Respiratory failure ICD 10. Acute respiratory failure. What it is

Respiratory failure - disruption of gas exchange between the surrounding air and the circulating blood with the development of hypoxemia. Gas exchange consists of two stages. Ventilation is the exchange of gases between environment and lungs. Oxygenation - intrapulmonary gas exchange; venous blood releases CO2 and is saturated with O2.

Code by international classification diseases ICD-10:

Causes

Etiology and pathogenesis. Decreased pO2 in inspired air (for example, decreased barometric pressure at high altitude). Airway obstruction (eg, COPD, asthma, cystic fibrosis, bronchiolitis) leads to alveolar hypoventilation with subsequent hypoxemia. Hypoxemia - leading link pathogenesis of respiratory failure. Hypoventilation (hypoxemia) due to lesions of the pulmonary interstitium.. Sarcoidosis.. Pneumoconiosis.. Systemic scleroderma.. SLE.. Hypersensitivity pneumonitis.. Pulmonary interstitial fibrosis.. Metastatic disseminated lung lesions.. Lymphocytic lymphoma.. Histiocytosis. Hypoventilation (hypoxemia) without primary pulmonary pathology.. Anatomical disorders... Anomalies respiratory center... Chest deformities (kyphoscoliosis) ... Structural changes chest wall: rib fractures.. Nervous - muscle diseases... Myasthenia gravis... Myopathies... Poliomyelitis... Polymyositis... Paralysis of the respiratory muscles or their uncoordinated work due to calcium, iron deficiency, sepsis, etc. .. Endocrine pathology... Hypothyroidism... Obesity.. Work overload of the lungs... Hyperventilation... Increased energy costs for breathing: increased aerodynamic resistance with airway obstruction. Hypoxemia without alveolar hypoventilation.. Shunt... Intracardiac for defects with right-to-left shunting... Pulmonary arteriovenous shunts... The presence of completely unventilated but perfused zones in the lung.. Pathologically low pO2 in venous blood due to anemia or heart failure.

Classification. The degree of respiratory failure is usually judged by the severity of shortness of breath, cyanosis and tachycardia. Important sign, allowing to assess the degree of respiratory failure - decreased tolerance to physical activity. There are three degrees of respiratory failure. I degree - the appearance of shortness of breath only during physical exertion. II degree - development of shortness of breath with minor physical exertion. III degree - the appearance of shortness of breath at rest.
Clinico - laboratory diagnostics
. Hypoxemia... Acute hypoxemia leads to rapid violation vital functions important organs(primarily the central nervous system and heart) and coma. Chronic hypoxemia leads to pulmonary vasoconstriction and the development pulmonary heart.
. Hypercapnia.. Acidosis.. Arterial hypotension.. Electrical instability of the heart.. Mental disorders(from mild personality changes to stupor) .. Increased stimulation of the respiratory muscles .. Clinical manifestations Acute and chronic hypercapnia are similar, but acute hypercapnia is more dramatic.
FVD study. Respiratory mechanics assessment. Measuring the ventilation-perfusion ratio - introducing inert gases into a vein, achieving stable gas exchange with the subsequent determination of pO2 in the alveoli and exhaled air.

Treatment

TREATMENT
. Management tactics.. Elimination of the cause of respiratory failure.. Oxygen therapy.. Mechanical ventilation.. Restoration of blood pressure.. Prevention of iatrogenic complications: ... barotrauma... infection... oxygen poisoning.
. Elimination of bronchial obstruction... Bronchodilators, incl. GK at bronchial asthma, vasculitis with damage to the pulmonary vessels, allergic reactions... Removal of bronchial secretions (postural drainage, expectorant drugs, percussion massage).
. Correction of hypoxemia.. Oxygen therapy under the control of the oxygen fraction (FiO2) in the inhaled gas mixture (on average 25-35%, but not more than 60% to avoid oxygen intoxication).. Increasing lung volumes... Vertical body position... Ensuring constant positive pressure in respiratory tract- a non-hardware method for straightening non-functioning alveoli... Positive end-expiratory pressure within 30-50 mm water column. - an important addition to mechanical ventilation.. Maintaining hemodynamics... Infusion therapy with pulmonary artery wedge pressure (PAWP)<15 мм рт.ст. и сниженном cardiac output... Infusion of inotropic agents (dopamine, dobutamine, starting dose - 5 mcg/kg/min) for PAWP >18 mm Hg. and low cardiac output.. Targeted reduction of tissue needs for O2... Elimination of anxiety and possible concomitant pathology (fever, sepsis, convulsions, burns)... Muscle relaxants are effective in excited patients or those who resist the ventilator in the first hours of mechanical ventilation.
. Ventilation.. Indications: ... The need for long-term maintenance of FiO2 in the inhaled mixture >60% during spontaneous breathing... Weakness of the respiratory muscles... Depression of the respiratory center.. Prevention of barotrauma - it is recommended to avoid pressure stretching the alveoli >350 mm water column. and tidal volume >12 ml/kg.

Reduction. PAWP—pulmonary artery wedge pressure.

ICD-10. J96 Respiratory failure, not elsewhere classified

Acute respiratory failure- acutely developed pathological condition, in which severe oxygen deficiency develops. This condition is life-threatening, and without timely medical care may be fatal.

Primary ARF

Device dysfunction external respiration and its regulating systems

  • 1. pain syndrome with respiratory depression (rib fracture, thoracotomy)
  • 2. obstruction of the upper respiratory tract
    • bronchitis and bronchiolitis with hypersecretion of mucus and the development of obstructive atelectasis
    • laryngeal edema
    • foreign body
    • aspiration
  • 3. insufficient functioning of the lung tissue
    • massive bronchopneumonia
  • 4. violation of central regulation of breathing
    • electrical injury
    • overdose of drugs, analeptics
  • 5. insufficient function of the respiratory muscles
    • polio, tetanus, botulism
    • residual effect of muscle relaxants

Secondary ODN

Lesions that are not part of the anatomical complex of the respiratory apparatus

  • massive unrecovered blood loss, anemia
  • acute heart failure with pulmonary edema
  • embolism and thrombosis of the branches of the pulmonary artery
  • intrapleural and extrapleural compression of the lungs
    • paralytic ileus
    • hydrothorax

Classification by mechanism of formation

  • Obstructive ARF
  • Restrictive ODN
  • Hypoventilation ODN
  • Shunt-diffuse ARF

Clinic

Characteristic clinical sign acute respiratory failure is the development of tachypnea, the patient complains of lack of air, suffocation. As hypoxia increases, the patient's excitement is replaced by depression of consciousness, and cyanosis develops. The patient is in a forced position, sitting with his hands resting on the seat, thus facilitating the work of the respiratory muscles. This allows us to differentiate this condition from hysterical fits. During which there are similar complaints and clinical symptoms, but unlike acute respiratory failure, such conditions are not life-threatening and do not require immediate medical attention.

Treatment

General aspects are given in the article: respiratory failure

Treatment this state depends on the reason that led to its development. In case of a foreign body or spasm of the glottis, a conicotomy is performed. For pneumothorax, the pleural cavity is sealed. In case of poisoning with hemic poisons, specific antidotes are used. For severe bronchospasm, glucocorticosteroids are used. If you are unsure of the cause of this condition, you should not do anything until emergency medical services arrive.

Forecast

The prognosis of the disease is relatively favorable; with timely medical care, the ability to work is completely restored. If medical care is not provided, death is possible.

Links


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Books

  • Emergency care at the prehospital stage. Textbook, Lychev Valery Germanovich, Babushkin Igor Evgenievich, Andrienko Alexey Vladimirovich. Tutorial dedicated to emergency therapy as an independent field of medicine. The most common urgent syndromes are described: acute respiratory failure, acute...

The clinical course of chronic respiratory failure depends on the underlying pathology, type and severity of DN. Its most typical manifestations are dyspnea, hypoxemia/hypercapnia effects, and respiratory muscle dysfunction.
The earliest and most universal symptom of CDN is dyspnea, or shortness of breath. Subjectively, this is perceived by patients as a feeling of lack of air, discomfort when breathing, the need to make a respiratory effort, etc. With obstructive DN, the shortness of breath is expiratory in nature (exhalation is difficult), with restrictive shortness of breath it is inspiratory (inhalation is difficult). Shortness of breath with physical exertion long years may serve as the only sign of chronic respiratory failure.
The main clinical sign indicating hypoxemia is cyanosis. Its severity and prevalence indicate the severity of chronic respiratory failure. So, if in the subcompensated stage patients only experience cyanosis of the lips and nail beds, then in the decompensation stage it becomes widespread, and in terminal stage– generalized character. Hemodynamic changes during hypoxemia include tachycardia, arterial hypotension. When PaO2 decreases to 30 mm, syncopal episodes occur.
Hypercapnia in chronic respiratory failure is accompanied by an increase in heart rate, disturbances in the central nervous system (night insomnia and daytime sleepiness, headaches). Signs of dysfunction of the respiratory muscles are changes in respiratory rate and breathing pattern. In most cases, chronic respiratory failure is accompanied by increased breathing (tachypnea). Reducing the RR to 12/min. And it serves less as a formidable harbinger, indicating the possibility of respiratory arrest. Altered breathing patterns include the involvement of additional muscle groups that are not normally involved in breathing (flaring of the wings of the nose, tension of the neck muscles, participation in exhalation abdominal muscles), paradoxical breathing, thoracoabdominal asynchrony.
Clinical classification respiratory failure provides for the identification of four stages.
I (initial). It has a hidden course, masked by the symptoms of the underlying disease. Feelings of shortness of breath and increased breathing occur during physical exertion.
II (subcompensated). Shortness of breath occurs at rest, the patient constantly complains of lack of air, and experiences a feeling of restlessness and anxiety. Additional muscles are involved in the act of breathing, and cyanosis of the lips and fingertips occurs.
III (decompensated). Shortness of breath is pronounced and forces the patient to take a forced position. Accessory muscles are involved in breathing, widespread cyanosis and psychomotor agitation are noted.

Various acute and chronic diseases bronchopulmonary system(bronchiectasis, pneumonia, atelectasis, cavernous cavities, disseminated processes in the lung, abscesses, etc.), central nervous system lesions, anemia, hypertension in the pulmonary circulation, vascular pathology lungs and heart, tumors of the lungs and mediastinum, etc.
Respiratory failure is classified according to a number of characteristics: 1. According to pathogenesis (mechanism of occurrence):
parenchymal (hypoxemic, respiratory or pulmonary failure Type I).
Respiratory failure of the parenchymal type is characterized by a decrease in the content and partial pressure of oxygen in the arterial blood (hypoxemia), which is difficult to correct with oxygen therapy. Most common reasons of this type respiratory failure are pneumonia, respiratory distress syndrome (shock lung), cardiogenic pulmonary edema.
ventilation (“pumping”, hypercapnic or type II respiratory failure).
The leading manifestation of ventilation-type respiratory failure is an increase in the content and partial pressure of carbon dioxide in the arterial blood (hypercapnia). Hypoxemia is also present in the blood, but it responds well to oxygen therapy. The development of ventilation respiratory failure is observed with weakness of the respiratory muscles, mechanical defects in the muscular and rib cage of the chest, and disruption of the regulatory functions of the respiratory center. 2. By etiology (reasons):
obstructive.
Respiratory failure of the obstructive type is observed when it is difficult for air to pass through airways– trachea and bronchi due to bronchospasm, inflammation of the bronchi (bronchitis), foreign bodies, stricture (narrowing) of the trachea and bronchi, compression of the bronchi and trachea by a tumor. In this case, the functionality of the external respiration apparatus suffers: full inhalation and especially exhalation are difficult, the breathing rate is limited.
restrictive (or restrictive).
Respiratory failure of the restrictive type is characterized by limited ability lung tissue to expansion and collapse and occurs with exudative pleurisy, pneumothorax, pneumosclerosis, adhesive process V pleural cavity, limited mobility of the rib frame, kyphoscoliosis Respiratory failure in these conditions develops due to the limitation of the maximum possible depth of inspiration.
combined (mixed).
Respiratory failure of the combined (mixed) type combines signs of obstructive and restrictive types with a predominance of one of them and develops with a long course of cardiopulmonary diseases.
hemodynamic.
The cause of the development of hemodynamic respiratory failure can be circulatory disorders (for example, thromboembolism), leading to the inability to ventilate the blocked area of ​​the lung. The development of hemodynamic-type respiratory failure also results from right-to-left shunting of blood through an open oval window with heart disease. In this case, a mixture of venous and oxygenated arterial blood occurs.
diffuse.
Respiratory failure diffuse type develops when the penetration of gases through the capillary-alveolar membrane of the lungs is impaired due to its pathological thickening. 3. According to the rate of growth of signs:
spicy.
Acute respiratory failure develops rapidly, over a few hours or minutes, is usually accompanied by hemodynamic disturbances and poses a threat to the life of patients (required emergency implementation resuscitation measures And intensive care). The development of acute respiratory failure can be observed in patients suffering from chronic form DN during its exacerbation or decompensation.
chronic.
The development of chronic respiratory failure can occur over several months and years, often gradually, with a gradual increase in symptoms, and can also be a consequence incomplete recovery after acute DN. 4. According to blood gas parameters:
compensated (blood gas composition is normal);
decompensated (presence of hypoxemia or hypercapnia of arterial blood). 5. According to the severity of symptoms of respiratory failure:
DN I degree – characterized by shortness of breath with moderate or significant exertion;
DN II degree - shortness of breath is observed with minor exertion, involvement is noted compensatory mechanisms at rest;

What it is?

Aneurysms associated with the lungs are local dilations of the walls of the vessels that provide blood supply to and outflow from the lungs. WITH respiratory system connected:

  • The pulmonary trunk is an artery that delivers venous blood to the lungs;
  • Own pulmonary arteries - small vessels in lung tissue that is not anatomically connected to the pulmonary trunk. Transport arterial blood;
  • Pulmonary veins - four veins that carry arterial blood;
  • Proper pulmonary veins are small veins with venous blood that are not connected to the pulmonary veins.

Distinctive features:

  1. Progressive course;
  2. Relationship with the underlying disease;
  3. Tendency to thrombosis;
  4. High risk of thromboembolism;
  5. Respiratory failure predominates in the clinic.

The pathology affects people of both sexes. Men and women suffer equally often.

Reasons for development

The lesion may be congenital or acquired. Congenital causative diseases:

  • Stenosis, atresia, hypoplasia of the pulmonary trunk;
  • Congenital heart defects;
  • Cystic fibrosis;
  • Transposition of the great vessels;
  • Pulmonary vein anomalies.

Acquired causative diseases:

  • Acquired heart defects;
  • Chronic obstructive pulmonary disease (COPD);
  • Protracted pneumonia;
  • Pulmonary fibrosis;
  • Emphysema;
  • Bronchial asthma.

Symptoms and treatment

Pulmonary trunk aneurysm

The ICD-10 code is I28.1.

The clinic distinguishes three syndromes:

  1. Respiratory failure;
  2. Hypoxia;
  3. Compression of adjacent anatomical structures.

When an aneurysm is present, the blood flow becomes turbulent. Less and less venous blood passes through the lungs - less blood becomes arterial. Hypoxia (oxygen starvation) occurs.

At large sizes an aneurysm compresses the heart chambers or one of the lungs, simulating the clinic of cardialgia, pleurisy, and inflammation of the mediastinum.

The course is long and steadily progressing. Symptoms are determined by the primary disease.

Prevalence: 2.3 per 100,000 population.

  • Congenital anomalies of the pulmonary trunk;
  • Vices of Fallot;
  • Acquired heart defects.

Based on complaints and clinical presentation, it is impossible to make a diagnosis. Imaging methods are used to confirm the diagnosis:

  • X-ray – reveals an additional arch of the pulmonary trunk;
  • Ultrasound of the heart - turbulent blood flow and a round vascular protrusion associated with the pulmonary trunk;
  • Angiography – determination of the exact location of the aneurysm, thrombosis and bleeding. The pathology is represented by a limited unilateral expansion of the vascular wall, usually filled with a thrombus;
  • CT and MRI - identifying the exact size of the aneurysm, thrombosis and thromboembolism.

Treatment is surgical in 100% of cases due to high risk lethal complications. Types of operations:

  • Aneurysm clipping;
  • Resection of the pulmonary trunk with prosthetics;
  • Stenting of the pulmonary trunk.

Aneurysm of the branches of the pulmonary artery

The ICD-10 code is I28.1.

The pulmonary artery is a common second name for the pulmonary trunk. The concepts are interchangeable and completely synonymous. The pulmonary artery, as it approaches the lungs, is divided into branches, for which the location must be specified. There are two branches:

  • Right (sometimes called the right pulmonary artery);
  • Left (left pulmonary artery).

Aneurysms rarely exceed 0.5-0.8 cm in size. The clinical picture develops slowly, sometimes over years, and is determined primarily by the underlying disease.

Diagnostic criteria:

  • Respiratory failure (increasing shortness of breath, bluish skin);
  • Tachycardia (due to hypoxia);
  • In case of complications – unilateral pain syndrome.

Prevalence: 0.8 per 100,000 population.

  • Congenital anomalies;
  • Acquired heart defects;
  • COPD and bronchial asthma;
  • Emphysema.

Diagnosis is difficult due to nonspecific and mild symptoms. The disease is confirmed by imaging methods:

  • X-ray – decreased intensity of the pulmonary field;
  • Ultrasound – a unilateral vascular protrusion is detected at the point where the artery enters the lung;
  • Angiography – confirmation of localization and possible complications;
  • CT (MRI) – identifying the exact size of the formation and thrombosis.

Surgical treatment:

  1. Clipping of the pathological area;
  2. Stent installation;
  3. Removal of the affected branch with prosthetics.

Disease of other pulmonary vessels

ICD-10 code: I72.8.

Intrapulmonary vessels are rarely affected. In view of small size such aneurysms may remain undetected indefinitely. No complaints. Characterized by rapid thrombus formation followed by calcification, which can be incidentally detected on screening radiography.

In case of rupture and bleeding, the clinic is observed finely focal pneumonia:

  • Unilateral lung pain;
  • Cough;
  • Fever;
  • In case of secondary infection, purulent-hemorrhagic sputum appears.

The frequency of occurrence is 0.1-0.3 per 100,000 population.

Causes:

  • Congenital vascular anomalies;
  • Emphysema;
  • COPD;
  • Bronchial asthma;
  • Cystic fibrosis.

Diagnostics:

  • X-ray – detection of rounded calcification in the lung up to 0.5 cm in size;
  • Cardiac ultrasound and angiography are not performed;
  • CT and MRI (rarely used) - small round formation filled with thrombus or calcification.

Treatment is carried out in relation to the underlying disease. When focal pneumonia develops, antibiotics, mucolytics, and painkillers are used.

Possible consequences

The consequences are fatal and difficult to diagnose:

  • Thromboembolism pulmonary artery and its branches - sudden blocking of the lumen of the vessel by the formed thrombus. The complication clinic can be very short - a person gets up and immediately falls dead. With a small size of the blood clot, the danger to life is less pronounced, the main symptom is cutting-compressive pain behind the sternum;
  • Rupture with bleeding - second fatal complication, manifested by rapidly increasing hypoxia and profuse hemorrhage. Patients lose consciousness and suffer collapse, turning into shock. Mortality varies from 70 to 95%;
  • Purulent mediastinitis is inflammation of the mediastinum that occurs against the background of bleeding with infection;
  • Pneumonia - pneumonia. It occurs as a focal or lobar type.

Prevention of the development of lung-related aneurysms is aimed at treating congenital and acquired cardiopulmonary diseases. The symptoms are represented by the main respiratory syndromes, which makes it difficult timely diagnosis and treatment. If you notice shortness of breath, bluish skin, increased heart rate, or pain in the chest you should seek help immediately. Specialists in this pathology are pulmonologist, vascular and thoracic surgeons.

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