What Is Respiratory Failure?
Respiratory failure is a serious disorder of lung ventilation and / or ventilation caused by various reasons, so that effective gas exchange cannot be performed, resulting in hypoxia with (or without) carbon dioxide retention, which causes a series of physiological and metabolic disorders. Clinical syndrome. At sea level atmospheric pressure, after breathing indoor air under resting conditions, and excluding anatomic shunt and primary decrease in cardiac output, the arterial oxygen pressure (PaO 2 ) is lower than 8kPa (60mmHg), or If the partial pressure of carbon dioxide (PaCO 2 ) is higher than 6.65kPa (50mmHg), it is respiratory failure (referred to as respiratory failure).
Basic Information
- nickname
- Respiratory failure, acute respiratory failure, chronic respiratory failure
- English name
- respiratory failure
- Visiting department
- Respiratory department, emergency department
- Common causes
- Respiratory disease, lung tissue disease, pulmonary vascular disease, thoracic disease
- Common symptoms
- In addition to the primary symptoms, hypoxia and carbon dioxide retention
- Contagious
- no
Causes of respiratory failure
- Respiratory tract disease
- Bronchial inflammation, bronchospasm, foreign bodies, etc. obstruct the airway, causing insufficient ventilation, uneven gas distribution leading to imbalance of ventilation / blood flow ratio, hypoxia and carbon dioxide retention.
- 2. Lung tissue lesions
- Pneumonia, severe tuberculosis, emphysema, diffuse pulmonary fibrosis, adult respiratory distress syndrome (ARDS), etc., can cause reduction in lung volume, ventilation volume, effective diffuse area, and imbalance of ventilation / blood flow leading to pulmonary artery-like shunts, causing Hypoxia and / or carbon dioxide retention.
- 3. Pulmonary vascular disease
- Pulmonary vascular embolism, pulmonary infarction, etc., caused some venous blood to flow into the pulmonary veins, resulting in hypoxia.
- 4. Thoracic lesions
- Such as thoracic trauma, surgical trauma, pneumothorax and pleural effusion, etc., affect thoracic activity and lung expansion, leading to reduced ventilation and uneven intake of air, affecting ventilation.
- 5. Nervous center and its conduction system respiratory muscle disorders
- Cerebrovascular disease, encephalitis, traumatic brain injury, drug poisoning, etc. directly or indirectly inhibit the respiratory center; polio and polyneuritis block muscle-nerve junction block affects conduction function; myasthenia gravis and other impaired respiratory dynamics cause ventilation insufficient.
Clinical manifestations of respiratory failure
- Classification
- (1) Classification by arterial blood gas analysis Respiratory failure type Hypoxia without CO 2 retention, or accompanied by a decrease in CO 2 (type ) is seen in ventilation dysfunction (ventilation / blood flow imbalance, diffusion function impairment, and pulmonary arteriovenous-like Shunt). Type respiratory failure is due to the lack of O 2 and CO 2 retention caused by insufficient alveolar ventilation. The degree of retention of O 2 and CO 2 deficiency is parallel with simple hypoventilation. If accompanied by impaired ventilation function, the lack of O 2 is more serious. Only increase the alveolar ventilation, if necessary, oxygen therapy to correct.
- (2) Classification by disease course According to the disease course, it can be divided into acute and chronic. Acute respiratory failure refers to the sudden causes of the aforementioned five categories of causes, which cause ventilation or severe damage to the ventilation function, and the clinical manifestations of respiratory failure suddenly occur, such as cerebrovascular accidents, drug poisoning inhibiting the respiratory center, respiratory muscle paralysis, pulmonary infarction, ARDS, etc., if not rescued in time, will endanger patients' lives.
- Chronic respiratory failure is more common in chronic respiratory diseases, such as chronic obstructive pulmonary disease and severe pulmonary tuberculosis, and its respiratory function is gradually worsened. Although there is O 2 deficiency or CO 2 retention, it can still be engaged in daily life through compensatory adaptation. activity.
- 2. Symptoms
- In addition to the symptoms of primary disease, it is mainly manifested by hypoxia and carbon dioxide retention, such as dyspnea, shortness of breath, neuropsychiatric symptoms, etc. When pulmonary encephalopathy is complicated, gastrointestinal bleeding may also occur.
- 3. Physical examination found
- There may be cyanosis of the lips and nail bed, disturbance of consciousness, conjunctival congestion, edema, flutter-like tremor, and optic nerve papillary edema.
Respiratory failure examination
- Blood gas analysis
- Arterial blood oxygen partial pressure (PaO 2 ) <8.0Kpa (60mmHg) Arterial blood carbon dioxide partial pressure (PaCO 2 )> 6.7Kpa (50mmHg) when inhaled in the resting state is type respiratory failure. Type 1 respiratory failure
- 2. Electrolyte check
- Respiratory acidosis combined with metabolic acidosis is often accompanied by hyperkalemia; respiratory acidosis combined with metabolic alkalosis is often accompanied by hypokalemia and hypochloremia.
- 3. Sputum examination
- The test results of sputum smear and bacterial culture are helpful to guide medication.
- 4. Other inspections
- Such as lung function examination, chest imaging examination, etc. have corresponding findings according to the different primary diseases.
Diagnosis of respiratory failure
- The main diagnosis of this disease is acute, such as drowning, electric shock, trauma, drug poisoning, severe infection, shock; chronic multiple secondary to chronic respiratory diseases, such as chronic obstructive pulmonary disease. Combining clinical manifestations and blood gas analysis is helpful for diagnosis.
Respiratory failure treatment
- 1. First, actively treat the primary disease. Sensitive antibiotics should be used when bacterial and other infections are combined to remove the predisposing factors.
- 2. Keep the airway open and effective ventilation, can be used to relieve bronchospasm and expectorant drugs, such as salbutamol (Shuchuanling), terbutaline sulfate (Boliconi), spasm, acetylcysteine, ammonia hydrochloride Bromoxol (mushutan) and other drugs expectorant. If necessary, intravenous infusion of adrenocortical hormone can be used.
- 3. To correct hypoxemia, use a nasal cannula or a mask to inhale oxygen, severe hypoxia and carbon dioxide retention, severe conscious disturbance, mechanical ventilation should be used to improve hypoxemia when pulmonary encephalopathy occurs.
- 4. Correct the complications of acid-base imbalance, heart rhythm disorder, heart failure and so on.
Respiratory failure prevention
- 1. Reduce energy consumption
- Relieve bronchospasm, eliminate bronchial mucosal edema, reduce bronchial secretions, reduce airway resistance, and reduce energy expenditure.
- 2. Improve the nutritional status of the body
- Enhance nutrition to increase the intake of sugar, protein and various vitamins, if necessary, intravenous drip of compound amino drum, plasma, albumin.
- 3. Keep exercising
- Do breathing gymnastics every day to enhance the function of the respiratory muscles.