Breathing is the basis of human life. Problems with this important and complex process can lead not only to serious he alth problems, but also to death. One of them is acute respiratory failure. About what it is, what help is possible and necessary, the consequences of this condition are discussed below.
Breathe - don't 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 procedures for converting one substance into another and at the same time maintaining the stability of the body and all its structures taken together. Breathing problems in a person can occur for completely different reasons, only specialists using different methods and means can help in one case or another. But it should be understood that violations of this process are very dangerous, as they can lead to irreversible changes in tissues and organs. Causes of acute respiratoryfailures can also be different, although the condition itself requires urgent care in any case.
Determining the state of respiratory failure
The term "acute respiratory failure", abbreviated as ARF, implies a pathological, that is, with a deviation from the norm, a condition. Moreover, the pathology can have two sides - impaired gas exchange in the lungs themselves and improper operation of the system - the heart-lungs, which also leads to disruption of gas exchange processes. In both cases, ARF negatively affects both well-being and performance, and as a result can lead to serious consequences, since all organs and systems suffer from a lack of oxygen, which must come through the lungs and bloodstream.
How is the state subdivided?
Quite often, people with problems of the cardiovascular system or respiratory tract are diagnosed with acute respiratory failure. The 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 problem here - one is characterized mainly by the defeat of the lungs themselves, while the other, on the contrary, has the advantage of extrapulmonary problems. The first type of ARF according to this classification includes: obstructive bronchial syndrome and disorders in the alveolar tissuelungs, such as pneumonia, edema, and the like. In the second case of acute respiratory failure pathogenetic classification observed:
- violations of the central regulatory function of breathing;
- disturbances in neuromuscular transmission of impulses;
- damage to the muscles involved in the breathing process;
- chest injury making breathing difficult;
- diseases of the hematopoietic system - anemia;
- disorders in the circulatory system.
Possible causes of acute respiratory failure
With any violation of the breathing process, such a pathology as acute respiratory failure can develop. Resuscitation requires identifying the cause of its occurrence in order to provide high-quality and timely assistance. A characteristic sign of the acuteness of the breathing problem is the fact that even the maximum efforts to carry out 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 therapy of pathology, it is important to establish its cause.
A doctor of any speci alty may encounter ARF in a patient, because its causes are very different. They are divided by specialists into bronchopulmonary, neuromuscular, centrogenous, thoraco-diaphragmatic.
The most extensive group of acute bronchopulmonary respiratory failure, which develops against the background of impaired airway patency. This may be due to:
- asthma attack;
- strangulation asphyxia,arising from mechanical compression of the trachea, nerve trunks and vessels of the neck;
- hypersecretion of bronchial mucus;
- difficulty in oxygen diffusion as a result of thickening of the alveolo-capillary membranes, characteristic of chronic lung diseases;
- laryngospasm;
- impaired elasticity of lung tissue;
- getting into the windpipe, 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.
The basis of ARF of central genesis is the inhibition of the activity of the respiratory center, which, in turn, can be caused by:
- stroke;
- poisoning;
- drug overdose, barbiturates, other drugs;
- compression of a tumor-like formation;
- traumatic brain injury;
- electrical injury.
Acute respiratory failure can be caused by impaired neuromuscular conduction and paralysis of the respiratory muscles, which are most often seen in:
- botulism;
- myasthenia gravis;
- overdose of muscle relaxants;
- polio;
- tetanus.
Causes, combined into a group of thoraco-diaphragmatic acute respiratory failure, are caused by impaired mobility of the chest, diaphragm, lungs, pleura, are observed with hemothorax, rib fractures, pneumothorax, chest injuries, exudative pleurisy. Also ODNmay develop with extreme degrees of posture disorder.
Acute cardiac insufficiency in its cause may have sources completely unrelated to the immediate respiratory apparatus:
- anemia;
- hypovolemic shock;
- arterial hypotension;
- massive bleeding;
- heart failure;
- Pulmonary embolism.
How can ODN be formed?
For quality care, the clinic of acute respiratory failure should also take into account such a side of the problem as the mechanisms of its development. For a specialist, when choosing the direction of therapy, it is important to identify the path along which acute respiratory failure was formed. Here stand out:
- hypoventilatory ORF - violation of ventilation in the alveoli, which causes their inability to fully absorb oxygen and remove carbon dioxide;
- obstructive ORF - airway obstruction;
- restrictive ORF - reduction in the tissue of the alveoli lining the lungs and directly carrying out gas exchange;
- shunt-diffuse ORF - shunting of blood of the small and / or systemic circulation (passage of blood flow through unventilated areas of the lungs, mixing of arterial and venous blood with a decrease in oxygen concentration in the first), impaired diffusion through the alveolar-capillary membrane.
Intensive care for acute respiratory failure requires the most accurate determination of the mechanism of occurrencean existing breathing problem.
Steps in the development of ODN
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 felt by the person symptoms. The invisibility of breathing problems is determined by compensatory mechanisms. One may suspect ARF only because shortness of breath or rapid breathing appears during physical exertion.
- 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. The patient becomes characterized by a posture in which it becomes much easier for him to breathe. At the same time, attacks of the manifestation of pathology are accompanied by dizziness, palpitations.
- The third stage is decompensated. Those mechanisms that could compensate for violations of the respiratory system completely are exhausted and cannot help, the blueness of the skin and mucous membranes is characteristic, the level of oxygen in the blood and blood pressure decrease. The patient may fall into a state of psychomotor agitation. This phase of ARF requires immediate medical intervention with certain medications.and medical procedures. 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 problem of the respiratory system, it is characterized by a strong decrease in the level of oxygen that enters the blood, the patient develops cold sweat, breathing is shallow and very frequent, the pulse is weak, the so-called thready. Loss of consciousness, anuria, hypoxic cerebral edema may develop. Unfortunately, this stage of respiratory failure is fatal in most cases.
This gradation of pathology is typical for cases of respiratory disorders caused by diseases of the respiratory system, for example, pneumonia. If destruction, blockage, or a violation of the impulse conduction of the respiratory center occurs, then the stages of ORF go astray, shifting. So, the initial stage is practically or completely absent, the second stage is minimal in its duration, and acute respiratory failure abruptly passes into the third stage. Studies and observations have revealed that in older people, due to the age-related characteristics of tissues to be content with less oxygen, the subcompensation stage can last much longer than in young and middle-aged people. But in children, a decompensatory period almost immediately begins, since all systems and tissues of a growing organism are in dire need of constant replenishment with oxygen and removal of carbon dioxide. If the cause of the development of acute respiratory failure is eliminated in time, theforeign body from the larynx, allergic edema is removed, the necessary medicines or manipulations are used, then all stages of ARF are reversed, returning the patient's 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 lung disease or pathology, for example, in case of an injury with a fracture of the ribs, in violation of the patency of the upper respiratory tract due to edema, or the ingress of a foreign body. In this case, restoration of the function of the respiratory apparatus itself in the area of the identified violation is required. Experts believe that identifying the cause of acute respiratory failure is the basis of quality therapy for this pathology.
ONE as a consequence
Secondary acute respiratory failure develops as a result of a he alth problem, for example, with a respiratory disease accompanied by a 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 in the air, for example, high in the mountains, with a sharp decrease in the volume of blood in the body or the ability to circulate in two circles of blood circulation. In this case, signs of acute respiratory failure should be isolated from the maincause, and medical assistance is required not only to restore the breathing process to the greatest extent possible, but also to eliminate the main cause that caused ARF as soon as possible.
The importance of stages in the formation of pathology
Some situations or diseases threaten to cause such a serious pathology that threatens not only he alth, but often human life as acute respiratory failure. Emergency care during this period of a fairly short time requires rapid diagnosis - both the causes of ARF 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 signs?
For a non-specialist who is faced with the sudden development of acute respiratory failure, it is quite difficult to understand what is happening. There are several main signs that indicate precisely a problem in the operation of the respiratory apparatus and the need for prompt intervention to normalize the condition, as well as seeking qualified medical help. These are symptoms of acute respiratory failure such as
- tachypnea - superficial, shallow, rapid breathing;
- feeling of suffocation;
- body position - sitting, resting your hands on the chair seat, which relieves 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 by taking a certain positionsitting, indicates that it is ARF, while other symptoms may appear 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, breathing becomes superficial and very frequent - up to 40 or more respiratory movements per minute. To avoid irreversible changes in the state of tissues and organs, it is necessary to take all possible methods to stop such a condition as acute respiratory failure. Emergency care should be provided to the patient as soon as possible.
Diagnostic methods for ARF
Qualitative diagnosis of the patient's condition with suspected acute respiratory failure is almost impossible due to insufficient time for medical care. In this case, a quick adequate assessment of the clinical situation is necessary in order to detect the main cause of the respiratory pathology. To do this, the specialist evaluates the following elements of the overall picture:
- airway patency;
- pulse;
- breath rate;
- inhale-exhale depth;
- heart rate;
- work of auxiliary muscles in the process of breathing;
- skin coloring.
Tests such as blood gas and acid-base balance should also be done.
These diagnostic methods are the minimum set for diagnosing ARF, assessing the degree of pathology and development prospects. If the patient's condition allows or it was possible to stabilize him, then spirometry and peak flowmetry are performed. Also may be prescribed: chest x-ray, bronchoscopy, electrocardiogram, complete blood count, biochemical blood test, toxicological studies of blood and urine. Naturally, all types of examination of the patient are carried out with sufficient stabilization of his condition. Only then can adequate therapy for acute respiratory failure be applied.
Principles of treatment
The clinic of various conditions and pathologies requires compliance with certain algorithms that allow you to correctly assess the patient's condition, diagnose the cause of the problem, provide emergency care, identify treatment prospects, and choose the most appropriate methods of therapy. The same stages are required by such a pathology as acute respiratory failure. Diagnosing the problem is the main step. It should help the doctor to establish the cause of the pathology, as well as its severity. Then it is necessary to use all available and possible techniques in a particular situation to optimize the breathing process - to ensure airway patency, restore impaired perfusion and ventilation of the lungs, and eliminate existing hemodynamic abnormalities.
What is the essence of the necessary medical manipulations? Examination of the oral cavity of the visible part of the trachea in order to detect and remove foreign objects, clean the airways by aspiration, and eliminate, ifnecessity, lingering language. In some cases, to ensure respiratory patency, it is possible to perform such manipulations as conicotomy or tracheotomy. In order to identify the bronchopulmonary cause of ARF, bronchoscopy is performed, and, if indicated, postural drainage.
If a patient is diagnosed with pneumo- or hemothorax, then drainage of the pleural cavity is indicated; if the cause of ARF is bronchospasm, then it should be stopped with special drugs, for example, glucocorticosteroids and bronchodilators, and the method of their administration (by inhalation or systemic injection) depends on the patient's condition.
The next stage of assistance will be the urgent provision of humidified oxygen to the patient - through a nasal catheter, a mask, an oxygen tent, hyperbaric oxygenation, with the help of mechanical ventilation.
Then follows the choice of drug therapy for concomitant respiratory disorders:
- pain relief with analgesics;
- stimulation of respiration and activation of the cardiovascular system using respiratory analeptics and cardiac glycosides;
- elimination of hypovolemia and intoxication with infusion therapy.
Necessary for adequate treatment of such a pathology as acute respiratory failure, clinical recommendations in each case will be individual, observing the main stages of care and saving the patient's life.
Life in danger
The process of breathing is the main tool for providing all cells of the body with oxygen -the main catalyst for biological processes. Situations and diseases leading to disruption of this process are characterized as acute respiratory failure. Resuscitation of this condition requires maximum concentration in terms of time and the use of necessary and available medical care measures. Violation of the respiratory process leads to serious and often irreversible consequences. The stages of pathology, unfortunately, do not always proceed exactly as described above. The acute form of such a condition in a short time becomes threateningly negative, capable of leading to death, even despite the intervention of professionals. That is why the syndrome of acute respiratory failure requires efficiency and professionalism both in the work of the personnel providing the resuscitation process, and in the modernity of methods, techniques, equipment, manipulations and medicines in accordance with the latest achievements of world medicine.
Children and ODN
The anatomical structure of all systems of the child's body, including the organs of the respiratory system in children, causes frequent diseases that are commonly called colds, and leads to he alth problems such as pneumonia, laryngitis, tracheolaryngitis and the like, accompanied by respiratory disorders.
Acute respiratory failure in children is a common pathology that disrupts the measured rhythm of the life of a child and his family. Many factors contribute to this. One of the main ones is that all the tissues of the child's body are constantlyneed oxygen. In addition, compensatory systems are still very poorly developed, especially in very 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 infancy, does not allow him to talk about his problems and feelings, doctors and parents can only carefully monitor his condition in order to notice the symptoms of ARF in time and take measures to eliminate the pathology. Acute respiratory failure in children can be identified with the following visual indicators:
- child breathing heavily, drawing in the intercostal space, the area above the jugular notch and interclavicular spaces;
- baby's breathing is very loud, noisy, wheezing or whistling;
- skin and mucous membranes become bluish;
- child overexcited compared to normal;
- increases heart rate - more than 15%.
Even a couple of these signs of ARF serve as an incentive to immediately seek qualified medical help.
What to do first?
Unfortunately, it happens that trouble comes from where you do not expect it. 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 onlyto preserve he alth, but, often, the life of a person. How can it be provided to help, not harm?
First, parents need to understand what happened to the child. If a foreign body has entered the respiratory tract, then it is not necessary to remove it with your hands. You should do this - turn the child with his back to himself or up and with a sharp movement press down on the epigastric region, trying to push out the object that has entered the respiratory tract. If the respiratory failure occurred due to the accumulation of vomit, then it is necessary to help the child cough them up, having previously cleaned the oral cavity with a clean napkin. If it is difficult for a child to breathe due to an asthmatic attack, then it is necessary to carry out inhalation with special means prescribed by the doctor. An attack of suffocation with laryngotracheitis can be relieved with the help of steam inhalation. Also, auxiliary means that can help with acute respiratory failure will be airing 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 plenty of warm drinks.
Professional help with ARF
Acute respiratory failure requires urgent medical attention even at the initial stage, especially when it comes to a child. Doctors from a professional point of view will assess the patient's condition, the severity of ARF, its possible causes and consequences. In each specific case, their own methods, preparations and manipulations will be used, whichhelp to alleviate the patient's condition, stop the pathology itself, if possible, eliminate the main cause of the development of breathing problems.
Consequences of ODN
Provision of assistance in case of acute respiratory failure - the main measures to preserve the he alth 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 he alth and prevent recurrent severe conditions caused by ARF. The lack of oxygen adversely affects all tissues and organs that suffer from hypoxia. At the same time, one should always remember that a rapidly developing respiratory pathology can lead, if not to death, then to irreversible disorders.
First of all, the heart suffers - right ventricular failure, pulmonary hypertension develops, which all together leads to the formation of the so-called cor pulmonale, with its characteristic stagnation of blood through the vessels of the systemic circulation. It is precisely because of the threats to he alth, 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 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 a poor prognosis for the onset and outcome of existing neuromuscular diseases, such as 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, as it is a significant factor influencing the reduction of the patient's life expectancy.
If the patient is diagnosed with "acute respiratory failure", the recommendations given by the doctor must be strictly followed. Only this will allow you to maintain a full life and he alth.
