The Sharp Respiratory Insufficiency (SRI) – the pathological syndrome which is characterized by sharp decrease in level of oxygenation of blood. Treats the zhizneugrozhayushchy, critical conditions capable to lead to a lethal outcome. Early signs of sharp respiratory insufficiency are: , suffocation, feeling of shortage of air, excitement, cyanosis. In process of progressing of a hypoxia violation of consciousness, a spasm, a hypoxemic coma develops. The fact of existence and severity of respiratory frustration is determined by gas composition of blood. First aid consists in elimination of the reason of ODN, performing oxygenotherapy, if necessary – IVL.
Sharp respiratory insufficiency
Sharp respiratory insufficiency – the syndrome of respiratory frustration which is followed by an arterial gipoksemiya and a giperkapniya. As diagnostic criteria of sharp respiratory insufficiency serve indicators of partial pressure of oxygen in blood (ro2) of 50 mm of mercury. Unlike chronic respiratory insufficiency, at ODN compensatory mechanisms of breath even at the maximum tension cannot support gas composition of blood, optimum for activity, and are quickly exhausted that is followed by the expressed metabolic violations of vitals and disorders of haemo dynamics. Death from sharp respiratory insufficiency can come within several minutes or hours therefore this state is among urgentny.
Classification of sharp respiratory insufficiency
Etiologichesky classification subdivides ODN on primary (caused by violation of mechanisms of gas exchange in lungs – external breath) and secondary (caused by violation of transport of oxygen to fabrics – tissue and cellular respiration).
Primary sharp respiratory insufficiency:
- plevrogenny or torako-diafragmalny
- bronchopulmonary (obstructive, restrictive and diffusion)
The secondary sharp respiratory insufficiency caused
- hypocirculator violations
- gipovolemichesky frustration
- cardiogenic reasons
- tromboembolichesky complications
- shunting (deposition) of blood at various shock states
In detail these forms of sharp respiratory insufficiency will be considered in the section "Reasons".
Besides, distinguish ventilating (giperkapnichesky) and parenchymatous (gipoksemichesky) sharp respiratory insufficiency. Ventilating DN develops as a result of decrease in alveolar ventilation, is followed by substantial increase rso2, an arterial gipoksemiya, respiratory acidosis. As a rule, arises against the background of the central, neuromuscular and torako-diafragmalny violations. Parenchymatous DN is characterized by an arterial gipoksemiya; at the same time the CO2 level in blood can be normal or a little raised. Such type of sharp respiratory insufficiency is a consequence of bronkho-pulmonalny pathology.
Depending on the partial tension of O2 and CO2 in blood allocate three stages of sharp respiratory frustration:
Stage ODN I – ro2 decreases to 70 mm of mercury., rso2 to 35 mm of mercury.
Stage ODN II - ro2 decreases to 60 mm of mercury., rso2 increases to 50 mm of mercury.
Stage ODN III - ro2 decreases to 50 mm of mercury. below, rso2 increases to 80-90 mm of mercury. above.
Reasons of sharp respiratory insufficiency
Etiologichesky factors of sharp respiratory insufficiency are very various therefore the doctors working in offices of resuscitation, pulmonology, traumatology, cardiology, toxicology, infectious diseases etc. can face this state in the practical activities. Depending on the leading pathogenetic mechanisms and immediate causes mark out primary sharp respiratory insufficiency of a tsentrogenny, neuromuscular, torako-diafragmalny and bronchopulmonary origin.
ODN of the central genesis is the cornerstone oppression of activity of the respiratory center which, in turn, can be caused by poisonings (overdose by drugs, tranquilizers, barbiturates, morphine, etc. medicinal substances), ChMT, an electric trauma, brain hypostasis, a stroke, a sdavleniye of the respective area of a brain a tumor.
Violation of neuromuscular conductivity leads to paralysis of respiratory muscles and can become the reason of sharp respiratory insufficiency at botulism, tetanus, poliomyelitis, overdose of muscular relaksant, a myasthenia. Torako-diafragmalny and parietal ODN pleurae, diaphragms are tied with restriction of mobility of a thorax, lungs. Sharp respiratory frustration can accompany pheumothorax, , ekssudativny pleurisy, thorax injuries, a fracture of edges, violations of a bearing.
The most extensive pathogenetic group is made by bronchopulmonary sharp respiratory insufficiency. ODN on obstructive type develops owing to violation of passability of airways at various level. As the reason of obstruction foreign matters of a trachea and bronchial tubes, a laryngospasm, the asthmatic status, bronchitis with slime hyper secretion, strangulyatsionny asphyxia, etc. can serve. Restrictive ODN arises at the pathological processes which are followed by decrease in elasticity of pulmonary fabric (krupozny pneumonia, hematomas, lung atelektaza, drowning, states after extensive resections of lungs etc.). The diffusion form of sharp respiratory insufficiency is caused by a considerable thickening of alveolo-capillary membranes and thereof oxygen diffusion difficulty. Such mechanism of respiratory insufficiency is more characteristic of chronic diseases of lungs (a pneumoconiosis, a pneumosclerosis, a diffusion fibroziruyushchy alveolit etc.), however can develop and sharply, for example, at respiratory a distress syndrome or toxic defeats.
Secondary sharp respiratory insufficiency arises in connection with the defeats which outright are not mentioning the central and peripheral bodies of the respiratory device. So, sharp respiratory frustration develop at massive bleedings, anemia, gipovolemichesky shock, arterial hypotonia, TELA, heart failure and other states.
Symptoms of sharp respiratory insufficiency
The sequence, expressiveness and speed of development of signs of sharp respiratory insufficiency can differ in each clinical case, however for convenience of assessment of severity of violations it is accepted to distinguish three degrees of ODN (according to stages of a gipoksemiya and a giperkapniya).
Degree ODN I (the compensated stage) is followed by feeling of shortage of air, concern of the patient, sometimes euphoria. Integuments are pale, slightly damp; easy cyanosis of fingers of hands, lips, a nose tip is noted. Objectively: (ChD 25-30 in min.), tachycardia (ChSS 100-110 in min.), moderate increase HELL.
At degree ODN II (a stage of incomplete compensation) psychomotor excitement develops, patients complain of severe suffocation. Confusion of consciousness, a hallucination, nonsense are possible. Coloring of integuments tsianotichny (sometimes with hyperaemia), is observed profuzny sweating. At the II stage of sharp respiratory insufficiency ChD (till 30-40 in 1 min.), pulse continue to accrue (to 120-140 in min.); arterial hypertension.
Degree ODN III (decompensation stage) is marked by development of a hypoxemic coma and the toniko-clonic spasms demonstrating heavy metabolic frustration of TsNS. Pupils extend and do not react to light, spotty cyanosis of integuments develops. ChD reaches 40 and more in the min., respiratory movements superficial. A terrible predictive sign is bystry transition in (ChD 8-10 in min.), being cardiac arrest harbinger. Arterial pressure critically falls, ChSS over 140 in arrhythmia, min. with the phenomena. Sharp respiratory insufficiency of the III degree, in fact, is a preagonalny phase of a terminal state and without timely resuscitation actions leads to a bystry lethal outcome.
Diagnostics of sharp respiratory insufficiency
Often the picture of sharp respiratory insufficiency is developed so promptly that practically does not leave time for performing expanded diagnostics. In these cases the doctor (the pulmonologist, the resuscitator, the traumatologist etc.) quickly assesses a clinical situation for clarification of the possible reasons of ODN. At survey of the patient it is important to pay attention to passability of airways, frequency and the characteristic of breath, involvement in the act of breath of auxiliary muscles, coloring of integuments, ChSS. For the purpose of assessment of degree of a gipoksemiya and a giperkapniya the diagnostic minimum joins definition of gas structure and the acid and main condition of blood.
If the condition of the patient allows (at degree ODN I) research FVD (a pikfloumetriya, spirometry) is made. Data of a X-ray analysis of a thorax, a bronkhoskopiya, the ECG, the general and biochemical blood test, a toxicological research of urine and blood can be important for clarification of the reasons of sharp respiratory insufficiency.
Emergency aid at sharp respiratory insufficiency
The sequence of actions of first aid is defined by the reason of sharp respiratory insufficiency, and also its weight. The general algorithm includes providing and maintenance of passability of airways, restoration of violations of pulmonary ventilation and perfusion, elimination of the accompanying haemo dynamic violations.
At the first stage it is necessary to examine a mouth of the patient, to take foreign matters (if those are available), to make aspiration of contents from airways, to eliminate a language zapadeniye. For the purpose of ensuring passability of airways imposing of a tracheostoma, carrying out a konikotomiya or tracheotomy, a medical bronkhoskopiya, posturalny drainage can be required. At pneumo - or a gemotoraksa drainage of a pleural cavity is made; at a bronchospasm glucocorticosteroids and bronchodilators are applied it (is system or inhalation). Further it is necessary to provide immediately supply of the moistened oxygen (by means of a nasal catheter, a mask, an oxygen tent, hyperbaric oxygenation, IVL).
For the purpose of correction of the accompanying violations caused by sharp respiratory insufficiency medicinal therapy is carried out: at a pain syndrome analgetics are appointed; for the purpose of stimulation of breath and cardiovascular activity – respiratory analeptik and warm glycosides; for elimination of a gipovolemiya, intoxication - infusional therapy etc.
The forecast at sharp respiratory insufficiency
Consequences of sharply developed respiratory insufficiency are always serious. The etiology of a pathological state, extent of respiratory violations, speed of first-aid treatment, age, the initial status exerts impact on the forecast. At promptly developed critical violations death is caused by respiratory standstill or warm activity. At less sharp gipoksemiya and a giperkapniya, bystry elimination of the reason of sharp respiratory insufficiency the favorable outcome is, as a rule, observed. The exception of repeated episodes of ODN requires intensive treatment of the background pathology which caused zhizneugrozhayushchy violations of breath.