Breathing is the basis of human life. Problems with this important and complex process can lead not only to serious health problems, but also to death. One of them is acute respiratory failure. About what it is, what kind of help is possible and necessary, the consequences of this condition are discussed below.
Breathe - do not breathe!
A complex physiological, biochemical, physical process, on which the work of all organs, systems and, of course, human life depends, is breathing. It is largely responsible for metabolism and homeostasis - the process of converting one substance to another and at the same time maintaining the stability of the body and all its structures combined. A person’s breathing problems can arise for completely different reasons; only specialists using different techniques and tools can help in this or that case. But it is worthwhile to understand that violations of this process are very dangerous, as they can lead to irreversible changes in tissues and organs. The causes of acute respiratory failure can also be varied, although the condition itself requires urgent help in any case.
Determining respiratory failure
The term "acute respiratory failure", in short - ONE, implies a pathological, that is, a deviation from the norm, condition. Moreover, pathology can have two sides - impaired gas exchange in the lungs themselves and improper operation of the system - heart-lungs, which also leads to disruption of gas exchange processes. In both cases, ONE negatively affects both well-being and working capacity, and as a result can lead to serious consequences, since all organs and systems suffer from a lack of oxygen, which must enter through the lungs and bloodstream.
According to what principle is the state divided?
Quite often, people with cardiovascular or respiratory problems are diagnosed with acute respiratory failure. Classification of such a pathological condition can be carried out according to several indicators.
The most convenient for medical purposes is the pathogenetic classification of acute respiratory failure. There are two types of problems - one is characterized mainly by damage to the lungs themselves, while the other, on the contrary, has extrapulmonary problems. The first type of ARF according to this classification includes: obstructive bronchial syndrome and disorders in the alveolar tissue of the lungs, for example, pneumonia, edema, and the like. In the second case of acute respiratory failure pathogenetic classification observed:
- violation of the central regulatory function of respiration;
- impaired neuromuscular transmission of impulses;
- damage to the muscles involved in the breathing process;
- chest trauma that makes breathing difficult;
- diseases of the hematopoietic system - anemia;
- disorders in the circulatory system.
Possible causes of acute respiratory failure
With any violations of the breathing process, such a pathology as acute respiratory failure can develop. Resuscitation requires identifying the causes of its appearance in order to provide quality and timely care. A characteristic sign of the severity of the breathing problem is the fact that even the maximum efforts for the implementation of the breathing process do not lead to the desired result - the body cannot get rid of excess carbon dioxide and saturate the tissues with the necessary amount of oxygen. For adequate treatment of pathology, it is important to establish its cause.
A doctor of any specialty may encounter ONE in a patient, because its causes are very different. Specialists they are divided into bronchopulmonary, neuromuscular, centrogenic, thoracic-diaphragmatic.
The most extensive group of acute bronchopulmonary respiratory failure, developing against a background of airway obstruction. This may be due to:
- asthmatic attack;
- strangulation asphyxia, arising from mechanical compression of the trachea, nerve trunks and vessels of the neck;
- hypersecretion of bronchial mucus;
- difficulties in the diffusion of oxygen as a result of thickening of the alveolo-capillary membranes, characteristic of chronic lung diseases;
- laryngospasm;
- violation of the elasticity of lung tissue;
- getting into the respiratory throat, trachea and bronchi of foreign objects;
- toxic damage to the alveolar tissue.
If we consider the causes of central genesis, then they are united by a violation of the respiratory center of the brain.
At the heart of ONE of central origin is the inhibition of the activity of the respiratory center, which, in turn, can be caused by:
- a stroke;
- poisoning;
- overdose of drugs, barbiturates, other medicinal substances;
- compression by tumor formation;
- traumatic brain injury;
- electrical injury.
Acute respiratory failure may be caused by a violation of neuromuscular conduction and respiratory muscle paralysis, which are most often observed with:
- botulism;
- myasthenia gravis;
- an overdose of muscle relaxants;
- poliomyelitis;
- tetanus.
The causes, combined in the group of thoraco-diaphragmatic acute respiratory failure, are caused by a violation of the mobility of the chest, diaphragm, lungs, pleura, are observed with hemothorax, rib fracture, pneumothorax, chest injuries, exudative pleurisy. Also, ODN can develop with extreme degrees of impaired posture.
Acute cardiac insufficiency may also have sources that are completely unrelated to the direct breathing apparatus:
- anemia;
- hypovolemic shock;
- arterial hypotension;
- massive bleeding;
- heart failure;
- pulmonary embolism.
How can one form?
For quality care, the clinic of acute respiratory failure must also take into account such a side of the problem as the mechanisms of its development. When choosing a direction of therapy, it is important for a specialist to identify the pathway along which acute respiratory failure has formed. It stands out:
- hypoventilation ODN - violation of ventilation in the alveoli, which causes their inability to fully absorb oxygen and remove carbon dioxide;
- obstructive ARF - impaired airway;
- restrictive ODN - reduction of the tissue of the alveoli that line the lungs and directly carry out gas exchange;
- shunt-diffuse ODN - shunting of blood of the small and / or large circle of blood circulation (blood flow through unventilated areas of the lungs, mixing of arterial and venous blood with a decrease in oxygen concentration in the first), diffusion through the alveolar-capillary membrane.
Intensive therapy for acute respiratory failure requires the most accurate determination of the mechanism of occurrence of an existing breathing problem.
Steps in the development of ONE
The degree of acute respiratory failure is important to consider, both in the treatment of the condition and in the prognosis and prevention of possible complications. Specialists distinguish several characteristic steps in the development of a pathological condition:
- The initial stage is the stage of silence. Like many diseases, respiratory failure in the first stage does not make itself felt, without showing any significant and perceived by the person symptoms. The invisibility of breathing problems is determined by compensatory mechanisms. One can be suspected only because during physical exertion shortness of breath appears or breathing quickens.
- The second stage is called subcompensatory. It is characterized by the depletion of mechanisms that compensate for respiratory failure, so shortness of breath appears even at rest, breathing after physical effort is restored for a long time. For the patient, a pose becomes characteristic, in which he becomes much easier to breathe. In this case, attacks of the manifestation of pathology are accompanied by dizziness, heart palpitations.
- The third stage is decompensated. Those mechanisms that could completely compensate for respiratory system disorders are depleted and cannot help, blue skin and mucous membranes are blue, blood oxygen level and blood pressure decrease. The patient may fall into a state of psychomotor agitation. This phase of ONE requires immediate medical intervention with the use of certain medications and medical manipulations. If help does not come, then the person’s condition deteriorates sharply, and respiratory failure passes into the terminal stage.
- Terminal - an extreme degree of the respiratory system problem, it is characterized by a strong decrease in the level of oxygen that enters the bloodstream, the patient develops cold sweat, breathing is shallow and very frequent, the pulse is weak, the so-called threadlike. Loss of consciousness, anuria, hypoxic cerebral edema may develop. Unfortunately, this stage of respiratory failure in most cases ends fatally.
This stepwise pathology is typical for cases of respiratory disorders caused by diseases of the respiratory system, for example, pneumonia. If destruction, clogging or violation of the impulse conduction of the respiratory center occurs, then the stages of ODN go astray, shifting. So, the initial stage is almost or completely absent, the second stage is minimal in duration, and acute respiratory failure sharply goes into the third stage. Studies and observations have revealed that in elderly people, due to the age-related characteristics of tissues, they are content with less oxygen, the stage of subcompensation can last much longer than in young and middle-aged people. But in children, the decompensatory period begins almost immediately, since all the systems and tissues of the growing organism are in urgent need of constant replenishment with oxygen and removal of carbon dioxide. If the cause of the development of acute respiratory failure is eliminated on time - a foreign body is removed from the larynx, allergic edema is removed, the necessary medications or manipulations are used, then all stages of the ONE go back, returning the patient respiratory functionality.
Primary respiratory failure
Like many other diseases or pathologies, acute respiratory failure can be divided into two parallels - primary and secondary. It will be considered primary if it appeared as a component of a disease or pathology of the lungs, for example, with an injury with a fractured rib, with a violation of the patency of the upper respiratory tract due to edema, or a foreign body. In this case, restoration of the function of the respiratory apparatus itself in the area of ​​the detected violation is required. Experts believe that identifying the cause of acute respiratory failure is the basis for quality therapy of this pathology.
ONE as a consequence
Secondary acute respiratory failure develops as a result of any health problem, for example, with a respiratory disease accompanied by distress syndrome, which is also called a shock lung. This classification also includes acute respiratory failure, not associated with diseases or pathologies of the body and its systems. It develops against the background of a lack of oxygen, for example, high in the mountains, with a sharp decrease in blood volume in the body or the ability to circulate in two circles of blood circulation. In this case, the signs of acute respiratory failure should be isolated from the main cause, and medical care is required not only in restoring the breathing process as much as possible, but also in eliminating the root cause that caused ONE as soon as possible.
The importance of staging in the formation of pathology
Some situations or diseases threaten to cause such a serious, threatening not only health, but often human life pathology as acute respiratory failure. Emergency care during this period of a fairly short time requires quick diagnosis - both the causes of ONE and the prospects for its development to prevent the stage of decompensation and the terminal period when it is almost impossible to help the patient.
What are the symptoms?
It is quite difficult for an amateur who is faced with the sudden development of acute respiratory failure to understand what is happening. There are several basic signs that indicate precisely the problem in the functioning of the respiratory apparatus and the need for early intervention to normalize the condition, as well as seeking qualified medical help. These are symptoms of acute respiratory failure such as
- tachypnea - shallow, shallow, rapid breathing;
- feeling of suffocation;
- body position - sitting, resting his hands on the chair seat, thereby relieving the load on the muscles of the body involved in the breathing process;
- cyanosis.
By the way, the fact that the patient is trying to facilitate the breathing process, taking a certain sitting pose, indicates that this is ONE, while other symptoms can also occur with other problems, for example, with a hysterical seizure.
From a medical point of view, a characteristic sign of respiratory pathology is a drop in blood pressure, an increase in heart rate, respiration becomes superficial and very frequent - up to 40 or more respiratory movements per minute. In order to avoid irreversible changes in the state of tissues and organs, it is necessary to take all possible methods to stop a condition such as acute respiratory failure. Emergency care should be provided to the patient as soon as possible.
Diagnostic methods ODN
A high-quality diagnosis of a patient’s condition with suspected acute respiratory failure is practically impossible due to insufficient time for medical care. In this case, a quick adequate assessment of the clinical situation is necessary in order to find the main cause of the appearance of respiratory pathology. For this, the specialist evaluates the following elements of the overall picture:
- airway patency;
- pulse;
- respiratory rate;
- the depth of inspiration;
- heart rate
- the work of auxiliary muscles in the process of breathing;
- coloration of the skin.
Analyzes and tests should also be done, such as determining the gas composition of the blood and its acid-base state.
These diagnostic methods are the minimum set for making a diagnosis of ARF, assessing the degree of pathology and development prospects. If the patient's condition allows or was able to stabilize, then spirometry and peak flowmetry are performed. Also may be prescribed: chest x-ray, bronchoscopy, electrocardiogram, general blood test, biochemical blood test, toxicological blood and urine tests. Naturally, all types of examination of the patient are carried out with sufficient stabilization of his condition. Only after this can adequate treatment of acute respiratory failure be applied.
Treatment principles
The clinic of various conditions and pathologies requires the observance of certain algorithms that can correctly assess the patient's condition, diagnose the cause of the problem, provide emergency care, identify treatment prospects, choose the most appropriate treatment methods. The same steps require a pathology such as acute respiratory failure. Diagnosing a problem is the main stage. It should help the doctor establish the cause of the pathology, as well as its severity. Then it is necessary to use all the techniques available and possible in a particular situation that allow optimizing the breathing process - to ensure airway patency, restore impaired perfusion and ventilation, and eliminate existing hemodynamic deviations.
What is the essence of the necessary medical manipulations? Examination of the oral cavity of the visible part of the trachea with the aim of detecting and removing foreign objects, cleansing the respiratory tract by aspiration, and also removing, if necessary, the sunken tongue. , . , .
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The anatomical structure of all body systems of the child, including the respiratory system in children, causes frequent diseases, which are commonly called colds, and leads to health problems such as pneumonia, laryngitis, tracheolaryngitis, and the like, accompanied by respiratory disorders.
Acute respiratory failure in children is a frequent pathology that violates the measured rhythm of the life of the child and his family. Many factors contribute to this. One of the main ones is that all the tissues of the child’s body constantly need oxygen for quality growth and development. In addition, compensatory systems are still very poorly developed, especially in young children. Therefore, acute respiratory failure, which appeared in a small person, rapidly passes into the third, decompensated stage, which can quickly lead to death. Since the patient’s childhood, including the infant’s age, does not allow him to talk about his problems and feelings, doctors and parents can only carefully monitor his condition in order to notice symptoms of ONE in time and take measures to eliminate the pathology. Acute respiratory failure in children can be detected with the following visual indicators:
- the child breathes heavily, drawing in the intercostal space, the area above the jugular notch and interclavicular spaces;
- the baby’s breathing is very loud, noisy, with wheezing or whistling;
- skin and mucous membranes acquire a bluish tint;
- the child is overexcited in comparison with the usual state;
- pulse rate increases - by more than 15%.
Even a pair of such signs of ARF serves as an incentive to immediately seek qualified medical help.
What to do first?
Unfortunately, it happens that trouble comes from where you can’t wait. So at home, at work, on a walk or while traveling, something can happen that leads to a serious pathology called acute respiratory failure. First aid in this case can not only preserve health, but, often, a person’s life. How to render it to help, but not to harm?
First, parents must understand what happened to the child. If a foreign body enters the respiratory tract, then it is not necessary to remove it by hand. You should do this - turn the child with his back to himself or up and with a sharp movement press downward on the epigastric region, trying to push out the object that got into the respiratory tract. If respiratory failure has occurred due to the accumulation of vomit, it is necessary to help the child cough them up, having previously cleaned the oral cavity with a clean cloth. If it is difficult for the child to breathe due to an asthmatic attack, then it is necessary to carry out inhalation with special means prescribed by the doctor. The attack of suffocation with laryngotracheitis can be removed by steam inhalation. Also, aids to help with acute respiratory failure will be aeration of the room - to ensure the flow of fresh air, a hot foot bath - to stimulate cardiovascular activity and relieve muscle spasm. Also, the baby should be given a large amount of warm drink.
Help of professionals with ONE
Acute respiratory failure requires immediate medical attention even at the initial stage, especially when it comes to a child. Physicians from a professional point of view will assess the patient's condition, the severity of ONE, its possible causes and consequences. In each case, their own methods, drugs and manipulations will be used that will help alleviate the patient’s condition, stop the pathology itself, and if possible eliminate the main cause of the development of breathing problems.
Consequences of ONE
Assistance in acute respiratory failure is the main measure to maintain the health and full life of the patient. But it is important to correctly assess the prospect of consequences in order to choose the right ways to restore health and prevent repeated severe conditions caused by ARF. Lack of oxygen adversely affects all tissues and organs that suffer from hypoxia. It should always be remembered that the rapidly developing pathology of breathing can lead, if not to death, then to irreversible disturbances.
First of all, the heart suffers - right-ventricular failure, pulmonary hypertension develops, which together leads to the formation of the so-called pulmonary heart, with its characteristic stagnation of blood through the vessels of a large circle of blood circulation. It is precisely because of health threats, often irreversible, that acute respiratory failure requires treatment, which will be carried out on time and in accordance with the needs of the clinic of this pathology.
What are the forecasts?
Any disease requires high-quality therapy, as it harms the body. Acute respiratory failure is a problem that can lead to serious disorders in the functioning of organs and systems, as well as death. It should be remembered that with existing chronic lung diseases, for example, with obstructive disease, respiratory failure develops in 30% of cases.
Acute respiratory failure has an unfavorable prognosis for the onset and outcome of existing neuromuscular diseases, for example, myotonia, amyotrophic lateral sclerosis, and some others.
In any case, the clinic of acute respiratory failure requires an individual approach and the mandatory implementation of all prescribed medical procedures, drugs and rehabilitation methods, since it is an essential factor affecting the reduction in the patient's life expectancy.
If the patient is diagnosed with acute respiratory failure, the recommendations given by the doctor must be strictly observed. Only this will save a full life and health.