Providing emergency care for respiratory failure. Algorithm for emergency care in acute respiratory failure Treatment for respiratory failure in a child

As you know, the respiratory function of the body is one of the main functions of the normal life of the body. The syndrome, in which the balance of blood components is disturbed, and to be more precise, the concentration of carbon dioxide greatly increases and the volume of oxygen decreases, is called "acute respiratory failure", it can also go into a chronic form. How does the patient feel in this case, what symptoms may bother him, what signs and causes of this syndrome - read below. Also from our article you will learn about diagnostic methods and the most modern methods of treating this disease.

What are the characteristics of this disease?

Respiratory failure (RD) is a special condition in which the human body is when the respiratory organs cannot provide the necessary amount of oxygen for it. In this case, the concentration of carbon dioxide in the blood increases significantly and can reach a critical level. This syndrome is a kind of consequence of an inadequate exchange of carbon dioxide and oxygen between the circulatory system and the lungs. Note that chronic respiratory failure and acute may differ significantly in their manifestations.

Any respiratory disorders trigger compensatory mechanisms in the body, which for some time are able to restore the necessary balance and bring the composition of the blood closer to normal. If gas exchange in the lungs of a person is disturbed, then the first organ that begins to perform a compensatory function will be the heart. Later, the amount and overall level will increase in the human blood, which can also be considered a reaction of the body to hypoxia and oxygen starvation. The danger lies in the fact that the forces of the body are not infinite and sooner or later its resources are depleted, after which the person is faced with a manifestation of acute respiratory failure. The first symptoms begin to disturb the patient when the partial pressure of oxygen falls below 60 mm Hg, or the carbon dioxide index rises to 45 mm.

How does the disease manifest itself in children?

Respiratory failure in children often has the same causes as in adults, but the symptoms are usually milder. In newborns, this syndrome outwardly manifests itself as a respiratory disorder:

Most often, this pathology occurs in newborns who were born before the due date, or in those newborns who have had a difficult birth.
In premature babies, the cause of insufficiency is the underdevelopment of surfactant, a substance that lines the alveoli.
Also, the symptoms of DN can also appear in those newborns who experienced hypoxia during intrauterine life.
Respiratory dysfunction can also occur in those newborns who swallowed their meconium, swallowed amniotic fluid or blood.
Also, untimely suction of fluid from the respiratory tract often leads to DN in newborns.
Congenital malformations of newborns can often cause respiratory distress. For example, underdeveloped lungs, polycystic lung disease, diaphragmatic hernia and others.

Most often, in newborn children, this pathology manifests itself in the form of aspiration, hemorrhagic and edematous syndrome, and atelectasis of the lungs is slightly less common. It is worth noting that acute respiratory failure is more common in newborns, and the sooner it is diagnosed, the greater the chance that the child will not develop chronic respiratory failure.

Causes of this syndrome

Often the cause of DN can be diseases and pathologies of other organs of the human body. It can develop as a result of infectious and inflammatory processes in the body, after severe injuries with damage to vital organs, with malignant tumors of the respiratory system, as well as with violations of the respiratory muscles and heart. A person may also experience breathing problems due to restriction of chest movement. So, attacks of insufficiency of respiratory function can lead to:

Narrowing of the airways or obstruction, which are characteristic of bronchiectasis, laryngeal edema, and.
The process of aspiration, which is caused by the presence of a foreign object in the bronchi.
Damage to lung tissue due to such pathologies: inflammation of the alveoli of the lung, fibrosis, burns, lung abscess.
Violation of blood flow, often accompanies pulmonary embolism.
Complex heart defects, mainly. For example, if the oval window is not closed in time, venous blood flows directly to the tissues and organs, without penetrating into the lungs.
General weakness of the body, decreased muscle tone. This state of the body can occur with the slightest damage to the spinal cord, as well as with muscle dystrophy, and polymyositis.
Weakening of breathing, which does not have a pathological nature, can be caused by excessive fullness of a person or bad habits - alcoholism, drug addiction, smoking.
Anomalies or injuries of the ribs and spine. They can occur with kyphoscoliosis or after a chest injury.
Often the cause of oppressed breathing can be a strong degree.
DN occurs after complex operations and severe injuries with profuse blood loss.
Various lesions of the central nervous system, both congenital and acquired.
Violation of the respiratory function of the body can be caused by a violation of pressure in the pulmonary circulation.
Various infectious diseases, for example, can bring down the usual rhythm of the transmission of impulses to the muscles involved in the breathing process.
Chronic imbalance of thyroid hormones can also serve as the cause of the development of this disease.

What are the symptoms of this disease?

The primary signs of this disease are also affected by the causes of its occurrence, as well as the specific type and severity. But any patient with respiratory failure will experience common symptoms of this syndrome:

hypoxemia;
hypercapnia;
dyspnea;
respiratory muscle weakness.

Each of the presented symptoms is a set of specific characteristics of the patient's condition, we will consider each in more detail.

hypoxemia

The main sign of hypoxemia is a low degree of saturation of arterial blood with oxygen. At the same time, a person’s skin can change color, they acquire a bluish tint. Cyanosis of the skin, or cyanosis, as this condition is called in another way, can be severe or mild, depending on how long and how strongly the signs of the disease in a person appear. Usually, the skin changes color after the partial pressure of oxygen in the blood reaches a critical level - 60 mm Hg. Art.

After overcoming this barrier, the patient may experience an increase in heart rate from time to time. There is also low blood pressure. The patient begins to forget the simplest things, and if the above figure reaches 30 mm Hg. Art., then a person most often loses consciousness, systems and organs can no longer work in the same mode. And the longer hypoxia lasts, the harder it will be for the body to restore its functions. This is especially true for brain activity.

Hypercapnia

In parallel with the lack of oxygen in the blood, the percentage of carbon dioxide begins to rise, this condition is called hypercapnia, it often accompanies chronic respiratory failure. The patient begins to experience problems with sleep, he cannot fall asleep for a long time or does not sleep all night long. At the same time, a person exhausted by insomnia feels overwhelmed all day and wants to sleep. This syndrome is accompanied by increased heart rate, the patient may feel sick, he experiences severe headaches.

Trying to save itself on its own, the human body tries to get rid of an excess of carbon dioxide, breathing becomes very frequent and deeper, but even this measure has no effect. At the same time, the decisive role in the development of the disease in this case is played by how quickly the carbon dioxide content in the blood grows. For the patient, a high growth rate is very dangerous, as this threatens with increased blood circulation in the brain and increased intracranial pressure. Without emergency treatment, these symptoms cause cerebral edema and a coma.

Dyspnea

When this symptom occurs, a person always seems to be short of breath. At the same time, it is very difficult for him to breathe, although he tries to increase his respiratory movements.

Weakness of the respiratory muscles

If the patient takes more than 25 breaths per minute, then his respiratory muscles are weakened, they are not able to perform their usual functions and get tired quickly. At the same time, a person tries with all his might to improve breathing and involves the muscles of the press, upper respiratory tract and even the neck in the process.

It is also worth noting that with a late degree of the disease, heart failure develops and various parts of the body swell.

Methods for diagnosing pulmonary insufficiency

To identify this disease, the doctor uses the following diagnostic methods:

The patient himself can best tell about the state of health and breathing problems, the task of the physician is to ask him in as much detail as possible about the symptoms, as well as to study the medical history.
Also, the doctor should, at the first opportunity, find out the presence or absence of concomitant diseases in the patient, which can aggravate the course of DN.
During a medical examination, the doctor will pay attention to the condition of the chest, listen to the lungs with a phonendoscope and calculate the heart rate and breathing.
The most important diagnostic point is the analysis of the gas composition of the blood, the indicator of saturation with oxygen and carbon dioxide is studied.
The acid-base parameters of the blood are also measured.
A chest x-ray is required.
The spirography method is used to assess the external characteristics of breathing.
In some cases, a consultation with a pulmonologist is necessary.

DN classification

This disease has several classifications depending on the characteristic feature. If we take into account the mechanism of the origin of the syndrome, then we can distinguish the following types:

Parenchymal respiratory failure, it is also called hypoxemic. This type has the following characteristics: the amount of oxygen decreases, the partial pressure of oxygen in the blood drops, this condition is difficult to correct even with oxygen therapy. Most often it is a consequence of pneumonia or distress syndrome.
Ventilatory or hypercapnic. With this type of disease in the blood, first of all, the content of carbon dioxide increases, while its saturation with oxygen decreases, but this can easily be corrected with the help of oxygen therapy. This type of DN is accompanied by weakness of the respiratory muscles, and mechanical defects of the ribs or chest are often observed.

As we noted earlier, most often this pathology can be a consequence of diseases of other organs, on the basis of etiology, the disease can be divided into the following types:

Obstructive DN implies obstructed air movement through the trachea and bronchi, it can be caused by bronchospasm, narrowing of the airways, the presence of a foreign body in the lungs, or a malignant tumor. With this type of disease, a person hardly takes a full breath, exhaling causes even greater difficulties.
The restrictive type is characterized by a limitation of the functions of the lung tissue in terms of expansion and contraction, a disease of this nature may be the result of pneumothorax, adhesions in the pleural cavity of the lung, and also if the movements of the rib frame are limited. As a rule, in such a situation, it is extremely difficult for the patient to inhale air.
The mixed type combines signs of both restrictive insufficiency and obstructive insufficiency, its symptoms most often manifest themselves with a late degree of pathology.
Hemodynamic DN may occur due to impaired air circulation in the absence of ventilation in a separate area of the lung. Right-to-left shunting of blood, which is carried out through an open oval window in the heart, can lead to this type of disease. At this time, mixing of venous and arterial blood can occur.
Diffuse type insufficiency occurs when the penetration of gases into the lung is impaired during the thickening of the capillary-alveolar membrane.

Depending on how long a person has been experiencing breathing problems and how quickly the signs of the disease develop, there are:

Acute deficiency affects the lungs of a person at a high speed, usually its attacks last no more than a few hours. Such a rapid development of pathology always causes hemodynamic disturbances and is very dangerous for the patient's life. With the manifestation of signs of this type, the patient needs a complex of resuscitation therapy, especially at those moments when other organs cease to perform a compensatory function. Most often it is observed in those who are experiencing an exacerbation of the chronic form of the disease.
Chronic respiratory failure worries a person for a long period of time, up to several years. Sometimes it is the result of an undertreated acute form. Chronic respiratory failure can accompany a person throughout life, weakening and intensifying from time to time.

In this disease, the gas composition of the blood is of great importance, depending on the ratio of its components, compensated and decompensated types are distinguished. In the first case, the composition is normal, in the second, hypoxemia or hypercapnia is observed. And the classification of respiratory failure according to the severity looks like this:

1 degree - sometimes the patient feels shortness of breath during strong physical exertion;
Grade 2 - respiratory failure and shortness of breath appear even with light exertion, while compensatory functions of other organs are involved at rest;
Grade 3 - accompanied by severe shortness of breath and cyanosis of the skin at rest, characteristic hypoxemia.

Treatment of respiratory dysfunction

Treatment of acute respiratory failure includes two main tasks:

Restore normal ventilation of the lungs as much as possible and maintain it in this state.
Diagnose and, if possible, treat comorbidities that cause breathing problems.

If the doctor notices a pronounced hypoxia in a patient, then first of all he will prescribe him oxygen therapy, in which doctors carefully monitor the patient's condition and monitor the characteristics of the blood composition. If a person breathes on his own, then a special mask or nasal catheter is used for this procedure. The patient in a coma is intubated, which artificially ventilates the lungs. At the same time, the patient begins to take antibiotics, mucolytics, and bronchodilators. He is prescribed a number of procedures: chest massage, exercise therapy, inhalation using ultrasound. A bronchoscope is used to clear the bronchi.

Respiratory failure is a pathology that complicates the course of most diseases of internal organs, as well as conditions caused by structural and functional changes in the chest. To maintain gas homeostasis, the respiratory section of the lungs, airways and chest must work in a stressful mode.

External respiration provides oxygen to the body and removal of carbon dioxide. When this function is disturbed, the heart begins to beat hard, the number of red blood cells in the blood increases, and the level of hemoglobin rises. Strengthened work of the heart is the most important element of compensation for insufficiency of external respiration.

In the later stages of respiratory failure, compensatory mechanisms fail, the functional capabilities of the body decrease, and decompensation develops.

Etiology

Pulmonary causes include a disorder in the processes of gas exchange, ventilation and perfusion in the lungs. They develop with lobar, lung abscesses, cystic fibrosis, alveolitis, hemothorax, hydrothorax, water aspiration during drowning, traumatic chest injury, silicosis, anthracosis, congenital malformations of the lungs, chest deformities.

Extrapulmonary causes include:

Alveolar hypoventilation and bronchial obstruction are the main pathological processes of respiratory failure.

At the initial stages of the disease, compensation reactions are activated, which eliminate hypoxia and the patient feels satisfactory. With severe disorders and changes in the gas composition of the blood, these mechanisms do not cope, which leads to the development of characteristic clinical signs, and in the future - severe complications.

Symptoms

Respiratory failure is acute and chronic. The acute form of pathology occurs suddenly, develops rapidly and poses a threat to the life of the patient.

In primary insufficiency, the structures of the respiratory tract and the respiratory organs are directly affected. Its reasons are:

Pain with fractures and other injuries of the sternum and ribs,
Bronchial obstruction with inflammation of the small bronchi, compression of the respiratory tract by a neoplasm,
Hypoventilation and lung dysfunction
Damage to the respiratory centers in the cerebral cortex - TBI, drug or drug poisoning,
Respiratory muscle damage.

Secondary respiratory failure is characterized by damage to organs and systems that are not part of the respiratory complex:

blood loss
Thrombosis of large arteries,
Traumatic shock,
intestinal obstruction,
Accumulation of purulent discharge or exudate in the pleural cavity.

Acute respiratory failure is manifested by rather vivid symptoms. Patients complain of a feeling of lack of air, shortness of breath, difficulty inhaling and exhaling. These symptoms appear before the others. Tachypnea usually develops - rapid breathing, which is almost always accompanied by respiratory discomfort. The respiratory muscles are overstrained, it requires a lot of energy and oxygen to work.

With an increase in respiratory failure, patients become excited, restless, euphoric. They cease to critically assess their condition and the environment. Symptoms of "respiratory discomfort" appear - whistling, remote wheezing, breathing is weakened, tympanitis in the lungs. The skin becomes pale, tachycardia and diffuse cyanosis develop, the wings of the nose swell.

In severe cases, the skin turns grayish and becomes sticky and moist. As the disease develops, arterial hypertension is replaced by hypotension, consciousness is depressed, coma and multiple organ failure develop: anuria, gastric ulcer, intestinal paresis, kidney and liver dysfunction.

The main symptoms of the chronic form of the disease:

Shortness of breath of various origins;
Increased breathing - tachypnea;
Cyanosis of the skin - cyanosis;
Strengthened work of the respiratory muscles;
compensatory tachycardia,
Secondary erythrocytosis;
Edema and arterial hypertension in the later stages.

Palpation is determined by the tension of the muscles of the neck, contraction of the abdominal muscles on exhalation. In severe cases, paradoxical breathing is revealed: on inspiration, the stomach is pulled inward, and on exhalation it moves outward.

In children, pathology develops much faster than in adults due to a number of anatomical and physiological features of the child's body. Babies are more prone to swelling of the mucous membrane, the lumen of their bronchi is rather narrow, the process of secretion is accelerated, the respiratory muscles are weak, the diaphragm is high, breathing is more shallow, and the metabolism is very intense.

These factors contribute to the violation of respiratory patency and pulmonary ventilation.

Children usually develop an upper obstructive type of respiratory failure, which complicates the course, paratonsillar abscess, false croup, acute epiglotitis, pharyngitis, and. The timbre of the voice changes in the child, and "stenotic" breathing appears.

The degree of development of respiratory failure:

First- difficult breathing and restlessness of the child, hoarse, "cock" voice, tachycardia, perioral, intermittent cyanosis, aggravated by anxiety and disappearing when breathing oxygen.
Second- noisy breathing that can be heard from a distance, sweating, constant cyanosis on a pale background, disappearing in an oxygen tent, coughing, hoarseness, retraction of the intercostal spaces, pallor of the nail beds, lethargic, adynamic behavior.
Third- severe shortness of breath, total cyanosis, acrocyanosis, marbling, pallor of the skin, drop in blood pressure, suppressed reaction to pain, noisy, paradoxical breathing, weakness, weakening of heart sounds, acidosis, muscle hypotension.
Fourth the stage is terminal and is manifested by the development of encephalopathy, asystole, asphyxia, bradycardia, seizures, coma.

The development of pulmonary insufficiency in newborns is due to an incompletely mature surfactant system of the lungs, vascular spasms, aspiration of amniotic fluid with primordial feces, and congenital anomalies in the development of the respiratory system.

Complications

Respiratory failure is a severe pathology requiring urgent therapy. The acute form of the disease is difficult to treat, leads to the development of dangerous complications and even death.

Acute respiratory failure is a life-threatening pathology that leads to the death of the patient without timely medical care.

Diagnostics

Diagnosis of respiratory failure begins with the study of the patient's complaints, the collection of an anamnesis of life and illness, and the clarification of comorbidities. Then the specialist proceeds to examine the patient, paying attention to the cyanosis of the skin, rapid breathing, retraction of the intercostal spaces, listens to the lungs with a phonendoscope.

To assess the ventilation capacity of the lungs and the function of external respiration, functional tests are carried out, during which the vital capacity of the lungs, the peak volumetric forced expiratory flow rate, and the minute respiratory volume are measured. To assess the work of the respiratory muscles, measure the inspiratory and expiratory pressure in the oral cavity.

Laboratory diagnostics includes the study of acid-base balance and blood gases.

Additional research methods include radiography and magnetic resonance imaging.

Treatment

Acute respiratory failure develops suddenly and rapidly, therefore you need to know how to provide emergency first aid.

The patient is laid on the right side, the chest is freed from tight clothing. To prevent the tongue from sinking, the head is thrown back, and the lower jaw is pushed forward. Then foreign bodies and sputum are removed from the pharynx using a gauze pad at home or an aspirator in a hospital.

It is necessary to call an ambulance team, since further treatment is possible only in the intensive care unit.

Video: first aid for acute respiratory failure

Treatment of chronic pathology is aimed at restoring pulmonary ventilation and gas exchange in the lungs, delivering oxygen to organs and tissues, pain relief, and eliminating the diseases that caused this emergency.

The following therapeutic methods will help restore pulmonary ventilation and airway patency:

After the restoration of respiratory patency, they proceed to symptomatic therapy.

Acute respiratory failure- a situation in which the body is not able to maintain the tension of gases in the blood, adequate to tissue metabolism. In the mechanism of development of acute respiratory failure, the leading role is played by violations of ventilation and membrane processes of gas exchange. In this regard, acute respiratory failure is divided into the following types:

Ventilatory acute respiratory failure:
1. Central.
2. Thoracoabdominal.
3. Neuromuscular.
Pulmonary acute respiratory failure:
1. Obstructive-constrictive:
  1. top type;
  2. bottom type.
2. Parenchymal.
3. Restrictive.
Acute respiratory failure due to violation of the ventilation-perfusion ratio.

Starting the treatment of acute respiratory failure, it is necessary first of all to highlight the cardinal criteria that determine the type of acute respiratory failure and the dynamics of its development. It is necessary to highlight the main symptoms that require priority correction. Hospitalization for any type of acute respiratory failure is mandatory.

The general directions of therapy for any type of acute respiratory failure are:

Timely restoration and maintenance of adequate tissue oxygenation. It is necessary to restore airway patency, give the patient an air-oxygen mixture (heating, humidification, adequate oxygen concentration). According to the indications, he is transferred to a ventilator.
The use of respiratory therapy methods from the simplest (mouth-to-mouth or mouth-to-nose breathing) to mechanical ventilation (attachments, devices or an automatic respirator). In this case, it is possible to prescribe both auxiliary respiratory therapy - breathing according to Gregory, Martin-Buyer (in the presence of spontaneous breathing), and replacement ventilation with constant positive pressure (PPP) and positive end-expiratory pressure (PEEP).

Upper obstructive-constrictive type of acute respiratory failure occurs most frequently in childhood. It accompanies SARS, true and false croup, foreign bodies of the pharynx, larynx and trachea, acute epiglotitis, retropharyngeal and paratonsillar abscesses, injuries and tumors of the larynx and trachea. The main pathogenetic component of acute respiratory failure of this type, which determines the severity of the condition and prognosis, is excessive work of the respiratory muscles, accompanied by energy depletion.

The clinic of stenosis is characterized by a change in the timbre of the voice, a rough barking cough, "stenotic" breathing with retraction of the supple places of the chest, epigastric region. The disease begins suddenly, often at night. Depending on the severity of clinical symptoms, reflecting the degree of resistance to breathing, there are 4 degrees of stenosis. The greatest clinical significance is stenosis of I, II and III degrees, which correspond to compensated, sub- and decompensated stages of acute respiratory failure (IV degree corresponds to the terminal stage).

Stenosis of the I degree is manifested by difficulty in breathing on inspiration, retraction of the jugular fossa, which increases with the child's motor restlessness. The voice becomes hoarse ("cock"). There is no cyanosis, the skin and mucous membranes are pink, there is a slight tachycardia.

Stenosis II degree is characterized by the participation in breathing of all auxiliary muscles. Breathing is noisy, heard at a distance. Hoarse voice, barking cough, marked anxiety. In contrast to grade I stenosis, retraction of the intercostal and epigastric regions, retraction of the lower end of the sternum, as well as cyanosis against the background of pallor of the skin, sweating are observed. Tachycardia increases, heart sounds are muffled, hiteroral cyanosis and unexpressed acrocyanosis are noted. In the blood, moderate hypoxemia is detected. Hypercapnia, as a rule, is not defined.

Stenosis III degree corresponds to the decompensated stage of acute respiratory failure and is characterized by a sharp manifestation of all the above symptoms: noisy breathing, sharp retraction of the intercostal space, jugular fossa and epigastric region, prolapse of the entire sternum, total cyanosis and acrocyanosis against the background of pale skin. Cold sticky sweat appears. In the lungs, only wired noises are heard. Motor restlessness is replaced by adynamia. Heart sounds are deaf, a paradoxical pulse appears. The blood shows severe hypoxemia and hyperkainia, combined acidosis with a predominance of the respiratory component. Severe posthypoxic encephalopathy develops. If the patient is not provided with medical care, then the stenosis passes into the terminal stage, which is characterized by asphyxia, bradycardia and asystole.

Treatment. In view of the risk of developing decompensated acute respiratory failure, all children with stenosis must be hospitalized in a specialized intensive care unit or intensive care unit.

At the prehospital stage, with degree I-II stenosis, foreign bodies or an excess amount of secretion from the oropharynx and nasopharynx should be removed. Produce oxygen inhalation and transport the child to the hospital. Medical therapy is not required. In the hospital, inhalations are prescribed (moistened warm air-oxygen mixture), sanitation of the oral cavity and nasal part of the pharynx is carried out, mucus is evacuated from the upper parts of the larynx and trachea under the control of direct laryngoscopy. Apply distracting procedures: mustard plasters on the feet, chest, compresses on the neck. Antibiotics are prescribed but indicated. Enter corticosteroids hydrocortisone, nednisolone. Timely hospitalization, physiotherapeutic procedures, adequate sanitation of the upper respiratory tract, as a rule, can avoid the progression of stenosis and, accordingly, acute respiratory failure.

In case of grade III stenosis, tracheal intubation is necessarily carried out with a thermoplastic tube of a obviously smaller diameter and the child is immediately hospitalized in a hospital. Intubation is performed under local anesthesia (aerosol irrigation of the entrance to the larynx 2 % lidocaine solution). When transporting the patient, oxygen inhalation is mandatory. With the development of an acute inefficient heart or its stop, cardiopulmonary resuscitation is performed. Tracheostomy with stenosis III-IV degree is used only as a necessary measure if it is impossible to provide adequate ventilation through the endotracheal tube.

Treatment in a hospital should mainly be aimed at adequate sanitation of the tracheobronchial tree and prevention of secondary infection.

Lower obstructive-constrictive type of acute respiratory failure develops with an asthmatic condition, asthmatic bronchitis, broncho-obstructive lung diseases. According to anamnestic data, the occurrence of the syndrome may be associated with previous sensitization to infectious, household, food or drug allergens. In the complex mechanisms of aerodynamic disorders, the functional disintegration of the central and peripheral airways is of decisive importance due to a decrease in their lumen due to muscle spasm, mucosal edema and an increase in the viscosity of the secret. This disrupts the ventilation-perfusion processes in the lungs.

The clinic of the disease is characterized by the presence of precursors: anxiety, loss of appetite, vasomotor rhinitis, skin itching. Then there is the development of "respiratory discomfort" - cough, wheezing, which are heard at a distance (the so-called remote wheezing), with expiratory dyspnea, cyanosis. In the lungs, tympanitis, weakened breathing, prolonged expiration, dry and wet rales are heard. Inadequate or untimely treatment can prolong this condition, which can turn into status asthmaticus. There are three stages in the development of status asthmaticus.

The first is the stage of subcompensation, in which, against the background of a general serious condition, severe suffocation and wheezing, tachycardia and arterial hypertension develop in the lungs. Cyanosis is perioral or not expressed. The child is conscious, excited.

The second is the stage of decompensation (syndrome of total pulmonary obstruction). Consciousness is confused, the child is extremely excited, breathing is frequent and superficial. Developed cyanosis and pronounced acrocyanosis appear. During auscultation, “zones of silence” are found in the lower parts of the lungs, significantly weakened breathing, dry rales are heard over the rest of the surface of the lungs. Tachycardia sharply increases, arterial hypertension increases.

The third is the coma stage. This stage is characterized by loss of consciousness, muscle atony, paradoxical type of breathing, a significant decrease in blood pressure, arrhythmia (single or group extrasystoles). Cardiac arrest may occur.

In subcompensated and decompensated stages, treatment at the prehospital stage includes the use of non-pharmacological means: oxygen inhalations, hot foot and hand baths, mustard plasters on the chest (if the child tolerates this procedure). It is necessary to isolate the child from potential allergens: house dust, pets, woolen clothes.

In the absence of effect, sympathomimetics are used - ß-adrenergic stimulants (novodrin, isadrin, euspiran), ß 2 - adrenostimulants (alupent, salbutamol, brikanil) in the form of inhalation aerosols - 2-3 drops of these drugs are dissolved in 3-5 ml of water or isotonic solution sodium chloride.

With a hormone-dependent form of the disease and the ineffectiveness of the above therapy, hydrocortisone (5 mg/kg) is prescribed in combination with prednisolone (1 mg/kg) intravenously.

Of the bronchodilators, the drug of choice is a 2.4% solution of aminophylline (aminophylline, diaphylline). Loading dose (20 - 24 mg / kg) is administered intravenously for 20 minutes, then a maintenance dose is administered - 1 - 1.6 mg / kg in 1 hour. Salbutamol is inhaled.

Antihistamines (piiolfen, diphenhydramine, suprastin, etc.) and adrenomimetic drugs such as adrenaline and ephedrine hydrochloride are not advisable to prescribe.

Treatment in a hospital is a continuation of prehospital therapy. In the absence of the effect of the therapy used and the progression of the syndrome, tracheal intubation and tracheobronchial lavage are mandatory. If necessary, apply IVL. Children in a state of subcompensation and decompensation and in a coma are hospitalized in the intensive care unit.

Parenchymal acute respiratory failure may accompany severe and toxic forms of pneumonia, aspiration syndrome, fatty embolism of the pulmonary artery branches, "shock" lung, exacerbation of cystic fibrosis, respiratory distress syndrome in newborns and infants, bronchopulmonary dysplasia. Despite various etiological factors, disturbances in the transmembrane transport of gases are of primary importance in the mechanisms of development of acute respiratory failure of this type.

The clinic is characterized by such basic symptoms as the frequency of breathing and pulse, their ratio, the degree of participation in the act of breathing of auxiliary muscles, the nature of cyanosis. An ambulance doctor must diagnose respiratory failure and determine its stage (compensation and decompensation).

The compensated form of parenchymal acute respiratory failure is characterized by unexpressed shortness of breath - breathing becomes more frequent in excess of the age norm by 20 - 25%. Observed perioral cyanosis, swelling of the wings of the nose.

In the decompensated form of shortness of breath, the respiratory rate increases sharply, increases by 30 - 70% compared with the age norm. The respiratory amplitude of the chest also increases, and hence the depth of breathing. Inflating of the wings of the nose is noted, all auxiliary muscles are actively involved in the act of breathing. Cyanosis of the skin and mucous membranes is pronounced, acrocyanosis appears.

Psychomotor agitation is replaced by lethargy and adynamia. Tachypnea occurs against the background of a decrease in heart rate.

Additional symptoms - fever, hemodynamic disorders, changes in the gas composition of the blood (hypoxemia and hypercapnia) determine the severity of the child's condition.

Acute respiratory failure (ARF) is an acute life-threatening condition, when even a strong strain of all organs and systems does not lead to an adequate supply of oxygen to all tissues. This condition is considered life-threatening and can quickly lead to death. The very first signs of ARF are cyanosis of the skin and mucous membranes, suffocation, disruption of the heart, a feeling of lack of air and increased arousal. As the pathology develops, the patient's consciousness is disturbed, convulsions appear, as a result, he falls into a coma. Emergency care for acute respiratory failure is to eliminate the cause that caused this condition. Oxygen therapy can be used, as well as artificial ventilation of the lungs.

The reasons

Acute respiratory failure can be triggered by various causes. This condition occurs against the background of some systemic diseases or a sharp disruption of the work of important organs and systems. The most common causes of respiratory failure are:

Diseases of the lung parenchyma, in which a significant part of the lung tissue is turned off from the process of general ventilation.
Severe pulmonary edema of various etiologies.
Prolonged attacks of bronchial asthma.
Pneumothorax.
Significant narrowing of the airways. This may occur due to the ingress of a foreign body into the organs of the nasopharynx, laryngeal edema, or mechanical compression of the trachea.
Fracture of the ribs, especially if they touch the tissue of the lung.
Pathologies that occur with disruption of the muscles of the respiratory organs. This happens with severe poisoning, tetanus and poliomyelitis. Often this condition occurs in epileptics.
Loss of consciousness due to drug overdose.
Hemorrhages in the brain.

Acute respiratory failure in adults and children may develop due to a violation of the normal exchange of gases with pneumonia, atelectasis and pleurisy. There is a high probability of developing this pathology with severely impaired hemodynamics. Sometimes there are mixed types of oxygen deficiency. In certain cases, a neuromuscular form of ARF occurs. This occurs when the spinal cord, some muscles or nerve cells are damaged.

Respiratory failure often occurs with traumatic brain injuries, as well as in a coma.

Symptoms

Initially, the clinical picture (clinic) of oxygen deficiency is poorly defined. The first signs may be excessive excitement or severe inhibition of a person. The main symptom of oxygen deficiency is cyanosis of the skin and all mucous membranes, and this condition is aggravated by the slightest physical exertion.

The patient breathes very noisily. Breathing, as it were, groaning, its rhythm is greatly disturbed. Additional muscles are involved in breathing. When inhaling, the muscles of the neck are strongly tense and the intercostal areas are noticeably retracted.

A person with ARF has a noticeable disruption of the heart and greatly increased blood pressure. As oxygen starvation progresses, convulsions occur, the work of the central nervous system is inhibited, and in most cases uncontrolled urination begins.

If oxygen starvation is associated with various disorders in a small circle of blood circulation, then pulmonary edema occurs. When listening to the sternum, the doctor notes wheezing of the fine-bubble and medium-bubble type. In people with acute respiratory failure, the pulse always quickens, shortness of breath and skin cyanosis appear. When coughing, a foamy liquid, pinkish in color, is released from the oral cavity.

There are three stages of acute respiratory failure, each of which is characterized by characteristic symptoms.

Moderate degree. The patient complains of lack of oxygen, he is restless and is in a state of some euphoria. Skin with a bluish tint, sticky to the touch, due to the release of cold sweat. If the respiratory center is not depressed, then the respiratory rate per minute is about 30. The work of the heart is disturbed. What is manifested by tachycardia and hypertension. With stage 1 oxygen deficiency, the prognosis is good, but only with timely treatment.
Significant degree. The person is too excited, delirium or hallucinations can be observed. The cyanosis of the skin is well expressed. The respiratory rate is about 40 per minute. Cold sweat is profusely released, so the skin feels moist and clammy to the touch. The heart rate increases, it can be up to 140 beats per minute. Arterial hypertension is rapidly increasing. With urgent resuscitation, the patient can be saved.
limiting degree. The person is in a severe coma. This may be accompanied by severe convulsions. The skin turns blue with spots, the pupils are greatly dilated. Breathing is superficial and very rapid, mostly 40 per minute. In some cases, breathing, on the contrary, slows down to 10 per minute. The patient's pulse is arrhythmic and frequent. It's very hard to feel it. The pressure is greatly reduced. Without medical assistance, such people die quickly.

At the first signs of acute respiratory failure, the patient is urgently assisted. Emergency care depends on the form of pathology and the general condition of the patient.

Children are more difficult to tolerate acute respiratory failure than adults. This is due to the small body weight and not yet fully formed organs.

Emergency help

First aid for respiratory failure depends on the degree of pathology. With hypoxic coma, resuscitation measures, as a rule, will not give much effect, therefore it is very important to provide assistance to the patient at the earliest stage.

Until the exact cause of this condition is clarified, the patient is forbidden to administer sedatives, hypnotics and neuroleptic drugs. In addition, do not resort to any drugs. Such a patient needs emergency medical help, so calling an ambulance cannot be postponed. A person with acute respiratory failure is placed in the intensive care unit or in the intensive care unit.

Before the arrival of the doctors, the patient is comfortably laid down, while the upper part of the body needs to be slightly raised by placing pillows. In this position, breathing is greatly facilitated. All restrictive clothing must be removed. It is recommended to remove the tie, unfasten buttons or zippers.

If there are removable dentures in the patient's oral cavity, they are immediately removed. Feeding and watering a person in this state is strictly prohibited. It is necessary to ensure the flow of fresh air into the room where the person with oxygen deficiency is located. To do this, you can open windows and doors, but you need to make sure that the patient does not lie in a draft.

If the cause of acute respiratory failure was a chest injury, then the patient can die not only from a lack of oxygen, but also from pain shock. In this case, anesthesia is mandatory. Tramadol and Metamizole sodium are administered to a person. Injections can be done both intramuscularly and intravenously. If possible, the patient is allowed to breathe pure oxygen through a mask.

When providing first aid to a person with respiratory failure, it is very important to restore normal airway patency. To do this, mucus is sucked out with a syringe, and foreign objects are also removed from the nose and throat.

First aid algorithm

Emergency care for acute respiratory failure is provided in several successive stages. When providing emergency care to the patient, the following algorithm should be followed:

Restore airway patency. Remove mucus with a syringe and remove squeezing clothing.
Carry out activities aimed at activating ventilation and gas exchange.
They fight against cardiovascular insufficiency and try to improve hemodynamics.

To restore airway patency, a person needs to be put on his right side and tilt his head back a little, this action prevents the tongue from falling back. Plastic or rubber air ducts are inserted into the oral cavity, if necessary, remove the pathological fluid from the bronchi and nasopharynx.

If indicated, tracheal intubation may be performed. After that, regular suction of mucus from the bronchi and trachea is carried out. When intubation is not possible, a tracheostomy is performed. To improve pulmonary gas exchange and ventilation of all respiratory organs, oxygenation and artificial ventilation of the lungs are done.

The patient is constantly monitored vital signs - pressure, pulse, heart function and respiration.

If symptoms of heart failure are observed, the patient is given heart medications. It can be Digoxin or Korglikon. In this case, diuretics and analeptics are also indicated. According to the doctor's indications, drugs that normalize blood pressure and painkillers can be used.

Patients are transported with the head of the stretcher slightly raised. If necessary, artificial ventilation of the lungs is carried out in the ambulance.

People with acute respiratory failure are treated in the intensive care unit or in the pulmonology intensive care unit. Such patients are under the constant supervision of health workers, at the slightest sign of deterioration, resuscitation measures are taken. More than a month is allotted for the recovery of the patient after ARF. For some time, patients are registered with a doctor.

They call the state when the breathing process is not able to provide the body with a sufficient amount of oxygen and remove the required amount of carbon dioxide.

Clinical picture

Such an ailment in children can cause serious consequences, so parents should know what factors affect the appearance of pathology. This condition can occur in childhood for a number of reasons. Doctors consider the main ones to be:

Types of respiratory failure in children

According to the mechanism of appearance, this problem is divided into parenchymal and ventilation.

Respiratory failure can also be acute (ARF) and chronic. The acute form develops within a short time, and chronic insufficiency can last several months and even years.

Degrees of respiratory failure

According to their severity, it is customary to distinguish 4 degrees of this pathology, which differ in clinical manifestations.

Respiratory failure in newborns

Respiratory failure can also occur in infants. The reasons for this may be:

Respiratory failure in newborn premature babies is caused by respiratory distress syndrome.

All principles of treatment are aimed at restoring airway patency, getting rid of bronchospasm and pulmonary edema, as well as positively affecting the respiratory function of the blood and eliminating metabolic disorders.

Symptoms of acute and chronic respiratory failure

Symptoms of the acute form of the disease are:

In chronic insufficiency, the same symptoms occur as in children, only they do not appear immediately, but gradually. But it is worth noting that in children this pathology develops much faster than in adults. This can be explained by the peculiarities of the anatomy of the child's body.

Children are more prone to swelling of the mucosa, their secretion is formed faster, and the muscles of the respiratory system are not as developed as in adults.

Children's oxygen requirements are much greater than those of adults, so the consequences of respiratory failure can be more severe. In chronic insufficiency, the child's voice timbre changes, a cough appears, and wheezing is heard when breathing.

Complications of pathology

Respiratory failure is a very serious disorder that can lead to serious consequences. From the side of the cardiovascular system, ischemia, arrhythmia, pericarditis, and hypotension may occur.

This condition also affects the nervous system. It can cause psychosis, polyneuropathy, decreased mental activity, muscle weakness, and even coma.

Also, respiratory failure can cause stomach ulcers, bleeding in the digestive tract, disruption of the liver and gallbladder. Acute respiratory failure even threatens the life of the child.

Treatment of respiratory failure in children

At first, all treatment is aimed at restoring pulmonary ventilation and freeing the airways. For this, oxygen treatment is used, which helps to normalize the gas composition of the blood. Oxygen is prescribed even for those patients who breathe themselves.

For the treatment of chronic insufficiency, in most cases, respiratory therapy is prescribed, which includes:

inhalation;
respiratory physiotherapy;
oxygen therapy;
aerosol therapy;
intake of antioxidants.

If the breathing problems in young patients are caused by infections, then they are prescribed antibiotics. The choice of these drugs occurs only after a sensitivity test has been carried out.

In order to clear the bronchi from the secret accumulated there, the patient is prescribed expectorants - a mixture of Altai root, Mukaltin. Doctors can also remove sputum from the bronchi through the nose or mouth with an endobronchoscope.

After the child's breathing has returned to normal, doctors begin symptomatic therapy. If the child had pulmonary edema, then he is prescribed diuretics. The most commonly used is furosemide. To eliminate pain, the child is prescribed painkillers - Panadol, Ibufen, Nimesil.

Basic diagnostic methods

First of all, the doctor examines the patient's history and learns about the disturbing symptoms. It is very important to establish if the child has diseases that can cause the development of insufficiency.

Next is a general inspection. During it, the specialist examines the chest and skin of the patient, counts the frequency of breathing and heartbeat, listens to the lungs with a phonendoscope.

Also, a mandatory study in the diagnosis of this pathology is the analysis of the gas composition of the blood. It makes it possible to find out the degree of its saturation with oxygen and carbon dioxide. The acid-base balance of the blood is also studied.

Additional diagnostic methods are chest x-ray and magnetic resonance imaging. In some cases, the doctor may prescribe a pulmonologist consultation for the child.

First aid for children with acute respiratory failure

This dangerous pathological condition can develop very quickly, so every parent should know how to provide first aid to their child.

The baby needs to be put on the right side and free his chest from tight clothing. So that the tongue does not sunk and does not block the airways even more, the child's head must be tilted back. If possible, mucus and foreign bodies (if any) should be removed from the nasopharynx. You can do this with a gauze pad. Next, you need to wait for an ambulance.

Doctors will perform airway aspiration, tracheal intubation, or other procedures to allow the child to breathe again. Then the baby can be connected to a ventilator and continue treatment in the hospital.

Preventive measures

Since respiratory failure is not a separate disease, but a symptom of other serious diseases and a consequence of mechanical influences, the prevention of this condition consists in the timely treatment of these causes. It is also very important to limit the child from contact with allergens and toxic substances.

In addition, you need to regularly undergo an examination with the child by specialists so that they can identify any pathologies of the respiratory system as early as possible.

Respiratory failure is a very serious pathological condition that can lead to hypoxia and even death. Therefore, everyone needs to know what to do with this disease. If all measures are taken on time, then this symptom can be eliminated quite easily. The main thing is to pay attention to all the complaints of the child and not to delay going to the doctor.