to be either a brain injury or the formation of a hematoma in it;
• if before the development of ONE a person had a cold, and then complained of a headache and fever for some time, after which a disturbance of consciousness developed and shortness of breath appeared, it is probably meningitis or meningoencephalitis;
• when a person suffers from hypertension or is very nervous, after which he suddenly faints and against this background begins to “breathe incorrectly”, he probably had a hemorrhagic stroke;
• scattered drugs, syringes, inadequate behavior some time before the disease indicate poisoning with drugs that depress the respiratory center. Examination of the pupils in this situation is not informative, since hypoxia / hypercapnia also changes the pupil diameter;
• if signs of ARF have arisen after consuming canned, dried or dried river fish, brawn, sausage, while the person first complained of visual impairment, fog before the eyes or double vision, this may be botulism. If a person has not used canned food or fish, and he has the same symptoms, this indicates a stroke or tumor in the brain stem;
• when a person has suffered a catarrhal illness or diarrhea with a rise in temperature, and his legs and then his arms and stomach gradually begin to numb, while his movement is disturbed in him, this may be Guillain-Barré syndrome;
• if a person suddenly felt a sharp pain in his chest, or he had a chest injury, and then suddenly it became worse to breathe, these are symptoms of pneumothorax;
• if the symptoms of ARF have developed amid a catarrhal illness with fever and cough, it is probably acute pneumonia, although there may be acute bronchitis.

What to do with ONE

First aid for respiratory failure should be provided after an ambulance call. We are not talking about any expectation of a local therapist with ONE.

The algorithm of actions is as follows:

1. Call an ambulance.
2. You can seat a person near the table so that he can put his hands on the table and raise his shoulders higher - closer to the chin. So for the auxiliary respiratory muscles will be more range of motion.
3. Try to reassure the victim.
4. Release him from outer clothing, unfasten all buttons and a belt of trousers, so that nothing will interfere with your breathing.
5. Provide fresh air from windows, windows.
6. Constantly reassure the patient, be close to him.
7. If a person has asthma, help him take 1-2 breaths from his inhaler.
8. If such symptoms arose after consuming fish or canned food, give him “Activated Carbon” or other sorbents.

In the event that ODN develops as a result of a foreign body falling into the throat, an urgent need to take Heimlich: stand behind the victim, grab him with both hands. Squeeze one of your hands into a fist, put a palm of your other hand under it. Now, pushing upward, bending our arms at the elbows, we press on the abdomen “under the spoon” until the respiratory tract of the victim is completely released.

If the development of ONE was preceded by a cold, there was a barking cough, it is recommended that before the ambulance arrives, inhalation with a 0.05% naphthyzine solution through a nebulizer is recommended: 3-4 drops per 5 ml of saline.

When a person who has a car accident has signs of ONE, it is only possible to remove it from the car or shift it after fixing his cervical collar with a Shants type collar.

ODN treatment

It is carried out by the ambulance resuscitation team and continues in the hospital. The first action is to provide oxygen support (through a mask or with a transfer to artificial ventilation). Further, it depends on the cause of ONE:

• in case of bronchial asthma and chronic bronchitis - this is the intravenous administration of “Eufillin”, inhalation of “Berodual” or “Salbutamol”;
• with pneumonia - the introduction of antibiotics;
• with pneumothorax - surgical treatment in the department of thoracic surgery;
• with botulism and tetanus - the introduction of specific sera (anti-botulinum or anti-tetanus);
• with Guillain-Barré syndrome - the introduction of intravenous immunoglobins;
• in case of stroke - treatment in a neurological department;
• with intracerebral hematoma, its surgical removal is possible;
• in case of myasthenia gravis - prescription of specific drugs: Proserinum, Kalimin;
• with an overdose of opiates - the introduction of antidotes;
• with pleurisy - antibiotic treatment and rinsing of the pleural cavity with antiseptics;
• with pulmonary edema - lowering blood pressure, the introduction of antifoam drugs.

With severe pulmonary fibrosis and bilateral pneumonia, a person can only be saved with extracorporeal membrane oxygenation.

Chronic respiratory failure

Chronic respiratory failure develops as a result of chronic pathologies of the respiratory tract (chronic bronchitis, bronchial asthma, tumors of the larynx, trachea or bronchi), chest wall deformity, myasthenia gravis. It manifests itself with symptoms such as:

• blue-violet shade of the skin on the face and fingers of the extremities, intensifying during physical exertion;
• more frequent breathing (over 20 per minute);
• flutter of the wings of the nose;
• fast fatiguability;
• change in the shape of fingers and nails. Fingers become like drumsticks, and nails become like watch glasses;
• frequent headaches;
• a change in the shape of the chest (in some cases, it becomes barrel-shaped).

In these cases, only the treatment prescribed by the doctor after a thorough examination can help.

Respiratory failure is a condition where the breathing process is not able to provide the body with a sufficient amount of oxygen and remove the desired amount of carbon dioxide.

Clinical picture

Such an ailment in children can cause serious consequences, so parents should know what factors affect the appearance of pathology. This condition can occur in childhood due to a number of reasons. The main of them, doctors consider:

Types of respiratory failure in children

According to the mechanism of occurrence, this problem is divided into parenchymal and ventilating.

Respiratory failure can also be acute (ONE) and chronic.  The acute form develops in a short time, and chronic failure can last several months or even years.

Degrees of respiratory failure

According to its severity, it is customary to distinguish 4 degrees of this pathology, which differ in clinical manifestations.

Respiratory failure in newborns

Respiratory failure may occur in infants. The reasons for this may be:

Respiratory failure in newborn premature infants is caused by respiratory distress syndrome.

All principles of treatment are aimed at restoring the airway, getting rid of bronchospasm and pulmonary edema, as well as positively affect the respiratory function of the blood and eliminate metabolic disorders.

Symptoms of acute and chronic respiratory failure

Symptoms of the acute form of the disease are:

In chronic insufficiency, the same symptoms occur as in acute respiratory failure in children, but they do not appear immediately, but gradually. But it is worth noting that in children this pathology develops much faster than in adults. This can be explained by the features of the anatomy of the child's body.

Children are more prone to swelling of the mucosa, their secret is formed more quickly, and the muscles of the respiratory system are not as developed as in adults.

The need of children for oxygen is much greater than in adults, so the consequences of respiratory failure in them can be more serious. In case of chronic insufficiency in a child, the timbre of the voice changes, a cough appears and wheezing is heard when breathing.

Complications of pathology

Respiratory failure is a very serious disorder that can lead to serious consequences. From the side of the cardiovascular system, ischemia, arrhythmia, pericarditis, and also hypotension can occur.

This condition also affects the nervous system. It can cause psychosis, polyneuropathy, decreased mental activity, muscle weakness, and even coma.

Also, respiratory failure can cause gastric ulcer, bleeding in the digestive tract, disruption of the liver and gall bladder. Acute respiratory failure even threatens the life of the child.

Treatment of respiratory failure in children

First, all treatment is aimed at restoring pulmonary ventilation and clearing the airways. To do this, apply oxygen treatment, which helps to normalize the gas composition of the blood. Oxygen is prescribed even to those patients who themselves breathe.

For the treatment of chronic insufficiency, in most cases, respiratory therapy is prescribed, which includes:

• inhalation;
• respiratory physiotherapy;
• oxygen therapy;
• aerosol therapy;
• taking antioxidants.

If breathing problems in young patients are caused by infections, they are prescribed antibiotics. The choice of these drugs occurs only after a sensitivity test is performed.

In order to clear the bronchial tubes of the secret accumulated there, the patient is prescribed expectorants - a medicine from the Altai root, Mukaltin. Doctors can also remove phlegm from the bronchi through the nose or mouth with an endobronchoscope.

After the child's breathing has returned to normal, doctors begin with symptomatic therapy. If the child had pulmonary edema, then diuretics are prescribed. Most often, furosemide is used. To eliminate the pain, the child is prescribed painkillers - Panadol, Ibufen, Nimesil.

Basic diagnostic methods

First of all, the doctor studies the patient's history and learns about the disturbing symptoms. It is very important to establish if the child has diseases that can cause the development of insufficiency.

The following is a general inspection. During it, the specialist examines the chest and skin of the patient, counts the frequency of respiration and heartbeat, listens to the lungs with a phonendoscope.

Also a mandatory study in the diagnosis of this pathology is an analysis of the gas composition of the blood.  It makes it possible to know the degree of its saturation with oxygen and carbon dioxide. The acid-base balance of the blood is also being studied.

Additional diagnostic methods are chest x-ray and magnetic resonance imaging. In some cases, the doctor may prescribe a pulmonologist consultation for the child.

First aid for children with acute respiratory failure

This dangerous pathological condition can develop very quickly, so every parent should know how to provide first aid to their child.

The baby needs to be put on his right side and his chest is free from tight clothing.  So that the tongue does not fuse and does not block the airways even more, the child's head must be thrown back. If possible, remove mucus and foreign bodies from the nasopharynx (if any). This can be done with a gauze napkin. Then you need to wait for an ambulance.

Doctors will perform a procedure for aspiration of the secretion from the respiratory tract, intubation of the trachea, or other procedures that allow the child to start breathing again. Then the baby can be connected to mechanical ventilation and continue treatment in the hospital.

Preventative measures

Since respiratory failure is not a separate disease, but a symptom of other serious diseases and the result of mechanical effects, the prevention of this condition consists in the timely treatment of these causes. It is also very important to limit the child from contact with allergens and toxic substances.

In addition, it is necessary to regularly undergo an examination with the child by specialists so that they can identify any pathology of the respiratory system as early as possible.

Respiratory failure is a very serious pathological condition that can lead to hypoxia and even death. Therefore, everyone needs to know what to do with this disease. If all measures are taken on time, then this symptom can be eliminated quite easily. The main thing is to pay attention to all the complaints of the child and not delay going to the doctor.

Respiratory failure most often develops in people with problems of the pulmonary, cardiovascular system or pathology of the chest muscles. This condition occurs when the body's oxygen demand is not satisfied, there is a violation of the gas composition of the blood and tissues suffer from hypoxia. With a mild degree of respiratory failure, the oxygen concentration may be within normal limits, but it is maintained by the inclusion of compensatory mechanisms that are depleted over time.

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  Syndrome Characterization

Respiratory failure is a syndrome, not a disease, and various pathological conditions of the body lead to its occurrence. Basically, the appearance of this condition is associated with the pathology of the pulmonary system, which for various reasons ceases to fulfill its main function - gas exchange. The blood oxygen content decreases and the carbon dioxide content rises, and peripheral tissues begin to suffer from hypoxia.

As a result, the gas composition of the blood is disturbed, which is very dangerous for humans, especially if these changes occurred within a short time, i.e. acute respiratory failure developed. This condition threatens the patient's life and requires immediate assistance. Violations of the normal content of oxygen and carbon dioxide in the blood lead to a shift in the acid-base balance, the blood pH decreases and acidosis develops. It negatively affects the central nervous system and exacerbates the manifestations of acute brain hypoxia.

Particularly dangerous to the patient's life is a decrease in the partial pressure of blood oxygen below 60 mm Hg. and / or increasing carbon dioxide above 45 mm Hg.

  Causes

Various pulmonary and extrapulmonary diseases cause disturbances in the supply of oxygen to the body. They occur both acutely and chronically.   The main pathologies that can cause respiratory failure (DN) include:

• Acute diseases of the respiratory system - an attack of bronchial asthma, pneumothorax, atelectasis, pneumonia, pleurisy.
• Chronic lung diseases - bronchiectasis, chronic obstructive pulmonary disease (COPD), emphysema.
• Various diseases of the cardiovascular system - heart failure, cardiomyopathies, coronary heart disease (myocardial infarction, angina pectoris), bicuspid valve stenosis.
• Disorders in the neuromuscular system - myasthenia gravis, Hyena-Bare syndrome, etc.
• Serious disorders in the central nervous system - damage to the respiratory center as a result of an injury or stroke can lead to respiratory arrest.
• Pathology of the vessels of the heart / lungs.

It is often not difficult to find out the cause, especially if respiratory failure is not severe and there is time for a diagnosis. In the case of acute DN, it is very difficult to understand the etiology, and sometimes there is simply no time for this, since the patient needs to be provided with emergency care and then diagnosed.



  Classification

The classification of respiratory failure is quite complex and includes divisions based on the etiology, mechanism of occurrence, and flow rate.   So, depending on the etiology, the following types of DN are distinguished:

• Obstructive DN - develops in violation of the patency of the tracheobronchial tree, due to its overlapping by a foreign body, mucus or pus. This condition is characteristic of chronic bronchitis, tumor formations growing in the lumen of the bronchus and reducing its lumen, bronchospasm, various strictures of the trachea and bronchial tree, etc.
• Restrictive - associated with a violation of the elasticity of the lung tissue. The respiratory failure of the restrictive type is also called restrictive, since there is a decrease in the extensibility of the lungs, which does not allow for a full cycle of inhalation and exhalation. A similar type of DN develops in pleurisy, hydrothorax, pneumothorax, pneumosclerosis, kyphoscoliosis, etc.
• Mixed - with this type of DN there are restrictive respiratory disorders together with obstructive ones. It develops with long-term diseases of the cardiovascular system in combination with lung pathology (pulmonary heart).
• Hemodynamic DN - occurs when a portion of lung tissue stops supplying blood. If blood does not reach the alveoli, gas exchange does not occur and the body does not receive oxygen. This condition develops when a thrombus or embolus clogs the branches of the pulmonary artery, as a result of which a certain part of the lungs is turned off from the blood circulation, and the larger it is, the more dangerous the violation. The disease is called pulmonary embolism or pulmonary embolism.
• Diffuse - a special type of respiratory failure is also called hyaline membrane disease or respiratory distress syndrome. Especially often develops in children born prematurely, and is associated with surfactant deficiency in the alveoli. The essence of the formation of this type of respiratory failure is that there is a thickening of the membrane between the capillary and the alveoli and gas exchange through it becomes impossible. In children, this is due to the prematurity and immaturity of the membrane itself, and in adults with the involvement of cellular elements in the lungs, which are deposited in the alveolus and thicken its wall, thereby blocking gas exchange.



Obstructive type of DN, subsequently emphysema is formed



Pulmonary embolism



  Separation by the mechanism of occurrence

Respiratory failure, in addition to the etiological factor, is divided into two groups depending on the mechanism of development.   Thus, according to the form of occurrence, they distinguish:

• Parenchymal DN (first type) - its appearance is associated with pathology of the lung tissue, when due to inflammatory or other phenomena it is impossible to carry out normal gas exchange. The blood oxygen content decreases and carbon dioxide rises, the peculiarity is that this type of respiratory failure is difficult to correct with the help of inhalation therapy or mechanical ventilation (mechanical ventilation). The main causes are pneumonia, respiratory distress syndrome.
• Ventilation DN (second type) - with this type of respiratory failure, a violation of the ventilation function occurs, that is, the ability of the lungs to carry out normal inhalation and exhalation. The same changes are observed in the blood, but they are easily corrected by oxygen therapy. This type of DN develops with weakness of the respiratory muscles (myasthenia gravis), dysregulation of the respiratory movements from the central nervous system.

In addition, depending on the gas composition of the blood, distinguished between compensated and decompensated respiratory failure are distinguished. In the first case, the content of oxygen and carbon dioxide is within normal limits, but it is maintained at a normal level when the compensatory mechanisms of the respiratory system are tensioned (increased and deepened breathing, increased heart rate). In the second case, the gas composition is violated, and even the additional capabilities of the body cannot keep it at the proper level.

  Grade Grade

Classification by severity is very important to determine the general condition of the patient and is crucial for establishing the disability group in people with lung pathology. Criteria for assessing the degree of respiratory failure include determining the saturation (in%) and the partial pressure (in mmHg) of oxygen in the blood. Both indicators are quite informative, but in the clinic it is much easier to establish the degree of DN according to oxygen saturation (saturation).

Table of severity depending on partial pressure and saturation:

In practice, to establish the degree of respiratory failure, physical activity disorders associated with the appearance or intensification of shortness of breath with various loads are also assessed:

• DN of the 1st degree - patients experience shortness of breath only with significant or moderate physical exertion.
• DN of the 2nd degree - shortness of breath occurs with minor exertion, the gas composition of the blood is kept within normal limits due to compensatory mechanisms.
• 3rd degree DN - the onset of dyspnea occurs at rest, physical activity is significantly limited in patients, and there are signs of hypoxemia and hypercapnia.

  Acute and chronic DN

Respiratory failure over the course is divided into acute and chronic, they have a different mechanism of occurrence and prognosis for the patient.

Distinctive features of acute DN is that it occurs in a matter of minutes or hours, leading to serious violations of the acid-base state of the body. It is especially dangerous for human life, because if you do not provide emergency assistance, there is a high risk of death. Acute DN can occur as a complication of chronic or on its own as a result of injuries, asphyxiation, drowning, etc.

The development of chronic respiratory failure takes a long time: from several months or even years. At the initial stages, patients themselves do not notice the first manifestations and seek help only in cases of severe respiratory distress.

  Pathogenesis of DN

Each type of respiratory failure differs in pathogenesis, but the point is that due to a violation of the exchange of gases between air and the capillary in the arterial blood, the oxygen content decreases, this leads to the development of hypoxia (lack of oxygen in the tissues). Oxygen is very important for the body, since many types of metabolism take place with its help, and brain cells cannot tolerate its deficiency for more than 5 minutes. In addition to hypoxemia (a decrease in oxygen in the blood), the carbon dioxide content (hypercapnia) increases, it is an acid oxide and causes manifestations of respiratory acidosis. The development of this condition is dangerous for human life, since a decrease in blood pH leads to a violation of ion exchange, and then disorders of the cardiovascular (up to cardiac arrest) and the central nervous system (coma).



Gas exchange in the lungs

The worst option is the occurrence of these violations in a short period of time, since the body does not have time to work protective mechanisms, and without medical help a person can simply die.

  Manifestations of acute respiratory failure

Acute respiratory failure is a threatening, emergency state of the human body, in which there is a sharp oxygen deficiency. In its course, ONE has three stages, each has its own characteristic features.

The first stage of ONE is characterized by the appearance of a feeling of lack of air, increased breathing to 25-30 per minute, heart rate up to 100-110 / min. Patients become restless, euphoria is possible. The skin turns pale, and the terminal phalanges and nail plates of the fingers and toes acquire a blue hue. This stage is called compensated, since violations of the gas content in the blood do not occur or are moderate.

The second stage (incomplete compensation). Patients have psychomotor agitation, severe suffocation, confused consciousness, hallucinations and delusions are possible. Breathing quickens to 30–40 / min., Heart rate increases to 120-140 / min.

Third stage (decompensated). Tonic-clonic convulsions appear, a hypoxic coma develops. The pupils expand, and they stop responding to light. The color of the skin becomes spotty blue. The respiratory rate increases to more than 40 per minute and acquires a superficial character. Heart rate is more than 140 per minute, and blood pressure begins to fall to critical numbers below 70/50 mm Hg. In the case of a sharp decrease in the frequency of respiratory movements from 40 to 10 / min. and lower increases the likelihood of sudden cardiac arrest.

In the third stage of DN, it is necessary to carry out emergency resuscitation measures, without which a person will not survive.

  Symptoms of chronic DN

Manifestations of chronic respiratory failure (CDI) are diverse and depend on the pathology that caused it. The main sign is shortness of breath or dyspnea (violation of the frequency and rhythm of breathing). Patients feel discomfort, lack of air, a characteristic feeling of dissatisfaction with the breath. Often, patients for the implementation of respiratory movements connect auxiliary muscles (intercostal, abdominal).

If CDN is caused by bronchitis, bronchiectasis and there are obstructive respiratory tract disorders, then shortness of breath will have an expiratory type (exhalation is difficult). If the elasticity of the lung tissue is impaired, for example, if there is an accumulation of fluid, pus or air in the pleural cavity, a restrictive variant of respiratory failure develops and the patient complains of inspiratory dyspnea (difficulty breathing).

In the presence of chronic diseases of the respiratory system, for a long time, patients may be disturbed only by slight dyspnea during physical exertion, but already at this stage it is necessary to undergo an examination and seek medical help. A symptom indicating the severity of respiratory distress is cyanosis (blue skin). If it covers the limbs, nasolabial triangle or the tip of the nose, then we can talk about respiratory failure in the subcompensated stage. Common cyanosis indicates an exacerbation of CDN and its transition to ONE, and this condition needs immediate emergency assistance.



Cyanosis of the nasolabial triangle

Specific symptoms that may indicate the presence of chronic hypoxia are:

• constant feeling of tiredness;
• drowsiness;
• headache;
• decreased physical activity;
• thickening of the terminal phalanges of the fingers in the form of "drum sticks";
• a change in the shape of nails that resemble "watch glasses."



Nail shape changes

The last two signs will be characteristic of chronic heart failure, in which hypoxia is associated with the release of a small amount of blood from the heart.

  Treatment

Help with acute respiratory failure consists in the use of a set of resuscitation measures that any person should be able to provide at the pre-medical stage. Clinical recommendations for emergency care for a patient with ONE:

In the mind		Unconscious
The first stage - assessment of the patient’s consciousness
To reassure the patient and try to find out from him information about his illness, to look for things in medicines		Lay on your back, throw your head back and place a roller (clothes, bag) under the neck. Open your mouth and inspect the cavity for the presence of foreign bodies, mucus. Pull the lower jaw forward to prevent tongue retraction
Stage two - breath assessment
Yes, but broken		Not
If foreign bodies enter the upper respiratory tract, it is necessary (if possible) to remove them. If food or other objects get into the trachea or bronchi, use the Heimlich technique, in which the person assisting comes up behind the victim and puts his arms around him, folding his hands in a lock at the patient’s abdomen level. Then a sharp blow is made to the epigastric region in the direction of the diaphragm. Thus, its reflex contraction occurs, and under pressure the foreign body flies out of the respiratory tract.		Examine the oral cavity for the presence of foreign objects, if possible, remove them. Then they start artificial respiration from mouth to mouth or from mouth to nose
Stage Three - Heart Rate Assessment
there is		Not
If at the second stage the help was provided on time, then there will be no circulatory disorders		Indirect massage of the heart begins, combining it with artificial respiration. For 30 chest compressions, two mouth-to-mouth or mouth-to-nose breaths are performed. 90 compressions should be released per minute

These measures provide patients with acute respiratory failure at the pre-medical stage, and if necessary, call an ambulance. In a hospital, patients with ARF are connected to an artificial lung ventilation apparatus, stabilization of vital functions is performed, and then they begin treatment of the underlying disease.

Patients with chronic respiratory failure need to undergo treatment for the underlying disease. With the elimination of airway obstruction and normalization of the elasticity of the lung tissue, the symptoms of CDN will be eliminated. For this purpose, bronchodilators (Salbutamol, Ventolin), mucolytics (Ambroxol, Acetylcysteine) are prescribed. With hydro-, pneumo- or pyothorax, surgery is performed - the pleural cavity is drained and restriction is eliminated (violation of lung extensibility).

If CDN is caused by diseases of the cardiovascular system, a therapy is carried out aimed at normalizing cardiac output and pressure in the pulmonary circulation. Prescribe diuretics (Furosemide, Indapamide), beta-blockers (Bisosprolol, Nebivolol), cardiac glycosides (Korglikon, Digoxin, Strofantin).

For each specific pathology, there is a treatment regimen, therefore, in no case can you prescribe drugs on your own. Only after establishing the true cause of respiratory failure can a specialist conduct adequate therapy.

As you know, the respiratory function of the body is one of the main functions of the normal functioning of the body. A syndrome in which the balance of blood components is disturbed, or more precisely, the concentration of carbon dioxide rises and the volume of oxygen decreases, is called "acute respiratory failure", it can also turn into a chronic form. How does the patient feel in this case, what symptoms may bother him, what signs and causes of this syndrome has - read below. Also from our article you will learn about diagnostic methods and the most modern methods of treating this disease.

What characteristics does this disease have?

Respiratory failure (DN) is a special condition in which the human body resides when the respiratory system cannot provide the necessary amount of oxygen for it. In this case, the concentration of carbon dioxide in the blood increases significantly and can reach a critical point. This syndrome is a kind of consequence of the defective exchange of carbon dioxide and oxygen between the circulatory system and the lungs. Note that chronic respiratory failure and acute can significantly differ in their manifestations.

Any breathing disorders trigger compensatory mechanisms in the body, which for some time can restore the necessary balance and bring the blood composition closer to normal. If gas exchange in the lungs of a person is disturbed, the heart will become the first organ that will begin to perform the compensatory function. Later, the amount and general level in the human blood will increase, which can also be considered a reaction of the body to hypoxia and oxygen starvation. The danger lies in the fact that the body’s forces are not infinite and sooner or later its resources are depleted, after which a person is faced with the manifestation of acute respiratory failure. The first symptoms begin to bother the patient when the partial oxygen pressure drops below 60 mmHg, or the carbon dioxide level rises to 45 mm.

How does the disease manifest in children?

Respiratory failure in children is often caused by the same reasons as in adults, but the symptoms are usually not so pronounced. In newborns, this syndrome externally manifests itself as a respiratory disorder:

1. Most often, this pathology occurs in newborns who were born before the due date, or in those newborns who have had a difficult birth.
2. In premature infants, the cause of failure is the underdevelopment of a surfactant - a substance that lines the alveoli.
3. Also, symptoms of DN can occur in those newborns who experienced hypoxia during fetal life.
4. Impaired respiratory function can occur in those newborns who swallowed their meconium, swallowed amniotic fluid or blood.
5. Also, untimely suction of fluid from the respiratory tract often leads to DN in newborns.
6. Congenital malformations of the newborn can often cause respiratory distress. For example, underdeveloped lungs, polycystic lung disease, diaphragmatic hernia and others.

Most often in newborns, this pathology manifests itself in the form of aspiration, hemorrhagic and edematous syndrome, lung atelectasis is slightly less common. It is worth noting that in newborns, acute respiratory failure is more common, and the sooner it is diagnosed, the more likely it is that the child will not have chronic respiratory failure.

The causes of this syndrome

Often the cause of DN can be diseases and pathologies of other organs of the human body. It can develop as a result of infectious and inflammatory processes in the body, after severe injuries with damage to vital organs, with malignant tumors of the respiratory system, as well as violations of the respiratory muscles and heart. A person may also experience breathing problems due to the restriction of movement of the chest. So, to attacks of respiratory failure can lead to:

1. Narrowing of the airways or obstruction, which are characteristic of bronchiectasis, and laryngeal edema.
2. The aspiration process, which is caused by the presence of a foreign object in the bronchi.
3. Damage to lung tissue due to such pathologies: inflammation of the alveoli of the lung, fibrosis, burns, lung abscess.
4. Blood flow disturbance often accompanies embolism of the lung artery.
5. Complicated heart defects, mainly. For example, if the oval window did not close in time, venous blood flows directly to the tissues and organs, without penetrating the lungs.
6. General weakness of the body, decreased muscle tone. This state of the body can occur with the slightest damage to the spinal cord, as well as with degeneration of muscles, and polymyositis.
7. The weakening of breathing, which does not have a pathological nature, can be caused by an overweight person or bad habits - alcoholism, drug addiction, smoking.
8. Anomalies or injuries of the ribs and spine. They can occur with kyphoscoliosis or after a chest wound.
9. Often the cause of depressed breathing can be a strong degree.
10. DN occurs after complex operations and severe injuries with heavy blood loss.
11. Various lesions of the central nervous system, both congenital and acquired.
12. Violation of the respiratory function of the body can be caused by a violation of pressure in the pulmonary circulation.
13. Various infectious diseases, for example, can knock down the usual rhythm of transmission of impulses to the muscles involved in the breathing process.
14. Chronic - imbalance of thyroid hormones can also serve as the cause of the development of this disease.

What are the symptoms of this disease?

The primary signs of this disease are affected by the causes of its appearance, as well as the specific variety and severity. But any patient with respiratory failure will experience symptoms common to this syndrome:

• hypoxemia;
• hypercapnia
• dyspnea;
• weakness of the respiratory muscles.

Each of the presented symptoms is a set of certain characteristics of the patient's condition, we will consider each in more detail.

Hypoxemia

The main sign of hypoxemia is a low degree of saturation of arterial blood with oxygen. In this case, the skin can change color in a person, they acquire a bluish tint. Cyanosis of the skin, or cyanosis, is another name for this condition, it can be severely or slightly expressed depending on how long and how strongly the symptoms of the disease have been manifested in a person. Typically, the skin changes color after the partial pressure of oxygen in the blood reaches a critical point of 60 mm RT. Art.

After overcoming this barrier, the heartbeat may occasionally increase in the patient. And also low blood pressure is observed. The patient begins to forget the simplest things, and if the above indicator reaches 30 mm RT. Art., then a person most often loses consciousness, systems and organs can no longer work in the previous mode. And the longer hypoxia lasts, the harder the body will regain its function. This is especially true of brain activity.

Hypercapnia

In parallel with the lack of oxygen in the blood, the percentage of carbon dioxide begins to increase, this condition is called hypercapnia, it often accompanies chronic respiratory failure. The patient begins to experience trouble sleeping, he cannot sleep for a long time or does not sleep all nights long. At the same time, a person exhausted by insomnia feels overwhelmed all day and wants to sleep. This syndrome is accompanied by increased heart rate, the patient may feel sick, he experiences severe headaches.

Trying to save himself, the human body tries to get rid of an excess of carbon dioxide, breathing becomes very frequent and deeper, but even such a measure has no effect. Moreover, the decisive role in the development of the disease in this case is played by how quickly the content of carbon dioxide in the blood rises. For the patient, a high growth rate is very dangerous, as this threatens increased blood circulation of the brain and increased intracranial pressure. Without emergency treatment, these symptoms cause cerebral edema and a coma.

Dyspnea

When this symptom occurs, a person always thinks that he does not have enough air. At the same time, it is very difficult for him to breathe, although he is trying to strengthen respiratory movements.

Weakness of the respiratory muscles

If the patient takes more than 25 breaths per minute, it means that his respiratory muscles are weakened, she is not able to perform the usual functions and quickly gets tired. At the same time, the person is trying by all means to establish breathing and involves the muscles of the press, upper respiratory tract and even the neck in the process.

It is also worth noting that with a late degree of the disease, heart failure develops and various parts of the body swell.

Methods for diagnosing pulmonary failure

To identify this disease, the doctor uses the following diagnostic methods:

1. It is best to talk about the well-being and breathing problems of the patient himself, the task of the physician is to ask him as much as possible about the symptoms, and also to study the medical history.
2. Also, the doctor should, at the earliest opportunity, find out the presence or absence of concomitant diseases in the patient that can aggravate the course of DN.
3. During a medical examination, the doctor will pay attention to the state of the chest, listen to the lungs with a phonendoscope and calculate the frequency of the heart rhythm and respiration.
4. The most important point of diagnosis is the analysis of the gas composition of the blood, the index of saturation with oxygen and carbon dioxide is investigated.
5. Acid-base blood counts are also measured.
6. A chest x-ray is required.
7. The spirography method is used to evaluate the external characteristics of respiration.
8. In some cases, consultation with a pulmonologist is necessary.

DN classification

This disease has several classifications depending on the characteristic. If we take into account the mechanism of the origin of the syndrome, then we can distinguish the following types:

1. Parenchymal respiratory failure, it is also called hypoxemic. This type has the following characteristics: the amount of oxygen decreases, the partial pressure of oxygen in the blood drops, this condition is hardly corrected even by oxygen therapy. The most common consequence is pneumonia or distress syndrome.
2. Ventilation or hypercapnic. With this kind of disease in the blood, first of all, the carbon dioxide content increases, while its saturation with oxygen decreases, but this can easily be corrected with the help of oxygen therapy. This type of DN is accompanied by weakness in the respiratory muscles, mechanical defects of the ribs or chest are often observed.

As we noted earlier, most often this pathology can be a consequence of diseases of other organs, on the basis of etiology, the disease can be divided into the following types:

1. Obstructive DN implies obstructed air movement along the trachea and bronchi, it can be caused by bronchospasm, narrowing of the airways, the presence of a foreign body in the lungs or a malignant tumor. With this type of disease, a person can hardly take a full breath; exhalation causes even greater difficulties.
2. The restrictive type is characterized by a limitation of the lung tissue functions in expansion and contraction, a disease of this nature can be a consequence of pneumothorax, adhesions in the pleural cavity of the lung, and also if the movements of the rib cage are limited. As a rule, in such a situation it is extremely difficult for the patient to breathe air.
3. The mixed type combines the signs of both restrictive insufficiency and obstructive, its symptoms most often occur with a late degree of pathology.
4. Hemodynamic DN can occur due to a violation of air circulation in the absence of ventilation in a separate section of the lung. Right-left blood bypass surgery, which is carried out through an open oval window in the heart, can lead to this type of disease. At this time, venous and arterial blood mixing may occur.
5. Diffuse type insufficiency occurs when gas penetration into the lung is impaired when the capillary-alveolar membrane is thickened.

Depending on how long a person experiences breathing problems and how quickly the signs of the disease develop, they secrete:

1. Acute failure affects the lungs of a person with high speed, usually its attacks last no more than a few hours. Such a rapid development of pathology always causes hemodynamic disturbances and is very dangerous for the patient's life. With the manifestation of signs of this type, the patient needs a complex of resuscitation therapy, especially at those moments when other organs cease to perform a compensatory function. Most often, it is observed in those who are experiencing an exacerbation of the chronic form of the disease.
2. Chronic respiratory failure worries a person for a long period of time, up to several years. Sometimes it is a consequence of an untreated acute form. Chronic respiratory failure can accompany a person throughout life, weakening and intensifying from time to time.

In this disease, the gas composition of the blood is of great importance, depending on the ratio of its components, compensated and decompensated types are secreted. In the first case, the composition is normal; in the second, hypoxemia or hypercapnia is observed. A classification of respiratory failure by severity looks like this:

• 1 degree - sometimes the patient feels shortness of breath with strong physical exertion;
• 2 degree - respiratory failure and shortness of breath appear even with light loads, while the compensatory functions of other organs at rest are involved;
• Grade 3 - accompanied by severe shortness of breath and cyanosis of the skin at rest, characteristic hypoxemia.

Treatment of respiratory dysfunction

The treatment of acute respiratory failure includes two main tasks:

1. As much as possible restore normal ventilation of the lungs and maintain it in this state.
2. Diagnose and, if possible, cure concomitant diseases, as a result of which breathing problems have appeared.

If the doctor notices a pronounced hypoxia in the patient, then first of all he will prescribe oxygen therapy to him, in which doctors carefully monitor the patient's condition and monitor the characteristics of the blood composition. If a person breathes on his own, then a special mask or nasal catheter is used for this procedure. The patient in a coma is intubated, which artificially ventilates the lungs. At the same time, the patient begins to take antibiotics, mucolytics, as well as bronchodilators. He is prescribed a number of procedures: chest massage, exercise therapy, inhalation using ultrasound. To cleanse the bronchi, a bronchoscope is used.