What Is Respiratory Insufficiency?

Acute respiratory insufficiency

Acute respiratory insufficiency is due to various causes of pulmonary ventilation and / or ventilatory function caused by various causes inside and outside the lungs, so that effective gas exchange cannot be performed. When breathing air, severe hypoxia accompanied by hypercapnia occurs, and A clinical syndrome that causes a series of physiological and metabolic disorders.

Introduction to Acute Respiratory Insufficiency

The patient suffers from shock, severe infection, inhalation injury, severe burns on the face and neck, excessive or too fast fluid replacement, surgery, massive input of old blood, aspiration of gastric contents and cardiac insufficiency, progressive hypoxia, difficulty breathing, Changes in consciousness and abnormal chest signs.

Overview of Acute Respiratory Insufficiency

Respiratory system

Acute respiratory insufficiency is a common emergency in children. It refers to the primary or secondary disease of the respiratory center, or the respiratory system.

Acute respiratory insufficiency Changes, causing ventilatory or ventilatory dysfunction, a clinical syndrome of a series of physiological and metabolic disorders caused by hypoxia or carbon dioxide retention, called respiratory failure. Acute onset is acute respiratory failure, and the child presents with cyanosis, dyspnea, irregular breathing, and irregular rhythms. The prognosis of this disease is poor and the mortality rate is high, but with the improvement of medical level and the use of ventilator, the cure rate has improved. Respiratory pathological changes and thoracic and pleural disorders cause respiratory dynamics damage, hypoventilation due to increased airway resistance and restriction of lung dilatation, and imbalance of ventilation to blood flow, resulting in hypoxia with hypercapnia. Lung tissue pneumonia, atelectasis, acute lung injury and vascular disease or renal insufficiency caused by pulmonary edema and extensive fibrosis of the lung.

Clinical manifestations of acute respiratory insufficiency

Human lungs

1. Buns and hypoxemia, manifested as bruising or pale.

2. Irritability or lethargy, sweating, severe coma, convulsions.

Acute respiratory insufficiency

3. Dyspnea, manifested by changes in frequency and rhythm.

4. Chest tightness, palpitations and heart rhythm disorders, pulmonary edema and left heart failure.

5. Gastrointestinal disorders: There may be vomiting, bleeding, even intestinal paralysis, and abnormal liver function.

Diagnosis basis of acute respiratory insufficiency

Acute respiratory insufficiency X films

1. Various factors (can be breathing, loops, nervous system diseases, drugs, etc.) cause serious damage to respiratory function

Acute respiratory insufficiency Lead to hypoxia or carbon dioxide retention, a series of clinical disorders of physiological dysfunction and metabolism.

2. Respiratory dysfunction: severe dyspnea, changes in cyanosis, respiratory frequency and rhythm.

3. Cardiovascular dysfunction: Early blood pressure rises, late blood pressure drops, peripheral capillaries and veins dilate, heart rhythm disorders, pulmonary edema, and even right heart failure.

4. Nervous System Disorders: Suppressing symptoms-lethargy, coma; Exciting symptoms-irritability, headache, insanity, convulsions, pupil diminution, optic nerve papillary edema, etc.

5. Disorders of digestive system: abdominal distension, vomiting, upper gastrointestinal bleeding and liver function damage. 6. Imbalance of acid and tritium and water and electrolyte disturbance. 7. Blood gas analysis: PaO2 <6.67KPa (50mmHg) or PaCO2> 6.67KPa (50mmHg) when breathing air in a resting state.

Treatment of acute respiratory insufficiency

Ventilator

The principle is to improve respiratory function and keep the airway unobstructed; give oxygen correctly and selectively apply respiratory stimulants; control

Acute respiratory insufficiency Infection, treatment of primary disease; correction of acid-base and electrolyte disorders to maintain heart, brain, lung and kidney function.

Acute respiratory insufficiency keeps airways open and improves ventilation

Respiratory obstruction is mainly caused by mucosal swelling, sputum accumulation and bronchospasm. In the treatment, warm and humid airway secretions and nebulization are very important. When inhaling oxygen, the humidification bottle of the oxygen device can be filled with hot water at about 60 ° C to humidify the temperature of the inhaled oxygen; atomize with an ultrasonic atomizer for 15 minutes each time, several times a day, and atomize the liquid Expectants (such as bisulfin, phlegm easy to clean, a-chymotrypsin, etc.), bronchial spasmolytic agents (such as isoproterenol, Shuchuanling, dexamethasone, etc.), antibiotics and other drugs can be added. Obstruction caused by sputum accumulation is often an important cause of respiratory failure or exacerbation. Therefore, sputum should be actively expelled. Severely ill children turn over regularly and often pat their chests and backs gently to expel sputum. The mucus of the mouth, nose and pharynx can be sucked out with a suction tube. For obstruction caused by viscous secretions of the lower respiratory tract, tracheal intubation is required for suction.

Acute respiratory insufficiency

Severe hypoxia can cause irreversible damage to important organ cells of the human body, especially brain cells, so active oxygen supply is very important. The purpose of oxygen delivery is to increase PaO2 and SaO2 to relieve hypoxia. The principle is the relief of hypoxia, and the sensitivity of the carotid sinus and aortic body to hypoxic partial pressure is not controlled. At present, it is considered that the effect of continuous oxygen supply at a low flow rate is better. The oxygen concentration is generally about 30% to 50%, and the flow rate is 2 to 3L per minute. When nasal catheter is used for oxygen supply, the oxygen flow rate and the oxygen concentration are roughly as follows: inhaled oxygen concentration (%) = 21 + 4 × oxygen flow rate (L / min). Moderate hypoxia, oxygen concentration is 30% to 40%; severe hypoxia concentration is 50% to 60%, but inhaled 60% of oxygen should not exceed 24 hours. During rescue, if 60% oxygen supply still can not improve cyanosis, 100% pure oxygen can be used, but the use time should not exceed 6 hours. In the future, oxygen with a concentration of <60% will be used instead. Regularly check the arterial blood for blood gas analysis. Generally, PaO2 is required to be maintained at 8.65 to 11.31 kPa (65 to 85 mmHg). It is not advisable to inhale high concentrations of oxygen for a long time to prevent harm caused by oxygen poisoning.

Application of respiratory stimulants for acute respiratory insufficiency

Scopolamine hydrobromide

The main role is to excite the respiratory center or stimulate the carotid sinus and aortic body chemoreceptors to stimulate the respiratory center reflexively. The former can be scopolamine hydrobromide and colamin, and the latter can be lobelin. Alternate intramuscular injection, intravenous bolus, or drip. However, respiratory stimulants are not effective in children with severe obstruction of the airways or retention of secretions, in patients with restrictive breathing disorders caused by neuromuscular diseases or severe extensive pulmonary lesions.

Acute respiratory insufficiency maintains water and electrolyte balance

The amount of calories needed to maintain basal metabolism was 209.2kj (50kcal) / kg daily, and the fluid volume was 60 80ml / kg daily. For respiratory acidosis, mainly to improve ventilation, such as blood pH <7.20, has been decompensated and combined with metabolic acidosis, can improve ventilation and

Acute respiratory insufficiency On the basis of oxygen therapy, 5% sodium bicarbonate is instilled intravenously according to the formula "sodium bicarbonate (mmol) = 0.3 x alkali deficiency (mmol) x body weight", usually half of the amount is used first. The course of the disease is often complicated by hyponatremia, or low potassium, low chloride metabolic alkalosis, and potassium, chloride, and sodium ions should be supplemented in time.

Prevention and treatment of acute respiratory insufficiency

Pulmonary and central nervous system infections are common causes of respiratory failure and should be diagnosed and treated early. If the cause is unknown, broad-spectrum antibiotics may be given first.

Other symptomatic treatment of acute respiratory insufficiency

Phentolamine

In patients with central acute respiratory failure showing increased intracranial pressure, dehydrating agents should be used in a timely manner. Cardiac agents can be given to those with heart dysfunction. For patients with cerebral edema and pulmonary edema, limit the water intake (50 to 80 ml / kg per day) and use diuretics such as furosemide. Phentolamine can improve microcirculation and increase tissue perfusion, generally 0.3 to 0.5 mg / kg at a time, the amount does not exceed 10 mg at a time, and intravenous drip is added to 10% glucose solution.

Tracheal intubation and tracheotomy for acute respiratory insufficiency

It can ensure the patency of the respiratory tract, facilitate the suction of respiratory secretions, and can be used to connect artificial respirators. Intubation

Acute respiratory insufficiency The indwelling time is generally not more than 48 hours, and the newborn is not more than 1 week. If there is a need in the future, tracheotomy should be used instead.

Acute respiratory insufficiency respirator

There are three types of mechanical respirators for clinical use: constant pressure, quantitative, and timing. In the treatment of pediatric acute respiratory failure, it is advisable to use time-converted respirators. The indications for the application of the ventilator are: sudden decrease in breathing frequency or irregular bleeding or even apnea; application of conventional high concentration oxygen, cyanosis is still difficult to alleviate; the condition has deteriorated sharply and cannot be improved by conservative treatment; blood gas analysis: Above 8.00 to 9.31 kPa (60 to 70 mmHg), Pa02 is lower than 6.65 to 8.00 kPa (50 to 60 mmHg) when inhaling 60% oxygen, but the ventilator should be used early; When combined with respiratory muscle paralysis, it should be applied in advance.

Evaluation of the effect of acute respiratory insufficiency

Acute respiratory insufficiency

Acute respiratory insufficiency treatment principles

1. Etiology treatment.

2. Keep the airway open.

3. Oxygen therapy: nasal oxygen or mechanical positive pressure.

4. Application of bronchodilator drugs. 5. Application of respiratory stimulants.

6. Cardiotonic drugs and vasoactive drugs.

7. Maintain water, electrolyte and acid balance.

8. Application of mechanical respirator.

9. Antibiotic application.

Principles of medication for acute respiratory insufficiency

1. Early respiratory failure, sedation, oxygen, keep the airway open, and treat the cause. 2. Patients with respiratory failure, dyspnea and wheezing, also need to use asthma (such as aminophylline, isoprenaline, Shuchuanling, etc.) or add hormones. 3. Respiratory irregularity

Acute respiratory insufficiency Lobelin is commonly used, and at the same time there is insufficiency of heart function, you can choose Nikosa. Central stimulants must be used with an open airway and enhanced oxygen inhalation. 4. Use supportive therapy and energy mixtures, dehydrating agents, vasoactive drugs and cardiotonics (Cecilandan, Lichidine, 654-2) as appropriate. 5. People with severe respiratory failure usually need to use an artificial respirator to provide oxygen and maintain effective respiratory function.

1. Cure (1) All symptoms of respiratory failure disappear. (2) Blood gas analysis: PaO2, SO2, and PaCO2 have returned to normal. (3) The blood PH is in the normal range, and the blood potassium, sodium, chlorine, calcium, and magnesium return to the normal range.

2. Improvement (1) All symptoms of respiratory failure are improved or relieved. (2) Blood gas analysis: <9.42 KPa (70 mmHg), PaO2> 6.76 KPa (> 50 mmHg), SO2> 80%, PaCO2 <6.76 KPa (<50 mmHg). (3) The blood PH is basically normal, and most of the blood potassium, sodium, chlorine, calcium, and magnesium are close to or return to normal.

3. Unhealed: No improvement or worsening of the condition after treatment.

Acute respiratory insufficiency precautions

Patients with respiratory failure, dyspnea and wheezing need to use anti-asthmatic drugs (such as aminophylline, isoprenaline, Shuchuanling, etc.) or hormones. Lobelin is often used in patients with irregular breathing rhythm, and at the same time there is insufficiency of heart function, Nicozarm can be used. Central stimulants must be used with an open airway and enhanced oxygen inhalation.