Adult respiratory distress syndrome (RDSV) was first described in detail in 1967. Until that time, a similar disease was observed in medical practice, which was fixed in newborns against a deficiency of surfactant. However, in the course of research it turned out that such a pathology can be secondary, that is, not arise from birth, but manifest itself at a later age. Thus, respiratory distress syndrome in children and adults can manifest itself in a variety of periods. Also, RDSV is often called pulmonary edema, or shock lung.
This is one of the most severe forms of respiratory failure, which is diagnosed in 150,000 patients in the United States every year. In other countries, the situation is slightly better. Thus, 0.6% of the population has a risk of getting this dangerous ailment. Therefore, it will be useful to learn more about pulmonary respiratory distress syndrome. Consider the phases of the development of the disease, its signs and symptoms.
Acute phase
The duration of this stage of the disease in adults, as a rule, is no more than 5 days. During the period of acute respiratory distress syndrome, the interstitial form of pulmonary edema passes into the alveolar phase. At the same time, proteins, red blood cells and white blood cells are found in the composition of the edematous fluid. There is also quite serious damage to the capillaries of the lungs. Against this background, microatelectases appear.
If acute respiratory distress syndrome in adults passes in the so-called favorable form, then after a few days the edematous fluid dissolves and a noticeable improvement in well-being is observed. However, far from always everything ends in the acute phase. Sometimes the disease flows into more serious forms.
Subacute and chronic phases
In some cases, acute respiratory distress syndrome goes into these degrees. If we talk about the subacute phase, then during this period, patients have interstitial and broncho-alveolar inflammatory processes.
If the patient does not receive proper treatment or the disease develops too rapidly, then the chronic phase sets in, during which fibrosing alveolitis develops. Membranes become denser and thicker due to rapidly growing connective tissue. In this case, the amount of collagen increases several times.
If you do not take measures, then the chronic stage occurs 2-3 weeks after the first manifestation of the disease. In addition, during this period, microthrombosis and vascular desolation may develop. This in turn leads to pulmonary hypertension and chronic respiratory failure.
Causes of acute respiratory distress syndrome
There are many factors that can affect the development of this pathology. Most often, vomiting, fresh or salt water in the lungs of a person leads to RDS. The same result is that the patient has long inhaled toxic substances (for example, chemicals, ammonium compounds, etc.).
Respiratory distress syndrome in adults can develop against the background of pulmonary infections (pneumonia), exposure to radiation, embolism of the arteries in the lungs, pneumothorax, and lung bruises.
In addition, septic, traumatic and other types of shock can provoke RDSV. In case of poisoning with barbiturates, acetylsalicylic acid and heroin, an acute form of edema can also occur.
The acute form of the disease can even be caused by injuries or burns, as well as infectious ailments (sepsis, peritonitis and others).
RDSV can also be caused by:
- Pancreatitis.
- Eclampsia.
- Uremia.
- Intestinal infarction.
- Heat stroke.
- The death of the fetus inside the womb.
- Arterial embolism.
- Lung transplantation.
If some sections of the lungs are filled with fluid, then a gas exchange process begins in them. There is an acute lack of oxygen, the alveolar epithelium is destroyed, and the fluid penetrates the alveoli. Such an environment is very favorable for microbes. Therefore, when acute respiratory distress syndrome occurs, pneumonia is also most often observed.
What are the signs that can identify RDSV
First of all, it is worth noting that the lungs of a healthy adult weigh about 380 g. If we are talking about respiratory distress syndrome, then in this case their mass increases to almost 1 kg.
When making a cut, you can notice how a liquid with a pinkish tint is formed at the place of the cut. The same components can be found in the trachea and bronchi.
Lesions affect almost all internal organs:
- The liver is disturbed. In this case, there is an increase in bilirubin and liver enzymes.
- The patient suffers from cardiovascular disorders. This manifests itself in the form of a sharply decreasing blood pressure. In this case, the development of tachycardia may occur, which will gradually turn into bradycardia. If treatment is not followed, then cardiac arrest occurs and the patient dies.
- The work of the kidneys is disturbed. In renal failure, gastrointestinal bleeding may also develop.
If the patient can be saved, then this is not a reason to breathe calmly. There is a great risk of developing sclerotic and diffuse inflammation. In this case, pneumonia, chronic bronchitis, emphysema, and in some cases bronchiectasis can be diagnosed simultaneously.
Due to all these ailments, the load on the heart muscles increases. Therefore, even with a temporary cure, there remains a risk that the patient will die.
Therefore, it is important to recognize the pathology in a timely manner. It develops in four stages. Let's consider them in more detail.
First stage
At first, the disease develops in a latent form. As a rule, within a day after the onset of the ailment, changes in the pathogenetic and pathophysiological nature occur.
During this period, there is no symptomatology that would cause the patient to worry and consult a doctor. Even if he visited a specialist who assigned him an x-ray, then the picture will not show any changes.
The only sign that should cause concern is a strong shortness of breath. A person begins to make 20 breaths per minute or more. This syndrome is called tachypnea.
Subsequent development
The second stage of respiratory distress syndrome is characterized by the first noticeable manifestations that appear already on the second day after dangerous changes began to occur in the human body.
First of all, the patient is diagnosed with tachycardia, shortness of breath intensifies. When listening to the lungs, dry rales of a diffuse type are clearly audible. If recommendations are followed at this stage, respiratory distress syndrome can be detected on an x-ray. The disease manifests itself in the form of a more pronounced vascular pattern. Most of all, picture enhancement is observed in the peripheral region.
Such changes indicate the beginning of interstitial pulmonary edema. Some doctors prescribe an additional analysis of the gas composition of the blood. However, in the second stage of the disease, he may not show serious deviations. In rare cases, the doctor may find that PaO2 has decreased quite a bit.
Third period
In the process of development of this stage, quite pronounced clinical manifestations are observed. Dyspnea begins to resemble respiratory failure. At the same time, the wings of the nose are greatly inflated, the intercostal spaces are also retracted and inflated. The manifestations of diffuse cyanosis can be fixed. When listening to the heart, a specialist fixes deaf heart tones and tachycardia. The level of blood pressure is rapidly falling.
Also, in the third stage, dry rales, hard breathing can be observed . If the patient shows crepitus, then this indicates that the fluid has already begun to flow into the alveoli. The data process may be minor or more pronounced.
Respiratory distress syndrome in the third stage is easily detected during radiography. In this case, pulmonary edema will be clearly visible in the image.
Terminal period of the disease
The fourth stage, which received this name, manifests itself in the form of highly progressive respiratory failure. In this case, the patient begins to suffer from arterial hypoxemia and hypercapnia, and sometimes metabolic acidosis develops.
If we talk about symptoms, then it, as a rule, manifests itself in the form of:
- Profuse sweating.
- Severe shortness of breath and cyanosis.
- A sharp drop in blood pressure (it can even reach a collapse).
- Deafness of heart sounds, tachycardia or arrhythmia.
- Wet wheezing observed in the lungs.
- Cough, during which pink foamy sputum is released.
During the ECG procedure, a specialist can easily notice deviations of the electrical axis, which will be directed to the right. If you take an x-ray, then you will notice obvious signs indicating that there is strong pressure on the pulmonary artery. In this case, a swelling of its body is observed.
At the fourth stage, multiple organ failure appears. The kidneys malfunction. Among other things, a specialist can detect:
- Proteinuria
- Increased urea in blood tests.
- Oligoanuria.
- Increased creatinine in blood tests.
- Microhematuria.
Due to violations of the liver, mild jaundice is manifested. At the same time, the volume of lactate dehydrogenase significantly increases in the blood. Also, the disease negatively affects the work of the brain. Patients note increased inhibition, frequent dizziness, migraines. The blood circulation of the brain may also be impaired.
Diagnosis of the disease
According to the researchers of Fisher and Foex, there are several main signs that experts pay attention to when determining the presence of an ailment. At the initial examination, the doctor pays attention to how the patient breathes. If breathing is difficult and during it there is a high stiffness of the chest, then the patient is sent to an x-ray.
The doctor also clarifies the symptoms indicating a possible pulmonary edema.
Standard survey programs include several steps. First, you need to study the data of general urine and blood tests. After this, electrocardiography and radiography are performed. If everything indicates the presence of respiratory distress syndrome, clinical recommendations also include checking the acid-base balance in the patient's body. A more detailed study of the patient’s gas composition may also be required.
Based on this, we can say that the diagnosis of an ailment implies a whole range of studies and other activities.
Your doctor may also find that transparency has decreased in your lung tissue. It is also recommended that you check your blood pressure.
Treatment for Respiratory Distress Syndrome
First of all, a sick person needs urgent hospitalization. In the intensive care unit , comprehensive measures are taken that are aimed at stabilizing the patient.
Oxygen therapy is mandatory. This is necessary in order to lower the level of O2 in the blood of the patient. For this, a special oxygen mask is put on the patient. If it does not help and the person is still in critical condition, he is transferred to mechanical ventilation.
However, if the patient is too long on mechanical ventilation, this can provoke pulmonary fibrosis. In this case, they change to more fibrous and coarse. Such a condition can be alleviated only a few months after shutting down the ventilator.
If the patient suffers from respiratory distress syndrome, emergency care also includes measures to normalize the blood circulation in the body. For the patient’s vein, an infusion solution is injected. The volume of the composition should be selected individually, depending on the evidence obtained during diagnostic measures.
If the doctor suspects that the cause of the disease has become an infection, then he prescribes a course of antibiotics with a wide spectrum of action. Very often, treatment with the use of hormonal drugs is required. This is especially necessary in a situation when it comes to complications of autoimmune processes.
It is also important to ensure that the patient's sputum leaves well. Mucolytic drugs can contribute to this process.
In addition, a positive result can be achieved by taking a course of physiotherapy. Most often, vibration massage is used for this.
If the treatment is effective, then the lung functions will recover quite quickly. There may be minor consequences. In some situations, no adverse effects are observed.
What to do if vomit enters the lungs
In this case, you cannot solve the problem yourself, so you need to seek emergency help. Only specialists will be able to perform intubation and take measures to aspirate vomit from the patient’s bronchi and trachea.
To be sure that there is no fluid left in the lungs, a probe is inserted into the patient’s stomach. Thanks to him, doctors can examine its contents and protect the respiratory tract from possible aspiration in the future.
If it is not possible to alleviate the patient’s condition, and the engine may still develop, then in this case they proceed to mechanical ventilation and other therapeutic measures described above.
Preventative measures
Prevention of respiratory distress syndrome is that, first of all, a person should treat all illnesses associated with the respiratory tract in a timely manner. If the patient had pneumonia, which he started, then this can become a favorable environment for the development of RVS.
It is also recommended to avoid factors that can trigger this dangerous syndrome. This means that you need to stay away from toxic fumes, sources of radiation, etc. In addition, it is worth protecting the chest. If she is injured, this can also lead to extremely unpleasant consequences.
If a person is given a blood transfusion, then you need to ensure that the procedure is carried out strictly according to all the rules. In addition, the patient's condition should be strictly monitored by a specialist. If something went wrong, the procedure ends.
In case of alarming symptoms, you must immediately seek emergency help. With difficulty breathing or increasing shortness of breath, you should not waste precious time.