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What is Respiratory Failure?
A pathological condition of the body in which gas exchange in the lungs is disrupted is called respiratory failure... As a result of these disorders in the blood, oxygen levels are significantly reduced and carbon dioxide levels are increased. Due to insufficient oxygen supply to tissues, hypoxia or oxygen starvation develops in organs (including the brain and heart).Normal blood gas composition in the initial stages of respiratory failure can be provided through compensatory reactions. The functions of the external respiratory organs and the functions of the heart are closely related to each other. Therefore, when gas exchange in the lungs is disturbed, the heart begins to work hard, which is one of the compensatory mechanisms that develop during hypoxia.
Compensatory reactions also include an increase in the number of erythrocytes and an increase in the level of hemoglobin, an increase in the minute volume of blood circulation. With a severe degree of respiratory failure, compensatory reactions are not enough to normalize gas exchange and eliminate hypoxia, the stage of decompensation develops.
Respiratory failure classification
There are a number of classifications of respiratory failure according to its various characteristics.By the mechanism of development
1. Hypoxemic or parenchymal pulmonary failure (or type I respiratory failure). It is characterized by a decrease in the level and partial pressure of oxygen in the arterial blood (hypoxemia). Oxygen therapy is difficult to eliminate. It is most common in pneumonia, pulmonary edema, and respiratory distress syndrome.2. Hypercapnic , ventilation (or type II pulmonary insufficiency). In this case, the content and partial pressure of carbon dioxide (hypercapnia) are increased in arterial blood. The oxygen level is lowered, but this hypoxemia is well treated with oxygen therapy. It develops with weakness and defects of the respiratory muscles and ribs, with dysfunctions of the respiratory center.
Due to the occurrence
- Obstructive respiratory failure: this type of respiratory failure develops when there are obstacles in the airways for the passage of air due to their spasm, constriction, compression, or foreign body ingress. In this case, the function of the respiratory apparatus is disrupted: the respiratory rate decreases. The natural narrowing of the bronchial lumen during exhalation is complemented by obstruction due to obstruction, therefore, exhalation is especially difficult. Obstruction can be caused by: bronchospasm, edema (allergic or inflammatory), blockage of the bronchial lumen with sputum, destruction of the bronchial wall or its sclerosis.
- Restrictive respiratory failure (restrictive): this type of pulmonary failure occurs when there are restrictions on the expansion and contraction of lung tissue as a result of effusion into the pleural cavity, the presence of air in the pleural cavity, adhesions, kyphoscoliosis (curvature of the spine). Respiratory failure develops due to the limitation of the depth of inspiration.
- Combined or mixed pulmonary insufficiency is characterized by the presence of signs of both obstructive and restrictive respiratory failure with the predominance of one of them. It develops with prolonged pulmonary heart disease.
- Hemodynamic respiratory failure develops with circulatory disorders that block ventilation of the lung area (for example, with pulmonary embolism). This type of pulmonary insufficiency can also develop with heart defects, when arterial and venous blood mix.
- Diffuse type respiratory failure occurs with pathological thickening of the capillary-alveolar membrane in the lungs, which leads to disruption of gas exchange.
By gas composition of blood
1. Compensated (normal blood gas readings).2. Decompensated (hypercapnia or hypoxemia of arterial blood).
In the course of the disease
According to the course of the disease, or according to the rate of development of the symptoms of the disease, acute and chronic respiratory failure are distinguished.By severity
There are 4 degrees of severity of acute respiratory failure:- I degree of acute respiratory failure: shortness of breath with difficulty breathing in or out, depending on the level of obstruction and increased heart rate, increased blood pressure.
- II degree: breathing is carried out with the help of auxiliary muscles; there is a diffuse cyanosis, marbling of the skin. There may be convulsions and darkening of consciousness.
- III degree: severe shortness of breath alternates with periodic stops of breathing and a decrease in the number of breaths; cyanosis of the lips is noted at rest.
- IV degree - hypoxic coma: rare, convulsive breathing, generalized cyanosis of the skin, a critical decrease in blood pressure, depression of the respiratory center up to respiratory arrest.
- I degree of chronic respiratory failure: shortness of breath occurs with significant physical exertion.
- II degree of respiratory failure: shortness of breath is noted with little physical exertion; at rest, compensatory mechanisms are activated.
- III degree of respiratory failure: shortness of breath and cyanosis of the lips are noted at rest.
Reasons for the development of respiratory failure
Various reasons can lead to the occurrence of respiratory failure when they affect the breathing process or the lungs: - obstruction or narrowing of the airways that occurs with bronchiectasis, chronic bronchitis, bronchial asthma, cystic fibrosis, pulmonary emphysema, laryngeal edema, aspiration and foreign body in the bronchi;
- damage to lung tissue in pulmonary fibrosis, alveolitis (inflammation of the pulmonary alveoli) with the development of fibrotic processes, distress syndrome, malignant tumor, radiation therapy, burns, lung abscess, drug effects on the lung;
- violation of blood flow in the lungs (with pulmonary embolism), which reduces the flow of oxygen into the blood;
- congenital heart defects (non-closure of the oval window) - venous blood, bypassing the lungs, goes directly to the organs;
- muscle weakness (with poliomyelitis, polymyositis, myasthenia gravis, muscular dystrophy, spinal cord injury);
- weakening of breathing (with an overdose of drugs and alcohol, with respiratory arrest during sleep, with obesity);
- anomalies of the rib cage and spine (kyphoscoliosis, chest injury);
- anemia, massive blood loss;
- damage to the central nervous system;
- increased blood pressure in the pulmonary circulation.
Respiratory failure pathogenesis
Lung function can be roughly divided into 3 main processes: ventilation, pulmonary blood flow, and gas diffusion. Deviations from the norm in any of them inevitably lead to respiratory failure. But the significance and consequences of violations in these processes are different.Respiratory failure often develops when ventilation is reduced, resulting in an excess of carbon dioxide (hypercapnia) and a lack of oxygen (hypoxemia) in the blood. Carbon dioxide has a large diffusion (penetrating) ability, therefore, with impaired pulmonary diffusion, hypercapnia rarely occurs, more often they are accompanied by hypoxemia. But diffusion disturbances are rare.
An isolated disturbance of ventilation in the lungs is possible, but most often combined disorders are noted, based on disturbances in the uniformity of blood flow and ventilation. Thus, respiratory failure is the result of abnormal changes in the ventilation / blood flow ratio.
Violation in the direction of increasing this ratio leads to an increase in physiologically dead space in the lungs (areas of lung tissue that do not perform their functions, for example, in severe pneumonia) and the accumulation of carbon dioxide (hypercapnia). A decrease in the ratio causes an increase in shunting or vascular anastomoses (additional blood flow paths) in the lungs, resulting in a decrease in the oxygen content in the blood (hypoxemia). The resulting hypoxemia may not be accompanied by hypercapnia, but hypercapnia, as a rule, leads to hypoxemia.
Thus, the mechanisms of respiratory failure are 2 types of gas exchange disorders - hypercapnia and hypoxemia.
Diagnostics
The following methods are used to diagnose respiratory failure: - Interviewing a patient about past and concomitant chronic diseases. This can help establish a possible cause for the development of respiratory failure.
- Examination of the patient includes: counting the respiratory rate, participation in breathing of the auxiliary muscles, identifying the cyanotic color of the skin in the area of the nasolabial triangle and nail phalanges, listening to the chest.
- Conducting functional tests: spirometry (determination of the vital capacity of the lungs and the minute volume of respiration using a spirometer), peakfluometry (determination of the maximum speed of air movement during forced expiration after maximum inhalation using a peakfluometer apparatus).
- Arterial blood gas analysis.
- Chest X-ray - to detect damage to the lungs, bronchi, traumatic injuries of the rib cage and defects of the spine.
Respiratory Failure Symptoms
The symptoms of respiratory distress depend not only on the cause of its occurrence, but also on the type and severity. The classic manifestations of respiratory failure are:- signs of hypoxemia (decreased oxygen levels in arterial blood);
- signs of hypercapnia (an increase in the level of carbon dioxide in the blood);
- dyspnea;
- syndrome of weakness and fatigue of the respiratory muscles.
Hypercapnia manifested by increased heart rate and sleep disturbance (drowsiness during the day and insomnia at night), headache and nausea. The body tries to get rid of excess carbon dioxide through deep and rapid breathing, but it turns out to be ineffective. If the level of partial pressure of carbon dioxide in the blood rises rapidly, then increased cerebral circulation and increased intracranial pressure can lead to cerebral edema and the development of a hypocapnic coma.
When the first signs of respiratory distress appear in a newborn, oxygen therapy is started (ensuring control of the gas composition of the blood). To do this, use an incubator, mask and nasal catheter. In case of severe respiratory distress and ineffectiveness of oxygen therapy, a ventilator is connected.
In the complex of therapeutic measures, intravenous administration of the necessary drugs and surfactant preparations (Kurosurf, Exosurf) are used.
In order to prevent the syndrome of respiratory disorders in a newborn with the threat of premature birth, pregnant women are prescribed glucocorticosteroid drugs.
Treatment
Acute Respiratory Failure Treatment (Emergency)
The amount of emergency care in the case of acute respiratory failure depends on the form and degree of respiratory failure and the cause that caused it. Emergency care is aimed at eliminating the cause that caused the emergency, restoring gas exchange in the lungs, pain relief (in case of injuries), and preventing infection.- With I degree of insufficiency, it is necessary to free the patient from constraining clothing, to provide access to fresh air.
- In case of II degree of insufficiency, it is necessary to restore the patency of the airways. To do this, you can use drainage (put in bed with a raised leg end, gently beat on the chest when exhaling), eliminate bronchospasm (Euphyllin solution is injected intramuscularly or intravenously). But Euphyllin is contraindicated in patients with low blood pressure and a pronounced increase in heart rate.
- To dilute sputum, diluting and expectorant agents are used in the form of inhalation or medicine. If the effect is not achieved, then the contents of the upper respiratory tract are removed using an electric suction (the catheter is inserted through the nose or mouth).
- If it is still not possible to restore breathing, artificial ventilation of the lungs is used without apparatus (mouth-to-mouth or mouth-to-nose breathing) or with the help of an artificial respiration apparatus.
- When restoring spontaneous breathing, intensive oxygen therapy and the introduction of gas mixtures (hyperventilation) are carried out. For oxygen therapy, use a nasal catheter, mask or oxygen tent.
- Improvement of the patency of the airways can be achieved with the help of aerosol therapy: warm alkaline inhalations, inhalations with proteolytic enzymes (chymotrypsin and trypsin), bronchodilators (Izadrin, Novodrin, Euspiran, Alupen, Salbutamol). If necessary, antibiotics can also be administered by inhalation.
- With symptoms of pulmonary edema, a semi-sitting position of the patient is created with lowered legs or with a raised head end of the bed. In this case, the appointment of diuretics is used (Furosemide, Lasix, Uregit). In the case of a combination of pulmonary edema with arterial hypertension, Pentamine or Benzohexonium is administered intravenously.
- With severe spasm of the larynx, muscle relaxants (Ditilin) are used.
- To eliminate hypoxia, sodium oxybutyrate, Sibazon, Riboflavin are prescribed.
- For traumatic lesions of the chest, non-narcotic and narcotic analgesics are used (Analgin, Novocain, Promedol, Omnopon, sodium oxybutyrate, Fentanyl with Droperidol).
- To eliminate metabolic acidosis (accumulation of under-oxidized metabolic products), intravenous administration of sodium bicarbonate and Trisamine is used.
- ensuring the patency of the airways;
- ensuring a normal supply of oxygen.
To maintain the patency of the airways, drugs are used (dilating the bronchi and thinning phlegm) and the so-called respiratory therapy, which includes various methods: postural drainage, phlegm suction, and breathing exercises.
The choice of respiratory therapy method depends on the nature of the underlying disease and the patient's condition:
- For postural massage, the patient assumes a sitting position with an emphasis on the arms and bending forward. The assistant pats the back. This procedure can be done at home. A mechanical vibrator can also be used.
- With increased production of sputum (with bronchiectasis, lung abscess or cystic fibrosis), you can also use the "cough therapy" method: after 1 calm exhalation, 1-2 forced exhalation should be done, followed by relaxation. Such methods are acceptable for elderly patients or in the postoperative period.
- In some cases, it is necessary to resort to suction of phlegm from the respiratory tract with the connection of an electric pump (using a plastic tube inserted through the mouth or nose into the respiratory tract). In this way, sputum is also removed with a tracheostomy tube from a patient.
- Respiratory gymnastics should be done for chronic obstructive diseases. To do this, you can use the device "incentive spirometer" or intensive breathing exercises of the patient himself. The method of breathing with half-closed lips is also used. This method increases the pressure in the airways and prevents them from collapsing.
- To ensure the normal partial pressure of oxygen, oxygen therapy is used - one of the main methods of treating respiratory failure. There are no contraindications to oxygen therapy. Nasal cannulas and masks are used to administer oxygen.
- Of the medicines, Almitrin is used - the only medicine that can improve the partial pressure of oxygen for a long time.
- In some cases, seriously ill patients need to connect a ventilator. The device itself supplies air to the lungs, and exhalation is performed passively. This saves the patient's life when he cannot breathe on his own.
- Mandatory treatment is the impact on the underlying disease. In order to suppress the infection, antibiotics are used in accordance with the sensitivity of the bacterial flora isolated from the sputum.
- Corticosteroid drugs for long-term use are used in patients with autoimmune processes, with bronchial asthma.
Acute respiratory failure: what to do if a foreign body enters the child's respiratory tract - video
How to correctly perform artificial ventilation of the lungs with respiratory failure - video
Before use, you must consult a specialist.In contrast to chronic respiratory failure, ODN is a decompensated state in which hypoxemia or respiratory acidosis rapidly progresses, and blood pH decreases. Disturbances in the transport of oxygen and carbon dioxide are accompanied by changes in the functions of cells and organs. In chronic respiratory failure, pH is usually within the normal range, respiratory acidosis is compensated by metabolic alkalosis. This condition does not pose an immediate threat to the patient's life.
ARF is a critical condition in which even with timely and correct treatment, a fatal outcome is possible.
Etiology and pathogenesis.
Among the common causes of ARF, which have been associated with an increase in this syndrome in recent years, the following are especially important:
- the increasing risk of possible accidents (road traffic accidents, terrorist attacks, injuries, poisoning, etc.);
- allergization of the body with immunoreactive damage to the respiratory tract and lung parenchyma;
- wide spread of acute bronchopulmonary diseases of an infectious nature;
- various forms of drug addiction, tobacco smoking, alcoholism, uncontrolled use of sedatives, sleeping pills and other drugs;
- aging of the population.
In the intensive care unit, patients with severe forms of ARF are often hospitalized against the background of multiple organ failure, septic complications, and severe traumatic injuries. Often the causes of ARF are exacerbation of chronic obstructive pulmonary disease (COPD), status asthmaticus, severe forms of pneumonia, adult respiratory distress syndrome (ARDS), various complications of the postoperative period.
Causes of Acute Respiratory Failure
Brain
- Diseases (encephalitis, meningitis, etc.)
- Cerebral circulation disorders
- Traumatic brain injury
- Poisoning (overdose) with narcotic, sedative and other drugs
Spinal cord
- Injury
- Diseases (Guillain-Barré syndrome, poliomyelitis, amyotrophic lateral sclerosis)
Neuromuscular system
- Diseases (myasthenia gravis, tetanus, botulism, peripheral neuritis, multiple sclerosis)
- The use of curariform drugs and other blockers of neuromuscular transmission
- Poisoning with organophosphates (insecticides)
- Hypokalemia, hypomagnesemia, hypophosphatemia
Chest and pleura
- Chest trauma
- Pneumothorax, pleural effusion
- Diaphragm paralysis
Airways and alveoli
- Obstructive sleep apnea with unconsciousness
- Upper airway obstruction (foreign bodies, inflammatory disease, post-intubation laryngeal edema, anaphylaxis)
- Tracheal obstruction
- Bronchopulmonary aspiration
- Asthmatic status
- Massive bilateral pneumonia
- Atelectasis
- Exacerbation of chronic lung disease
- Lung contusion
- Sepsis
- Toxic pulmonary edema
The cardiovascular system
- Cardiogenic pulmonary edema
- Pulmonary embolism
Factors contributing to the development of ARF
- Increased pressure in the pulmonary artery system
- Excess fluid
- Decrease in colloidal osmotic pressure
- Pancreatitis, peritonitis, intestinal obstruction
- Obesity
- Old age
- Smoking
- Dystrophy
- Kyphoscoliosis
ARF arises as a result of disturbances in the chain of regulatory mechanisms, including the central regulation of respiration, neuromuscular transmission and gas exchange at the level of the alveoli.
The defeat of the lungs, one of the first "target organs", is due to both the pathophysiological changes characteristic of critical states and the functional features of the lungs - their participation in many metabolic processes. These conditions are often complicated by the development of a nonspecific reaction, which is realized by the immune system. The response to the primary effect is explained by the action of mediators - arachidonic acid and its metabolites (prostaglandins, leukotrienes, thromboxane A2, serotonin, histamine, B-epinephrine, fibrin and its decay products, complement, superoxide radical, polymorphonuclear leukocytes, platelets, free fatty acids, bradykinins, proteolytic and lysosomal enzymes). These factors, combined with primary stress exposure, cause increased vascular permeability leading to capillary leakage syndrome, i.e. pulmonary edema.
Thus, the etiological factors of ARF can be combined into two groups - extrapulmonary and pulmonary.
Extrapulmonary factors:
- lesions of the central nervous system (centrogenic ODN);
- lesions of the neuromuscular apparatus (neuromuscular ODN);
- chest and diaphragm lesions (thoracoabdominal ARF);
- other extrapulmonary causes (left ventricular failure, sepsis, electrolyte imbalance, energy deficiency, excess fluid, uremia, etc.).
Pulmonary factors:
- airway obstruction (obstructive ARF);
- damage to the bronchi and lungs (bronchopulmonary ODN);
- impaired ventilation due to poor lung compliance (restrictive ODN);
- disruption of diffusion processes (alveolocapillary, block diffusion ODN);
- pulmonary circulation disorders.
Clinical picture.
In acute respiratory disorders, arterial blood oxygenation and carbon dioxide excretion are impaired. In some cases, the phenomena of arterial hypoxemia predominate - this form of disturbance is usually called hypoxemic respiratory failure. Since hypoxemia is most common in parenchymal pulmonary processes, it is also called parenchymal respiratory failure. In other cases, the phenomena of hypercapnia predominate - hypercapnic, or ventilation, a form of respiratory failure.
Hypoxemic form of ODN.
The causes of this form of respiratory failure can be: pulmonary shunt (blood discharge from right to left), inadequacy of ventilation and blood flow, alveolar hypoventilation, diffusion disorders and changes in the chemical properties of hemoglobin. It is important to identify the cause of the hypoxemia. Alveolar hypoventilation is easy to determine when examining PaCO 2. Arterial hypoxemia, which occurs with changes in the ventilation / blood flow ratio or with diffusion restriction, is usually eliminated by supplemental oxygen administration. In this case, the inhaled fraction of oxygen (ROS) does not exceed 5%, i.e. is equal to 0.5. In the presence of a shunt, an increase in HFK has very little effect on the level of oxygen in arterial blood. Carbon monoxide poisoning does not lead to a decrease in PaO 2, but is accompanied by a significant decrease in the oxygen content in the blood, since part of the hemoglobin is replaced by carboxyhemoglobin, which is unable to carry oxygen.
The hypoxemic form of ODN can occur against a background of low, normal, or high levels of carbon dioxide in the blood. Arterial hypoxemia leads to a restriction of oxygen transport to the tissues. This form of ARF is characterized by a rapidly progressive course, mild clinical symptoms and the possibility of death within a short period of time. The most common causes of hypoxemic ARF are ARDS, chest and lung trauma, and airway obstruction.
In the diagnosis of the hypoxemic form of ARF, attention should be paid to the nature of breathing: inspiratory stridor - in case of violations of the patency of the upper airways, expiratory dyspnea - in case of broncho-obstructive syndrome, paradoxical breathing - in case of chest trauma, progressive oligopnea (shallow breathing, decreased MOU) with the possibility of apnea. Other clinical signs are not expressed. Initially, tachycardia with moderate arterial hypertension. From the very beginning, nonspecific neurological manifestations are possible: inadequacy of thinking, confusion of consciousness and speech, lethargy, etc. Cyanosis is not pronounced, only with the progression of hypoxia, it becomes intense, consciousness is suddenly disturbed, then coma (hypoxic) occurs with the absence of reflexes, blood pressure falls, and cardiac arrest occurs. The duration of hypoxemic ARF can range from several minutes (with aspiration, asphyxia, Mendelssohn's syndrome) to several hours and days (ARDS).
Thus, the main thing in the doctor's tactics is to quickly establish a diagnosis, the cause that caused ARF, and take urgent emergency measures to treat this condition.
Hypercapnic form of ODN.
Hypercapnic ARF includes all cases of acute hypoventilation of the lungs, regardless of the cause of the occurrence: 1) central origin; 2) caused by neuromuscular disorders; 3) hypoventilation in chest trauma, asthmatic condition, chronic obstructive pulmonary disease (COPD).
Unlike hypoxemic, hypercapnic ARF is accompanied by many clinical manifestations that depend on the stimulation of the adrenergic system in response to an increase in PaCO 2. The increase in PCO 2 leads to the stimulation of the respiratory center, which should result in a significant increase in all parameters of external respiration. However, this does not happen due to the pathological process. If this is accompanied by active oxygenation, then apnea may occur as a result of depression of the respiratory center. The increase in blood pressure with hypercapnia is usually more significant and persistent than with hypoxia. It can rise up to 200 mm Hg. and more, and the cerebral symptoms are the more pronounced, the slower the development of hypercapnia. In pulmonary heart disease, arterial hypertension is less pronounced and turns into hypotension due to decompensation of the right heart. The very characteristic symptoms of hypercapnia are significant sweating and lethargy. If you help the patient to clear his throat and eliminate bronchial obstruction, then lethargy disappears. Hypercapnia is also characterized by oliguria, which is always present in severe respiratory acidosis.
Decompensation of the state occurs at the moment when the high level of PCO 2 in the blood ceases to stimulate the respiratory center. Signs of decompensation are a sharp decrease in the MOU, circulatory disorders and the development of coma, which, with progressive hypercapnia, is a CO 2 anesthesia. PaCO 2 in this case reaches 100 mm Hg, but coma may occur earlier due to the existing hypoxemia. At this stage, it is necessary not only to carry out oxygenation, but also mechanical ventilation to eliminate carbon dioxide. The development of shock against the background of a coma means the onset of rapid damage to the cellular structures of the brain, internal organs and tissues.
Clinical signs of progressive hypercapnia:
- breathing disorders (shortness of breath, gradual decrease in respiratory and minute volumes of respiration, oligopnea, bronchial hypersecretion, unexpressed cyanosis);
- growing neurological symptoms (indifference, aggressiveness, agitation, lethargy, coma);
- cardiovascular disorders (tachycardia, persistent increase in blood pressure, then decompensation of cardiac activity, hypoxic cardiac arrest against the background of hypercapnia).
Diagnosis of ARF is based on clinical signs and changes in arterial blood gases and pH.
Signs of ONE:
- acute respiratory failure (oligopnea, tachypnea, bradypnea, apnea, pathological rhythms);
- progressive arterial hypoxemia (RaO 2< 50 мм рт.ст. при дыхании воздухом);
- progressive hypercapnia (PaCO 2> 50 mm Hg);
- NS< 7,3
All these signs are not always detected. The diagnosis is made if at least two of them are present.
Acute respiratory failure- this is the inability of the respiratory system to provide oxygen and carbon dioxide excretion, which is necessary to maintain the normal functioning of the body.
Acute respiratory failure (ARF) is characterized by rapid progression, when in a few hours, and sometimes minutes, the patient may die.
Causes
- Airway obstruction: tongue retraction, foreign body obstruction of the larynx or trachea, laryngeal edema, severe laryngospasm, hematoma or swelling, bronchospasm, chronic obstructive pulmonary disease and bronchial asthma.
- Injuries and diseases: injuries of the chest and abdomen; respiratory distress syndrome or "shock lung"; pneumonia, pneumosclerosis, emphysema, atelectasis; thromboembolism of the branches of the pulmonary artery; fat embolism, amniotic fluid embolism; sepsis and anaphylactic shock; convulsive syndrome of any origin; myasthenia gravis; Guillain-Barré syndrome, erythrocyte hemolysis, blood loss.
- Exo- and endogenous intoxication (opiates, barbiturates, CO, cyanides, methemoglobin-forming substances).
- Injuries and diseases of the brain and spinal cord.
Diagnostics
According to the severity, ARF is divided into three stages.
- 1st stage... Patients are agitated, tense, often complain of headache, insomnia. NPV up to 25-30 per minute. The skin is cold, pale, moist, cyanosis of the mucous membranes, nail beds. Blood pressure, especially diastolic, is increased, tachycardia is noted. SpO2< 90%.
- 2nd stage... Consciousness is confused, motor excitement, NPV up to 35-40 in 1 min. Severe cyanosis of the skin, accessory muscles take part in respiration. Persistent arterial hypertension (except in cases of pulmonary embolism), tachycardia. Involuntary urination and defecation. With a rapid increase in hypoxia, convulsions may occur. There is a further decrease in O2 saturation.
- 3rd stage... Hypoxemic coma. Consciousness is absent. Breathing can be infrequent and shallow. Convulsions. The pupils are dilated. The skin is cyanotic. Blood pressure is critically reduced, arrhythmias are observed, often tachycardia is replaced by bradycardia.
Respiratory failure is a pathology that complicates the course of most diseases of internal organs, as well as conditions caused by structural and functional changes in the chest. To maintain gas homeostasis, the respiratory tract of the lungs, airways and chest must work in a tense mode.
External respiration provides oxygen to the body and removes carbon dioxide. When this function is impaired, the heart begins to beat hard, the number of red blood cells in the blood increases, and the level of hemoglobin rises. Enhanced work of the heart is the most important element in compensating for insufficiency of external respiration.
In the later stages of respiratory failure, compensatory mechanisms fail, the functional capabilities of the body decrease, and decompensation develops.
Etiology
Pulmonary causes include disturbances in the processes of gas exchange, ventilation and perfusion in the lungs. They develop with croupous, lung abscesses, cystic fibrosis, alveolitis, hemothorax, hydrothorax, water aspiration during drowning, traumatic chest injury, silicosis, anthracosis, congenital lung malformations, breast deformities.
Extrapulmonary causes include:
Alveolar hypoventilation and bronchial obstruction are the main pathological processes of respiratory failure.
At the initial stages of the disease, compensation reactions are activated, which eliminate hypoxia and the patient feels satisfactory. With pronounced violations and changes in the gas composition of the blood, these mechanisms do not cope, which leads to the development of characteristic clinical signs, and in the future - severe complications.
Symptoms
Respiratory failure is acute and chronic. The acute form of pathology arises suddenly, develops rapidly and poses a threat to the patient's life.
In case of primary insufficiency, the structures of the respiratory tract and respiratory organs are directly affected. Its reasons are:
- Pain with fractures and other injuries of the sternum and ribs,
- Bronchial obstruction with inflammation of the small bronchi, compression of the airways by a neoplasm,
- Hypoventilation and lung dysfunction
- Damage to the respiratory centers in the cerebral cortex - TBI, narcotic or drug poisoning,
- The defeat of the respiratory muscles.
Secondary respiratory failure is characterized by damage to organs and systems that are not part of the respiratory complex:
- Blood loss
- Thrombosis of large arteries,
- Traumatic shock
- Intestinal obstruction
- Accumulation of purulent discharge or exudate in the pleural cavity.
Acute respiratory failure is manifested by rather vivid symptoms. Patients complain of a feeling of shortness of breath, shortness of breath, difficulty breathing in and out. These symptoms appear before the rest. Usually tachypnea develops - rapid breathing, which is almost always accompanied by respiratory discomfort. The respiratory muscles are overstrained and require a lot of energy and oxygen to work.
With an increase in respiratory failure, patients become agitated, restless, euphoric. They stop critically assessing their condition and their surroundings. Symptoms of "respiratory discomfort" appear - wheezing, distant wheezing, weakened breathing, tympanitis in the lungs. The skin becomes pale, tachycardia and diffuse cyanosis develop, the wings of the nose swell.
In severe cases, the skin becomes greyish and sticky and moist. As the disease progresses, arterial hypertension is replaced by hypotension, consciousness is suppressed, coma and multiple organ failure develop: anuria, stomach ulcer, intestinal paresis, kidney and liver dysfunction.
The main symptoms of the chronic form of the disease:
- Shortness of breath of various origins;
- Rapid breathing - tachypnea;
- Cyanosis of the skin - cyanosis;
- Enhanced work of the respiratory muscles;
- Compensatory tachycardia,
- Secondary erythrocytosis;
- Edema and arterial hypertension in the later stages.
Palpation is determined by the tension of the muscles of the neck, contraction of the abdominal muscles on exhalation. In severe cases, paradoxical breathing is detected: on inhalation, the stomach is pulled inward, and on exhalation, it moves outward.
In children, pathology develops much faster than in adults due to a number of anatomical and physiological characteristics of the child's body. Babies are more prone to edema of the mucous membrane, the lumen of their bronchi is rather narrow, the secretion process is accelerated, the respiratory muscles are weak, the diaphragm is high, breathing is more shallow, and the metabolism is very intense.
The listed factors contribute to the violation of respiratory patency and pulmonary ventilation.
Children usually develop an upper obstructive type of respiratory failure, which complicates the course, paratonsillar abscess, false croup, acute epiglotitis, pharyngitis, etc. The child's tone of voice changes, and "stenotic" breathing appears.
The degree of development of respiratory failure:
- The first- Difficulty breathing and anxiety of the child, a hoarse, "cock" voice, tachycardia, perioral, intermittent cyanosis, aggravated by anxiety and disappearing when breathing oxygen.
- The second- noisy breathing, which is heard at a distance, sweating, constant cyanosis on a pale background, disappearing in the oxygen tent, cough, hoarseness, retraction of the intercostal spaces, pallor of the nail beds, sluggish, adynamic behavior.
- The third- severe shortness of breath, total cyanosis, acrocyanosis, marbling, pallor of the skin, drop in blood pressure, suppressed reaction to pain, noisy, paradoxical breathing, weakness, weakening of heart sounds, acidosis, muscle hypotension.
- Fourth the stage is terminal and is manifested by the development of encephalopathy, asystole, asphyxia, bradycardia, convulsions, coma.
The development of pulmonary insufficiency in newborns is due to an incompletely mature surfactant system of the lungs, vascular spasms, aspiration of amniotic fluid with original feces, congenital anomalies in the development of the respiratory system.
Complications
Respiratory failure is a serious pathology that requires urgent therapy. The acute form of the disease responds poorly to treatment, leads to the development of dangerous complications and even death.
Acute respiratory failure is a life-threatening pathology that leads to the death of the patient without timely medical care.
Diagnostics
The diagnosis of respiratory failure begins with the study of the patient's complaints, collecting anamnesis of life and illness, clarifying concomitant pathologies. Then the specialist proceeds to examine the patient, paying attention to the cyanosis of the skin, rapid breathing, retraction of the intercostal spaces, listens to the lungs with a phonendoscope.
To assess the ventilation capacity of the lungs and the function of external respiration, functional tests are carried out, during which the vital capacity of the lungs, the peak forced expiratory flow rate, and the minute volume of respiration are measured. To assess the work of the respiratory muscles, the inspiratory and expiratory pressures in the oral cavity are measured.
Laboratory diagnostics includes the study of acid-base balance and blood gas composition.
Additional research methods include radiography and magnetic resonance imaging.
Treatment
Acute respiratory failure develops suddenly and quickly, therefore you need to know how to provide emergency, first aid.
The patient is placed on the right side, the chest is freed from tight clothing. To prevent the tongue from sinking, the head is thrown back, and the lower jaw is pushed forward. Then foreign bodies and phlegm are removed from the pharynx using a gauze pad at home or an aspirator in a hospital.
It is necessary to call the ambulance team, since further treatment is possible only in the intensive care unit.
Video: first aid for acute respiratory failure
Treatment of chronic pathology is aimed at restoring pulmonary ventilation and gas exchange in the lungs, delivering oxygen to organs and tissues, pain relief, as well as eliminating diseases that caused this emergency.
The following therapeutic methods will help restore pulmonary ventilation and airway patency:
After the restoration of respiratory patency, they switch to symptomatic therapy.
In the absence of the effect of the therapy, they switch to surgical treatment - lung transplantation.
Video: lecture on respiratory failure
Acute respiratory failure is an extremely dangerous condition, which is accompanied by a sharp decrease in the level of oxygen in the blood. Such a pathology can occur for various reasons, but regardless of the development mechanism, it poses a serious threat to human life. That is why it is useful for each reader to learn about what such a state is. What symptoms is it accompanied by? What are the first aid rules?
What is Respiratory Failure?
Acute respiratory failure is a pathological syndrome that accompanies changes in the normal blood gas composition. In patients in this state, there is a decrease in oxygen levels with a simultaneous increase in the amount of carbon dioxide in the blood. Respiratory failure is indicated if the oxygen partial pressure is below 50 mm Hg. Art. In this case, the partial pressure of carbon dioxide, as a rule, is above 45 - 50 mm Hg. Art.
In fact, a similar syndrome is characteristic of many diseases of the respiratory, cardiovascular and nervous systems. Developing hypoxia (oxygen starvation) is the most dangerous for the brain and heart muscle - it is these organs that suffer in the first place.
The main mechanisms of respiratory failure
Today, there are several systems for classifying this condition. One of them is based on the development mechanism. If we take into account this very criterion, then the syndrome of respiratory failure can be of two types:
- Respiratory failure of the first type (pulmonary, parenchymal, hypoxemic) is accompanied by a decrease in oxygen levels and partial pressure in arterial blood. This form of pathology is difficult to treat with oxygen therapy. Most often, this condition develops against the background of cardiogenic pulmonary edema, severe pneumonia, or respiratory distress syndrome.
- Respiratory failure of the second type (ventilation, hypercapnic) is accompanied by a significant increase in the level and partial pressure of carbon dioxide in the blood. Naturally, there is a decrease in oxygen levels, but this phenomenon can be easily eliminated with the help of oxygen therapy. As a rule, this form of insufficiency develops against the background of weakness of the respiratory muscles, as well as disruption of the respiratory center or the presence of mechanical defects in the chest.
Classification of respiratory failure by causes of occurrence
Naturally, many people are interested in the reasons for the development of such a dangerous condition. And right away it should be noted that many diseases of the respiratory system (and not only) can lead to a similar result. Depending on the cause of the occurrence, insufficiency of the respiratory system is usually divided into the following groups:
- The obstructive form of insufficiency is associated primarily with the difficulty of air passage through the respiratory tract. A similar condition occurs in diseases such as inflammation of the bronchi, ingress of foreign substances into the airways, as well as pathological narrowing of the trachea, spasm or compression of the bronchi, the presence of a tumor.
- There are other diseases of the respiratory system that lead to failure. For example, the restrictive type of this condition arises against the background of limiting the ability of the lung tissues to expand and collapse - in patients, the depth of inspiration is significantly limited. Failure develops with pneumothorax, exudative pleurisy, as well as the presence of adhesions in the pleural cavity, pneumosclerosis, kyphoscoliosis, limitation of rib mobility.
- Accordingly, mixed (combined) insufficiency combines both factors (changes in lung tissue and obstruction of air flow). Most often, this condition develops against the background of chronic cardiopulmonary diseases.
- Naturally, there are other reasons as well. Respiratory failure of the hemodynamic type is associated with impaired normal blood circulation. For example, a similar phenomenon is observed with thromboembolism and some heart defects.
- There is also a diffuse form of insufficiency, which is associated with a significant thickening of the capillary-alveolar wall. In this case, the penetration of gases through the tissues is disturbed.
Severity of respiratory failure
The severity of the symptoms that accompany respiratory failure also depends on the severity of the condition. The severity levels in this case are as follows:
- The first or minor degree of insufficiency is accompanied by shortness of breath, which, however, occurs only with significant physical exertion. At rest, the patient's pulse is about 80 beats per minute. Cyanosis at this stage is either absent altogether, or is mild.
- A second or moderate degree of impairment is accompanied by the onset of shortness of breath even with the usual level of physical activity (for example, when walking). You can clearly see a change in the color of the skin. The patient complains of a constant increase in heart rate.
- At the third, pronounced degree of respiratory failure, shortness of breath appears even at rest. In this case, the patient's pulse increases sharply, cyanosis is pronounced.
In any case, it should be understood that, regardless of the severity, such a condition requires qualified medical care.
Features and causes of acute respiratory failure in children
Unfortunately, respiratory failure in children is not considered a rarity in modern medicine, since a similar condition develops in various pathologies. Moreover, some anatomical and physiological features of the child's body increase the likelihood of a similar problem.
For example, it is no secret to anyone that in some babies the respiratory muscles are very poorly developed, which leads to impaired ventilation. In addition, respiratory failure in children may be associated with narrow airways, physiological tachypnea, and lower surfactant activity. At this age, insufficient work of the respiratory system is most dangerous, because the baby's body is just beginning to develop, and a normal blood gas balance for tissues and organs is extremely important.
The main symptoms of acute respiratory failure
It should be said right away that the clinical picture and the intensity of symptoms directly depend on the type of insufficiency and the severity of the patient's condition. Of course, there are several main signs that you should definitely pay attention to.
The first symptom in this case is shortness of breath. Breathing difficulties can appear both during physical exertion and at rest. Due to such difficulties, the number of respiratory movements is significantly increased. As a rule, cyanosis is also observed. At first, human skin turns pale, after which it acquires a characteristic bluish tint, which is associated with a lack of oxygen.
Acute respiratory failure of the first type is accompanied by a sharp decrease in the amount of oxygen, which leads to disruption of normal hemodynamics, as well as severe tachycardia, a moderate decrease in blood pressure. In some cases, there is a violation of consciousness, for example, a person cannot recall recent events in his memory.
But with hypercapnia (failure of the second type), along with tachycardia, headaches, nausea, and sleep disturbances appear. A sharp increase in carbon dioxide levels can lead to the development of a coma. In some cases, there is an increase in cerebral circulation, a sharp increase in intracranial pressure, and sometimes cerebral edema.
Modern diagnostic methods
Acute respiratory failure requires correct diagnosis, which helps to determine the severity of this condition and to find the causes of its occurrence. To begin with, the doctor must examine the patient, measure the pressure, determine the presence of cyanosis, count the number of respiratory movements, etc. In the future, a laboratory analysis of the blood gas composition will be required.
After the patient is provided with first aid, additional studies are carried out. In particular, the doctor must study the functions of external respiration - tests such as peak flowmetry, spirometry and other functional tests are performed. X-ray allows you to detect lesions of the chest, bronchi, lung tissue, blood vessels, etc.
Acute Respiratory Failure: Emergency
Often, this condition develops unexpectedly and very quickly. That is why it is important to know about what the first aid looks like for respiratory failure. First of all, you need to give the patient's body the correct position - for this purpose, doctors recommend laying the person on a flat surface (floor), preferably on his side. In addition, you need to tilt the patient's head back and try to push the lower jaw forward - this will help prevent the tongue from sinking and blocking the airways. Naturally, call the ambulance team, since further treatment is possible only in a hospital setting.
There are some other measures that acute respiratory failure sometimes requires. Urgent care may also include cleansing mucus and debris from the mouth and throat (if you can). When respiratory movements stop, it is advisable to perform mouth-to-nose or mouth-to-mouth artificial respiration.
Chronic respiratory failure
Of course, this form of pathology is also quite common. Chronic respiratory failure, as a rule, develops over the years against the background of certain diseases. For example, chronic or acute bronchopulmonary diseases may be the cause. Failure can result from damage to the central nervous system, pulmonary vasculitis, and lesions of peripheral muscles and nerves. Some cardiovascular diseases, including hypertension of the pulmonary circulation, can also be attributed to risk factors. Sometimes the chronic form occurs after incorrectly performed or incomplete treatment of acute failure.
For quite a long time, the only symptom of this condition may be shortness of breath, which occurs with physical exertion. As the pathology progresses, the signs become brighter - pallor appears, and then cyanosis of the skin, frequent diseases of the respiratory system are observed, patients complain of constant weakness and fatigue.
As for the treatment, it depends on the cause of the development of chronic failure. For example, patients are recommended to undergo therapy for certain diseases of the respiratory system, drugs are prescribed to correct the work of the cardiovascular system, etc.
In addition, it is necessary to restore the normal blood gas balance - for this purpose, oxygen therapy, special drugs that stimulate breathing, as well as breathing exercises, special gymnastics, spa treatment, etc. are used.
Modern methods of treatment
Respiratory failure syndrome in the absence of therapy will sooner or later be fatal. That is why in no case should you refuse medical appointments or ignore the recommendations of a specialist.
Respiratory failure treatment has two goals:
- First of all, it is necessary to restore and maintain normal blood ventilation and normalize the gas composition of the blood.
- In addition, it is extremely important to find the primary cause of the development of failure and eliminate it (for example, prescribe appropriate therapy for pneumonia, pleurisy, etc.).
The technique for restoring ventilation and blood oxygenation depends on the patient's condition. Oxygen therapy is performed first. If a person can breathe on their own, then additional oxygen is supplied through a mask or nasal catheter. If the patient is in a coma, the doctor performs intubation and then connects the ventilator.
Further treatment directly depends on the cause of the development of the deficiency. For example, antibiotic therapy is indicated in the presence of infections. In order to improve the drainage function of the bronchi, mucolytic and bronchodilator drugs are used. In addition, therapy may include chest massage, physiotherapy exercises, ultrasound inhalations, and other procedures.
What complications are possible?
It is worth emphasizing once again that acute respiratory failure is a real threat to human life. In the absence of timely medical care, the likelihood of death is high.
In addition, there are other dangerous complications. In particular, with oxygen deficiency, the central nervous system suffers primarily. Over time, damage to the brain can lead to a gradual extinction of consciousness up to a coma.
Often, against the background of respiratory failure, the so-called multiple organ failure develops, which is characterized by disruption of the intestines, kidneys, liver, the appearance of gastric and intestinal bleeding.
Chronic insufficiency is no less dangerous, which primarily affects the work of the cardiovascular system. Indeed, in such a state, the heart muscle does not receive enough oxygen - there is a risk of developing right ventricular heart failure, hypertrophy of parts of the myocardium, etc.
That is why in no case should you ignore the symptoms. Moreover, it is extremely important to know about the main symptoms of such a dangerous condition, as well as about what first aid looks like in acute respiratory failure - the right actions can save a person's life.
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