Emergency care for one. Acute respiratory failure of mixed origin. Treatment of chronic respiratory failure

When a person has acute respiratory failure, the organs cannot get enough oxygen to function properly. Acute tissue oxygen deprivation can develop if the lungs cannot eliminate carbon dioxide from the blood on their own. This is one of the emergencies that occurs against the background of a violation of external respiration. The main reasons for this complication are various mechanical obstacles that impair breathing, allergic or inflammatory edema, spasms in the bronchi and pharynx. Since this process interferes with normal breathing, it is necessary to know the rules of first aid in order to preserve the health and life of a person.

What is acute respiratory failure?

Respiratory failure is a condition in which gas exchange in the lungs is impaired, resulting in low blood oxygen levels and high carbon dioxide levels. There are two types of respiratory failure. In the first case, the oxygen that enters the lungs to be delivered to the rest of the body is not enough. This can lead to further problems because the heart, brain, and other organs need an adequate supply of oxygen-rich blood. This is called hypoxemic respiratory failure because respiratory failure is caused by low oxygen levels in the blood. Another type is hypercapnic respiratory failure, which results from high levels of carbon dioxide in the blood. Both types can be present at the same time.

To understand the process of respiration, one must know how gas exchange occurs. Air initially enters through the nose or mouth into the trachea, then passes through the bronchi, bronchioles, and enters the alveoli, the air sacs, where gas exchange occurs. Capillaries pass through the walls of the alveoli. It is here that oxygen is efficiently passed through the walls of the alveoli and enters the blood, while simultaneously moving carbon dioxide from the blood to the air sacs. If acute respiratory failure occurs, then oxygen does not enter the body in sufficient quantities. Accordingly, the state of health worsens, the organs and the brain do not receive oxygen, the consequences appear immediately after the onset of the attack. If it is not stopped in time, then the person will most likely die.

Symptoms of respiratory failure

Acute respiratory failure can occur in various pathological conditions in the body.. Any form of injury that compromises the airways can significantly affect blood gases. Respiratory failure depends on the amount of carbon dioxide and oxygen present in the blood. If carbon dioxide levels are elevated and blood oxygen levels are low, the following symptoms may occur:

  • cyanosis of the fingertips, tip of the nose, lips;
  • increased anxiety;
  • confusion of consciousness;
  • drowsiness;
  • increase in heart rate;
  • change in the rhythm of breathing;
  • extrasystole or arrhythmia;
  • profuse sweating.

Causes of acute respiratory failure

One of the most common causes of respiratory failure is the obstruction of the lumen of the respiratory tract after vomiting, bleeding, or ingestion of small foreign objects. Cases of acute respiratory failure can be in medicine. For example, in dentistry, practitioners often encounter forms of insufficiency such as stenotic or obstructive. Stenotic asphyxia is the result of allergic edema. Obstructive asphyxia can be caused by entry into the respiratory tract of various objects used in treatment, such as a tooth, gauze sponges, or impression materials. From this, a person begins to suffocate and, again, oxygen in sufficient quantities does not enter the body.

In the case of acute asphyxia, the patient's breathing becomes frequent with a further stop. The patient may have convulsions, tachycardia. Against the background of asphyxia, the patient's skin becomes gray, the pulse is weak, consciousness is disturbed. It is important that the medical staff act immediately and accurately if this happened in the hospital, if not, first aid must be provided so that the person survives before the arrival of the SP team. The danger is that there is no time to think. The lack of oxygen begins to destroy cells. At any moment, either the brain or one of the vital organs can fail, and the loss of consciousness will only aggravate the situation.

There are various other causes of acute respiratory failure that you should be familiar with. The most important factor in the health of any person is his lifestyle. Since medical intervention rarely leads to shortness of breath and asthma attacks. The reasons for the development of this condition should be sought precisely in your usual way of life. In addition, if an attack begins due to surgical intervention, the doctors will quickly orient themselves and provide the necessary assistance. As for other situations, no one guarantees that a person with a medical education will be nearby. Therefore, doctors themselves advise avoiding factors that are a potential cause of acute respiratory failure.

Main reasons:

  • medical intervention in the nasopharynx or oral cavity;
  • trauma;
  • acute respiratory distress syndrome;
  • chemical inhalation;
  • alcohol abuse;
  • stroke;
  • infection.

Any form of injury that compromises the airways can significantly affect the amount of oxygen in the blood. Try not to injure your body. Acute respiratory distress syndrome is a serious disease that occurs against the background of an inflammatory process in the lungs, determined by a violation of the diffusion of gases in the alveoli and a low oxygen content in the blood. Also, the attack leads to the so-called "chemical inhalation" - the inhalation of toxic chemicals, vapors or smoke, which can lead to acute respiratory failure.

Alcohol or drug abuse is not the last cause of an attack. An overdose of them can disrupt the brain and stop the ability to inhale or exhale. A stroke in itself causes disruptions in the body, not only the brain and heart suffer, but also the respiratory system. Infection is the most common cause of respiratory distress syndrome.

First aid for acute respiratory failure

The goal of treatment and prevention of respiratory failure is to saturate the body with oxygen and reduce the level of carbon dioxide in the body. Treating an attack may include eradicating the underlying causes. If you notice a person has acute respiratory failure, then the following steps should be taken. First, immediately seek emergency medical attention - call an ambulance. Then, the victim needs to be given first aid.

Check circulation, airways and breathing. To check the pulse, place two fingers on the neck to check for breathing, tilt your cheek between the victim's nose and lips, and feel the breath. Watch for chest movements. Do all the necessary manipulations within 5-10 seconds. If the person has stopped breathing, give artificial respiration. With your mouth open, pinch your nose and press your lips to the victim's mouth. Breathe in. If necessary, repeat the manipulation several times. Continue mouth-to-mouth resuscitation until medical personnel arrive.

As for treatment in the hospital, it is usually based on the complete elimination of the attack. The doctor will eliminate respiratory failure with the help of drugs to improve breathing. If the person can adequately breathe on their own and the hypoxemia is mild, oxygen can be given from a special canister (a portable air reservoir is always available if needed). In the event that a person cannot breathe on their own, the doctor will insert a breathing tube into the nose or mouth and “connect” a ventilator to the machine to assist with breathing.

(ODN) is a pathological syndrome characterized by a sharp decrease in the level of blood oxygenation. Refers to life-threatening, critical conditions that can lead to death. Early signs of acute respiratory failure are: tachypnea, suffocation, feeling short of breath, agitation, cyanosis. As hypoxia progresses, impaired consciousness, convulsions, and hypoxic coma develop. The fact of the presence and severity of respiratory disorders is determined by the gas composition of the blood. First aid consists in eliminating the cause of ARF, oxygen therapy, and, if necessary, mechanical ventilation.

ICD-10

J96.0 Acute respiratory failure

General information

Violation of neuromuscular conduction leads to paralysis of the respiratory muscles and can cause acute respiratory failure with botulism, tetanus, poliomyelitis, an overdose of muscle relaxants, myasthenia gravis. Thoraco-diaphragmatic and parietal ARF are associated with limited mobility of the chest, lungs, pleura, and diaphragm. Acute respiratory disorders may be accompanied by pneumothorax, hemothorax, exudative pleurisy, chest trauma, rib fractures, and posture disorders.

The most extensive pathogenetic group is broncho-pulmonary acute respiratory failure. ARF of the obstructive type develops as a result of impaired airway patency at various levels. The cause of obstruction can be foreign bodies of the trachea and bronchi, laryngospasm, status asthmaticus, bronchitis with mucus hypersecretion, strangulation asphyxia, etc. Restrictive ORF occurs during pathological processes accompanied by a decrease in the elasticity of the lung tissue (croupous pneumonia, hematomas, lung atelectasis, drowning, conditions after extensive lung resections, etc.). The diffuse form of acute respiratory failure is due to a significant thickening of the alveolo-capillary membranes and, as a result, the difficulty of oxygen diffusion. This mechanism of respiratory failure is more typical for chronic lung diseases (pneumoconiosis, pneumosclerosis, diffuse fibrosing alveolitis, etc.), but it can also develop acutely, for example, with respiratory distress syndrome or toxic lesions.

Secondary acute respiratory failure occurs due to lesions that do not directly affect the central and peripheral organs of the respiratory apparatus. So, acute respiratory disorders develop with massive bleeding, anemia, hypovolemic shock, arterial hypotension, pulmonary embolism, heart failure and other conditions.

Classification

The etiological classification divides ARF into primary (due to a violation of the mechanisms of gas exchange in the lungs - external respiration) and secondary (due to a violation of oxygen transport to tissues - tissue and cellular respiration).

Primary acute respiratory failure:

  • centrogenous
  • neuromuscular
  • pleurogenic or thoraco-diaphragmatic
  • broncho-pulmonary (obstructive, restrictive and diffuse)

Secondary acute respiratory failure due to:

  • hypocirculatory disorders
  • hypovolemic disorders
  • cardiogenic causes
  • thromboembolic complications
  • shunting (depositing) of blood in various shock conditions

These forms of acute respiratory failure will be discussed in detail in the "Causes" section.

In addition, there are ventilation (hypercapnic) and parenchymal (hypoxemic) acute respiratory failure. Ventilatory DN develops as a result of a decrease in alveolar ventilation, accompanied by a significant increase in pCO2, arterial hypoxemia, and respiratory acidosis. As a rule, it occurs against the background of central, neuromuscular and thoraco-diaphragmatic disorders. Parenchymal DN is characterized by arterial hypoxemia; while the level of CO2 in the blood may be normal or slightly elevated. This type of acute respiratory failure is a consequence of broncho-pulmonary pathology.

Depending on the partial voltage of O2 and CO2 in the blood, three stages of acute respiratory disorders are distinguished:

  • ODN stage I– pO2 decreases to 70 mm Hg. Art., pCO2 up to 35 mm Hg. Art.
  • ODN stage II- pO2 decreases to 60 mm Hg. Art., pCO2 increases to 50 mm Hg. Art.
  • ARF stage III- pO2 decreases to 50 mm Hg. Art. and below, pCO2 increases to 80-90 mm Hg. Art. and higher.

Symptoms of ARF

The sequence, severity and rate of development of signs of acute respiratory failure may vary in each clinical case, however, for the convenience of assessing the severity of disorders, it is customary to distinguish three degrees of ARF (in accordance with the stages of hypoxemia and hypercapnia).

ODN I degree(compensated stage) is accompanied by a feeling of lack of air, anxiety of the patient, sometimes euphoria. The skin is pale, slightly moist; there is a slight cyanosis of the fingers, lips, tip of the nose. Objectively: tachypnea (RR 25-30 per minute), tachycardia (HR 100-110 per minute), moderate increase in blood pressure.

At ODN II degrees(stage of incomplete compensation) psychomotor agitation develops, patients complain of severe suffocation. Possible confusion, hallucinations, delirium. The color of the skin is cyanotic (sometimes with hyperemia), profuse sweating is observed. At the II stage of acute respiratory failure, the respiratory rate continues to increase (up to 30-40 per 1 minute), pulse (up to 120-140 per minute); arterial hypertension .

ODN III degree(stage of decompensation) is marked by the development of hypoxic coma and tonic-clonic convulsions, indicating severe metabolic disorders of the central nervous system. Pupils dilate and do not react to light, spotted cyanosis of the skin appears. Respiratory rate reaches 40 or more per minute, respiratory movements are superficial. A formidable prognostic sign is the rapid transition of tachypnea to bradypnea (RR 8-10 per minute), which is a harbinger of cardiac arrest. Arterial pressure drops critically, heart rate over 140 per minute. with arrhythmias. Acute respiratory failure of the III degree, in fact, is the preagonal phase of the terminal state and, without timely resuscitation, leads to a rapid death.

Diagnostics

Often, the picture of acute respiratory failure unfolds so rapidly that it leaves little time for advanced diagnostics. In these cases, the doctor (pulmonologist, resuscitator, traumatologist, etc.) quickly assesses the clinical situation to determine the possible causes of ARF. When examining a patient, it is important to pay attention to the patency of the airways, the frequency and characteristics of breathing, the involvement of auxiliary muscles in the act of breathing, the color of the skin, heart rate. In order to assess the degree of hypoxemia and hypercapnia, the diagnostic minimum includes the determination of the gas composition and acid-base state of the blood.

At the first stage, it is necessary to examine the patient's oral cavity, remove foreign bodies (if any), aspirate the contents from the respiratory tract, and eliminate the retraction of the tongue. In order to ensure airway patency, it may be necessary to impose a tracheostomy, a conicotomy or tracheotomy, therapeutic bronchoscopy, and postural drainage. With pneumo- or hemothorax, drainage of the pleural cavity is performed; with bronchospasm, glucocorticosteroids and bronchodilators are used (systemically or by inhalation). Further, humidified oxygen should be immediately provided (using a nasal catheter, mask, oxygen tent, hyperbaric oxygen, mechanical ventilation).

In order to correct concomitant disorders caused by acute respiratory failure, drug therapy is carried out: for pain syndrome, analgesics are prescribed; in order to stimulate respiration and cardiovascular activity - respiratory analeptics and cardiac glycosides; to eliminate hypovolemia, intoxication - infusion therapy, etc.

Forecast

The consequences of acute respiratory failure are always serious. The prognosis is influenced by the etiology of the pathological condition, the degree of respiratory disorders, the speed of first aid, age, and initial status. With rapidly developing critical disorders, death occurs as a result of respiratory or cardiac arrest. With less severe hypoxemia and hypercapnia, the rapid elimination of the cause of acute respiratory failure, as a rule, a favorable outcome is observed. To exclude repeated episodes of ARF, intensive treatment of the background pathology, which entailed life-threatening respiratory disorders, is necessary.

The term acute respiratory failure defines a pathological condition in which the function of external respiration is sharply impaired. This leads to a decrease in the supply of oxygen to the blood with the development of hypoxia (a state of insufficient supply of oxygen to all cells and tissues of the body, followed by a violation of energy metabolic processes occurring with its participation). Respiratory failure is a life-threatening condition for a child, so it requires prompt assistance to restore the function of external respiration.

Development mechanism

External respiration is provided by the structures of the respiratory system, namely the respiratory tract, through which the inhaled air enters the alveoli of the lungs, where gas exchange takes place between the blood (oxygen binds to hemoglobin, and carbon dioxide from the blood enters back into the alveoli). Violation of the function of external respiration most often in its development has several pathogenetic mechanisms leading to a violation of the passage of air through the respiratory tract:

Various mechanisms of development of acute respiratory failure require appropriate approaches in emergency therapy. The provision of care at the prehospital stage is almost the same.

The reasons

Acute respiratory failure is a polyetiological pathological condition, the development of which can be caused by a significant number of causes. The most common of these in children are:

Under the influence of these causes, various mechanisms for the development of a pathological condition are realized, which require appropriate therapeutic approaches aimed at eliminating their impact.

Clinical symptoms

Against the background of acute respiratory failure, hypoxia develops, from which neurocytes (cells of the nervous system) of the brain primarily suffer. As a result, the clinical picture is dominated by manifestations of impaired functional activity of the central nervous system, these include:

  • Euphoria is a state of unmotivated joy and mood elevation, which is the first manifestation of insufficient oxygen supply to the brain cells.
  • Decreased concentration of attention (ability to concentrate), increased speech arousal, accompanied by talkativeness.
  • Emotional disorders, accompanied by increased resentment, irritability, tearfulness, an uncritical assessment of the child's own condition.
  • Decreased motor activity (pronounced hypodynamia).
  • Inhibition of various types of reflexes (skin, tendon, periosteal).
  • The state of decortication is a critical decrease in the functional activity of the cerebral cortex with the preserved activity of subcortical structures. This condition is accompanied by loss of consciousness, motor excitation, moderate dilation of the pupils with their sluggish reaction to light, absence of skin reflexes with increased tendon and periosteal reflexes.
  • The development of hypoxic coma is an extreme degree of hypoxia of the structures of the nervous system, manifested by a lack of consciousness, reactions to various types of stimuli, a significant expansion of the pupils with their absence of reaction to light, dry eyes with a decrease in luster, and movement of the eyeballs in different directions.

In addition to manifestations of inhibition of the activity of the structures of the central nervous system, acute respiratory failure is also accompanied by various respiratory disorders in the form of shortness of breath, difficulty in inhaling or exhaling, remote wheezing, dry or wet cough. The color of the skin becomes bluish (cyanosis).

Help

First of all, with the appearance of even minimal signs of the development of acute respiratory failure, an ambulance should be called. Prior to her arrival, it is necessary to perform a number of measures aimed at improving blood oxygen saturation and reducing signs of hypoxia:

After the arrival of medical specialists, the hospital stage of care begins. After assessing the child's condition, the severity of hypoxia, the possible causes of its development, various drugs are administered, inhalations with oxygen are carried out. If it is impossible to restore patency for air in the larynx, a tracheostomy is performed.

Acute respiratory failure It is the inability of the respiratory system to provide the supply of oxygen and the removal of carbon dioxide necessary to maintain the normal functioning of the body.

Acute respiratory failure (ARF) is characterized by rapid progression, when after a few hours, and sometimes minutes, the patient may die.

The reasons

  • Respiratory tract disorders: retraction of the tongue, foreign body obstruction of the larynx or trachea, laryngeal edema, severe laryngospasm, hematoma or tumor, 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 intoxications (opiates, barbiturates, CO, cyanides, methemoglobin-forming substances).
  • Injuries and diseases of the brain and spinal cord.

Diagnostics

According to the severity of ARF is divided into three stages.

  • 1st stage. Patients are excited, tense, often complain of headache, insomnia. NPV up to 25-30 in 1 min. The skin is cold, pale, moist, cyanosis of the mucous membranes, nail beds. Arterial pressure, especially diastolic, is increased, tachycardia is noted. SpO2< 90%.
  • 2nd stage. Consciousness is confused, motor excitation, respiratory rate up to 35-40 in 1 min. Severe cyanosis of the skin, auxiliary muscles take part in breathing. Persistent arterial hypertension (except in cases of pulmonary embolism), tachycardia. Involuntary urination and defecation. With a rapid increase in hypoxia, there may be convulsions. A further decrease in O2 saturation is noted.
  • 3rd stage. Hypoxemic coma. Consciousness is absent. Breathing can be rare and superficial. Seizures. The pupils are dilated. The skin is cyanotic. Arterial pressure is critically reduced, arrhythmias are observed, often tachycardia is replaced by bradycardia.

Acute respiratory failure (ARF) is a pathological condition in which even the maximum stress of the body's life support mechanisms is insufficient to supply its tissues with the necessary amount of oxygen and remove carbon dioxide. There are two main types of acute respiratory failure: ventilatory and parenchymal.
Ventilation ORF - insufficiency of ventilation of the entire gas exchange zone of the lungs, occurs with various violations of the airway patency, central regulation of breathing, insufficiency of the respiratory muscles. Characterized by arterial hypoxemia and hypercapnia
Acute parenchymal respiratory failure - inconsistency with the method of ventilation and blood circulation in various parts of the lung parenchyma, which leads to arterial hypoxemia, often combined with hypocapnia due to compensatory hyperventilation of the gas exchange zone of the lungs
Among the most common causes of acute respiratory failure are diseases of the pulmonary parenchyma, pulmonary edema, a prolonged attack of bronchial asthma, asthmatic status, pneumothorax, especially tense, a sharp narrowing of the airways (laryngeal edema, foreign body, compression of the trachea from the outside), multiple fractures of the ribs, diseases that occur with damage to the respiratory muscles (myasthenia gravis, FOV poisoning, poliomyelitis, tetanus, status epilepticus), an unconscious state due to poisoning with hypnotics or cerebral hemorrhage.
Symptoms. There are three degrees of acute respiratory failure.

  1. degree of ODN. Complaints about lack of air. Patients are restless, euphoric. The skin is moist, pale acrocyanosis. The respiratory rate reaches 25-30 per minute (if there is no oppression of the respiratory center). Tachycardia moderate arterial hypertension.
  2. degree of ODN. The patient is agitated, there may be delusions, hallucinations. Severe cyanosis, respiratory rate 35-40 per minute. The skin is moist (may be profuse sweat), heart rate 120-140 per minute, arterial hypertension increases
  3. degree of ODN (limiting). The patient is in a coma, often accompanied by clonic and tonic convulsions. Spotted cyanosis of the skin. The pupils are dilated. RR more than 40 per minute (sometimes RR 8-10 per minute), shallow breathing. The pulse is arrhythmic, frequent, barely palpable. Arterial hypotension

urgenthelp. Ensure free airway patency (retraction of the tongue, foreign bodies), lateral position of the patient, preferably on the right side, airway Aspiration of pathological secretions, vomit, tracheal intubation or tracheostomy or conicotomy. or injecting 1-2 thick needles from infusion sets (internal diameter 2-2.5 mm) below the thyroid cartilage. Oxygen therapy: oxygen is supplied through a nasopharyngeal catheter or mask at a rate of 4-8 l/min, with parenchymal ARF - moderate hyperventilation up to 12 l/min.
Hospitalization Transportation of patients with I and II degrees of ARF should be carried out with an elevated head end, on the side, with II-III degrees - mandatory mechanical ventilation in one way or another during transportation.

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