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Respiratory distress syndrome


The Respiratory Distress Syndrome of Adults (RDSA) – extremely heavy manifestation of respiratory insufficiency which is followed by development of not cardiogenic hypostasis of lungs, violations of external breath and a hypoxia. Despite variety of the factors leading to RDVS the damages of pulmonary structures causing insolvency of transportation of oxygen in lungs are its cornerstone. Other names respiratory a distress syndrome are a "shock", "moist", "traumatic" lung.

Respiratory distress syndrome

The Respiratory Distress Syndrome of Adults (RDSA) – extremely heavy manifestation of respiratory insufficiency which is followed by development of not cardiogenic hypostasis of lungs, violations of external breath and a hypoxia. Despite variety of the factors leading to RDVS the damages of pulmonary structures causing insolvency of transportation of oxygen in lungs are its cornerstone. Other names respiratory a distress syndrome are a "shock", "moist", "traumatic" lung.

Sharp decrease in oxygenation and ventilation of an organism causes oxygen insufficiency of heart and brain and development of the states menacing for life. At RDSV the lethality in a case out of time or inadequately given help reaches 60-70%.

Reasons and mechanism of development of RDSV

As the mechanism starting development respiratory a distress syndrome serves the embolization of small vessels of lungs blood microclots, parts of the damaged fabrics, fat drops against the background of the toxic biologically active agents which are formed in fabrics — kinin, prostaglandins, etc. Mikroembolization of pulmonary vessels develops as a result of the direct or mediated impact on a capillary and alveolar membrane of different pulmonary atsinus of the damaging factors.

The direct damaging impact is made by aspiration of blood, emetic masses and water, inhalation of smoke and toxic substances, a contusion of lungs, a fracture of edges, a rupture of a diaphragm, overdose of drugs. The mediated, indirect damage of capillary and alveolar membranes is caused by activation and aggregation of uniform elements of blood at bacterial and virus pneumonia, sepsis, burns, the combined injuries and traumatic shock which are followed by massive blood loss, pancreatitis, autoimmune processes, an electric trauma, an eklampsiya etc.

Increase in permeability of a membrane for protein and liquid causes hypostasis of interstitsialny and alveolar fabrics, decrease in tensile properties and gas exchange function of lungs. These processes lead to development of a gipoksemiya, giperkapniya and sharp respiratory insufficiency. The respiratory distress syndrome can develop for several hours or days from the moment of influence of the damaging factor. During RDSV allocate three patomorfologichesky phases:

  • Sharp phase RDSV (up to 2-5 days) – interstitsialny and alveolar hypostasis of lungs, defeat of capillaries of lungs and an epithelium of alveoluses, development of mikroatelektaz. In case of a favorable current respiratory a distress syndrome several days later sharpness of the phenomena abates, resolves; otherwise transition to a subsharp or chronic current is possible.
  • Subsharp phase RDSV – development of a bronkhoalveolyarny and interstitsialny inflammation.
  • Chronic phase RDSV – corresponds to development of a fibroziruyushchy alveolit. There is a thickening and flattening of capillary and alveolar membranes, growth in them connecting fabric, formation of microthromboses and a zapustevaniye of the vascular course. An outcome of a chronic phase respiratory the distress syndrome serves development of pulmonary hypertensia and chronic respiratory insufficiency. The expressed alveolar fibrosis can arise already 2-3 weeks later.

Symptoms respiratory distress syndrome

Development respiratory a distress syndrome of adults is characterized by consecutive change of the stages reflecting pathological changes in lungs and a typical picture of sharply increasing respiratory insufficiency.

I (a damage stage) – the first 6 hours since influence of a stressful factor. Complaints, as a rule, are absent, kliniko-radiological changes are not defined.

II (a stage of imaginary wellbeing) – from 6 to 12 hours since influence of a stressful factor. The accruing short wind, cyanosis, tachycardia, (breath increase more than 20 in min.), concern of the patient, cough with a foamy phlegm and streaks of blood develop. Short wind and cyanosis are not stopped by oxygen inhalations, the content of oxygen in blood steadily falls. Auskultativno in lungs – rattles, a krepitation; radiological signs correspond to diffusion interstitsialny hypostasis.

III (a stage of respiratory insufficiency) – 12-24 hours later after influence of a stressful factor. The bubbling breath with allocation of a foamy pink phlegm, the accruing gipoksemiya and a giperkapniya, superficial breath, increase central venous and a lowering of arterial pressure. On all surface of lungs damp, multiple rattles of various caliber are listened. On roentgenograms merge of focal shadows is defined. In this stage there is a formation of hyaline membranes, filling of alveoluses with fibrin, exudate, the breaking-up blood cells, defeat an endoteliya of capillaries to formation of hemorrhages and mikroatelektaz.

IV (a terminal stage) - metabolic acidosis, a gipoksemiya and a giperkapniya are not eliminated with extremely large volumes of intensive therapy and IVL. False positive radiological dynamics (emergence of the centers of enlightenments) is caused by growth of the connecting fabric replacing a parenchyma of lungs. In this terminal period respiratory the distress syndrome develops the polyorgan insufficiency which is characterized:

  • the arterial hypotonia expressed by tachycardia, fibrillation of auricles, ventricular tachycardia;
  • giperbilirubinemiy, giperfermentemiy, gipoalbuminemiy, gipokholesterinemiy;
  • DVS-syndrome, leykopeniya, thrombocytopenia;
  • increase in urea and creatinine, oliguriya;
  • gastrointestinal and pulmonary bleedings;
  • consciousness oppression, coma.

Complications respiratory distress syndrome

During knocking over respiratory a distress syndrome complications in the form of barotraumas of slight, bacterial pneumonia, development of the DVS-syndrome, left ventricular heart failure are possible. As displays of the barotrauma developing owing to carrying out hardware ventilation of lungs serve hypodermic emphysema, pheumothorax, . The increased risk of development of barotraumas in patients with respiratory a distress syndrome is caused by restretching of alveoluses at decrease in elasticity of pulmonary fabric.

Sharp left ventricular insufficiency (or cardiogenic hypostasis of lungs) at RDSV is caused by stagnation of blood circulation in a small circle. The DVS-syndrome (a syndrome of disseminirovanny intra vascular folding) develops at sepsis, a pankreonekroza and other damaging factors and is expressed in polyorgan defeat of various systems.

Diagnostics respiratory distress syndrome

The respiratory distress syndrome is critical condition and demands the emergency assessment of a condition of the patient. As early objective manifestations of RDSV serve the accruing short wind, tachycardia and cyanosis. The Auskultativny picture of lungs changes according to stages respiratory a distress syndrome: from rigid "amforichesky" breath to the bubbling damp rattles and a symptom of the "mute" ("silent") lung in a terminal stage.

Characteristic indicator of gas composition of blood at RDSV is Rao2 lower than 50 mm of mercury. (gipoksemiya), despite the carried-out oxygenotherapy (at FiO2 more> 60%.), increase of a giperkapniya. At patients with RDSV the expressed respiratory insufficiency and a gipoksemiya remain even at inhalations of the high-concentrated oxygen mix.

Biochemical indicators of blue blood are characterized by a gipoalbuminemiya, increase in the curtailing factors, increase and bilirubin. At a X-ray analysis of lungs on the periphery diffusion multiple shadows (a symptom of "blizzard") come to light, decrease in transparency of pulmonary fabric, a pleural exudate usually is absent.

Indicators of function of external breath demonstrate reduction of all respiratory volumes and static stretching of pulmonary fabric less than 5 ml/mm w.g. Measurement of pressure in a pulmonary artery Ghanaian Swan's catheter shows its "jamming" at the level of less than 15 mm hg. The respiratory distress syndrome should be distinguished from cardiogenic hypostasis of lungs, pneumonia, TELA.

Treatment respiratory distress syndrome

Treatment respiratory a distress syndrome is performed in the conditions of intensive care unit and resuscitation. Actions for knocking over of RDSV include:

  • elimination of the stressful damaging factor;
  • correction of a gipoksemiya and sharp respiratory insufficiency;
  • treatment of polyorgan violations.

At the first stage of treatment respiratory a distress syndrome the direct damaging factors of lungs are eliminated, massive antibacterial therapy at bacterial pneumonia, sepsis is appointed, the corresponding treatment of burns and injuries is performed. For elimination of a hypoxia selection of the adequate mode of a kislorodoterapiya with dynamic control of gases of blood is carried out (with maintenance of PO2 not less than 60 mm hg). Supply of oxygen can be carried out through a mask or a nasal catheter, at inefficient oxygenation IVL (is shown at ChD 30 in a minute).

For prevention of development of the DVS-syndrome are appointed acetilsalicylic acid, and , heparin. Despite interstitsialny and alveolar hypostasis, infusional therapy for improvement of food of bodies, normalization of a diuresis and maintenance of level HELL is carried out. Efficiency of treatment respiratory a distress syndrome depends on its timeliness: it is successful only at early stages of this state before irreversible defeats of pulmonary fabric.

Forecast and prevention respiratory distress syndrome

The lethality in the III stage respiratory a distress syndrome makes about 80%, in a terminal stage, the corresponding polyorgan insufficiency, usually all patients perish. At a favorable outcome after knocking over of RDSV function of lungs can be restored almost completely, however the thicket needs the long supporting therapy.

Specific preventive actions respiratory a distress syndrome are absent. It is necessary to be careful of influence of the stressful damaging factors leading to development of RDSV.

Respiratory distress syndrome - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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