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Respiratory failure can be acute or chronic. The former occurs suddenly - within minutes or hours - and its effects can be reversed. The prognosis of patients with chronic respiratory failure, characterized by gradual and progressive deterioration of the respiratory function over a long period of time, is much worse, because its effects are irreversible. What are the causes and symptoms of respiratory failure? What is the treatment?

Respiratory failureis a condition in which the respiratory system is disturbed, leading to hypoxia.

Respiratory failure can be divided according to the duration of the disorder into acute and chronic. Due to the changes in the blood, we distinguish hypoxemic (partial) failure with a decrease in blood oxygen partial pressure below 60 mm Hg and hypoxemic-hypercapnic (total) failure characterized by both a decrease in oxygen partial pressure and an increase in carbon dioxide above 45 mm Hg.

Acute respiratory failure

Acute respiratory failure develops within a week of getting sick or exacerbating previous symptoms. This condition is usually reversible, but in some cases, multi-organ failure, leading to death, may develop as a result of tissue hypoxia.

Acute respiratory failure - causes

The causes of acute failure include:

  • pulmonary edema - may be caused by left ventricular heart failure, hyperhydration, fusion, condition after lung transplantation, or after removal of an arterial embolism
  • bleeding into the alveoli - this occurs in vasculitis, connective tissue diseases and in the course of hemorrhagic diathesis
  • severe pneumonia
  • atelectasis - caused by obstruction of the respiratory tract by a foreign body or a tumor
  • lung injury
  • reduction of blood flow through the pulmonary vessels - may result from pulmonary embolism or shock
  • pleural disease
  • sepsę
  • aspiration of gastric contents
  • inhalation of toxins or smoke
  • chest irradiation
  • massive transfusion of blood products - may lead to acute transfusion lung injury
  • pregnancy complications - eclampsia, amniotic embolism
  • acute pancreatitis - may lead to a fatty embolism
  • drug reactions and drug poisoning

Acute respiratory failure - symptoms

The most characteristic symptom of respiratory failure is shortness of breath. It can be divided into rest and exercise.

Other symptoms depend on the underlying disease. They can be:

  • sputum product cough - often associated with pneumonia
  • haemoptysis - characterized by systemic vasculitis
  • fever
  • chest pain - a symptom characteristic of pulmonary embolism, pneumothorax, angina and heart attack
  • cyanosis
  • tachycardia, i.e. increased heart rate
  • rapid breathing

Acute respiratory failure - diagnosis

In the diagnosis of respiratory failure, it is essential to exclude other causes of dyspnea, such as carbon monoxide or cyanide poisoning, hyperthyroidism, pain, anxiety, and strenuous exercise in he althy people.

Research such as:

  • pulse oximetry - it is a non-invasive test that allows the percutaneous assessment of the partial pressure of oxygen in the blood, which is reduced in the case of respiratory failure
  • blood gas - shows hypoxemia, or in some cases additionally hypercapnia and acidosis
  • microbiological tests - due to the fact that infections are a frequent cause, it is worth identifying the etiological factor by, for example, blood culture
  • Chest X-ray - may show atelectasis, pneumothorax, fluid in the pleural cavity, or the presence of inflammatory infiltrates in the lungs
  • EKG - detects signs of myocardial ischemia.

Acute Respiratory Failure - Treatment

Treatment of acute respiratory failure involves opening the airway, which can be done in different ways depending on the patient's problem.

  • deviceless airway opening - consists in placing the patient on his back, tilting the head back and removing any foreign bodies from the mouth, and then lifting or extending the jaw.
  • endotracheal intubation - during this procedure, the patient is under the influence of sedatives, sleeping pills and painkillers. The tracheal tube is inserted through the mouth or nose through the glottis opening into the trachea and then connected to the ventilation set. This technique is used in the case of loss of consciousness and defensive reflexes in a patient, and under anesthesiageneral.
  • cricothyrotomy - pierces the cricothyroid ligament of the larynx with a needle connected to the syringe, and then slides the catheter over the needle and removes the needle. Cricothyrotomy is indicated in the case of laryngeal edema, obstruction of the airway by a foreign body, or a craniofacial injury.
  • tracheotomy - it is an otolaryngological procedure consisting in opening the anterior wall of the trachea and placing a tube in the airways that allows the lungs to be ventilated. This method is usually used in the case of massive laryngeal edema and long-term mechanical ventilation.

In order to combat hypoxemia, oxygen therapy is used with a high oxygen content in the respiratory mixture. If this is unsuccessful, extracorporeal respiratory support may be provided.

Depending on the cause of the disease, pharmacotherapy and treatments such as pneumothorax, or the removal of fluid from the pleural cavity may also be helpful. In some cases, an anti-deficiency and low-carbohydrate diet that reduces carbon dioxide production is also important.

Chronic Respiratory Failure

Chronic respiratory failure develops gradually and cannot be fully reversed.

Chronic Respiratory Failure - Causes

The causes of chronic respiratory failure include:

  • bronchial obstructive diseases such as chronic obstructive pulmonary disease, bronchiectasis, or cystic fibrosis
  • chronic interstitial lung diseases, for example: sarcoidosis, post-inflammatory fibrosis and cirrhosis, pneumoconiosis, idiopathic pulmonary fibrosis
  • cancers of the respiratory system
  • chest deformities
  • severe obesity
  • muscle diseases and diseases of the nervous system, e.g. myopathies, Guillain-Barré syndrome, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, polyneuropathies, permanent traumatic nerve damage
  • cardiovascular diseases: chronic heart failure, cyanosis, heart defects, chronic pulmonary embolism

Chronic respiratory failure - symptoms

Symptoms in chronic respiratory failure are usually less severe than in acute respiratory failure. The dyspnea that occurs can be both at rest and exercise. There are many scales for the assessment of dyspnea, one of them is the mMRC scale (modified Medical Research Council), which is used to assess its severity.

0 - it is breathlessness that occurs only during considerable physical exertion
1 - shortness of breath occurs during a brisk flat walkon terrain or when climbing a small hill
2 - due to breathlessness, the patient walks slower than he althy people his age or, walking at his own pace on flat terrain, must stop to gain breath
3 - after covering ~ 100m or after a few minutes of walking on flat ground, the patient must stop to gain breath
4 - shortness of breath prevents the patient from leaving the house, occurs with simple everyday activities such as undressing or dressing

The occurrence of other symptoms often depends on the underlying disease. They can be:

  • sleepiness
  • headache
  • entanglement
  • cyanosis
  • haemoptysis - common in the case of a lung tumor and chronic bronchitis
  • muscle weakness, neurological symptoms - typical for myasthenia gravis, amyotrophic lateral sclerosis and Guillan-Barry syndrome
  • accelerated heart rate
  • rapid breathing
  • hypertrophy of accessory respiratory muscles and inspiratory chest position
  • redness of the skin and conjunctiva as a result of vasodilation

Chronic respiratory failure - diagnosis

The diagnosis of chronic respiratory failure is made mainly on the basis of an interview indicating a long course combined with met gasometric criteria. Tests performed to find the cause of the disease include chest X-ray, spirometry and a blood gas meter.

Chronic Respiratory Failure - Treatment

Treatment of chronic respiratory failure is mainly based on oxygen therapy. Usually, it can be used at home, but in the event of exacerbations, it should be administered in hospitals.

In some cases, chronic mechanical ventilation is also used. Treatment of the underlying disease is very important. A diet that prevents deficiencies and limits carbohydrates, rehabilitation and education of the patient and loved ones are also important.

Chronic respiratory failure - complications

Chronic respiratory failure has a much worse prognosis than acute respiratory failure due to the irreversibility of the changes. It leads to many unfavorable changes in the functioning of the body, such as:

  • pulmonary hypertension
  • right ventricular failure
  • secondary polycythemia and hyperviscosity syndrome
  • venous thromboembolism
  • malnutrition and cachexia

Tests performed to assess complications of chronic respiratory failure include ECG, echocardiography, and blood countsperimeter.

Mistake

Student of medicine. He is passionate about he alth and everything related to it, including he althy eating. In his spare time, he is engaged in reading crime novels and strength training.

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Respiratory system