Respiratory failure
Introduction
Introduction to respiratory failure Respiratory failure is a clinical syndrome in which a series of pathophysiological disorders occur due to various causes of severe respiratory dysfunction, causing a decrease in arterial partial pressure of oxygen (PaO2), accompanied by or without an increase in arterial blood carbon dioxide partial pressure (PaCO2). It is a state of dysfunction, not a disease that can be caused by a lung disease or a complication of various diseases. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Causes of respiratory failure
Respiratory lesions (20%):
Bronchial inflammation, upper respiratory tract tumors, foreign bodies and other obstruction of the airway, causing insufficient ventilation, uneven gas distribution leading to imbalance in ventilation/blood flow, hypoxia and carbon dioxide retention.
Lung tissue lesions (10%):
Pneumonia, severe tuberculosis, emphysema, diffuse pulmonary fibrosis, pulmonary edema, adult respiratory distress syndrome (ARDS), silicosis, etc., can cause lung volume, ventilation, effective diffusion area reduction, ventilation / blood flow imbalance Pulmonary artery-like shunt, causing hypoxia and/or carbon dioxide retention.
Pulmonary vascular disease (15%):
Pulmonary vascular embolism, pulmonary infarction, and pulmonary capillary hemangioma cause some venous blood to flow into the pulmonary veins, causing hypoxia.
Thoracic lesions (20%):
Such as thoracic trauma, deformity, surgical trauma, pneumothorax and pleural effusion, etc., affecting thoracic activity and lung expansion, resulting in ventilation to reduce the inhalation of gas unevenness affecting ventilation.
Nerve center and its conduction system respiratory muscle disease (10%):
Cerebrovascular disease, encephalitis, brain trauma, electric shock, drug poisoning, etc. directly or indirectly inhibit the respiratory center; poliomyelitis and muscle neuritis block caused by polyneuritis affect conduction function; myasthenia gravis and other damage to respiratory power Causes insufficient ventilation.
Prevention
Respiratory failure prevention
1. Reduce energy consumption to relieve bronchospasm, eliminate bronchial mucosal edema, reduce bronchial secretions, eliminate stubbornness, reduce airway resistance, and reduce energy consumption.
2. Improve the nutritional status of the body to enhance nutrition and increase the intake of sugar, protein and various vitamins. If necessary, intravenous infusion of complex amino drum, plasma, albumin.
3. Insist on daily breathing gymnastics to enhance the activity of the respiratory muscles.
4. When using extracorporeal diaphragm muscles for respiratory muscle fatigue, an external diaphragm pacemaker can be used to improve alveolar ventilation, exercise the diaphragm, and enhance the diaphragmatic function.
Complication
Respiratory failure complications Complications
Respiratory failure is a complication of each of the above-mentioned causes, not a single disease, and complications occur due to different causes.
Symptom
Respiratory failure symptoms Common symptoms Respiratory failure, acute dyspnea, pulmonary fibrosis, obvious mixed acid-base balance disorder, flapping tremor, labor endurance, decreased consciousness, heart function, sudden decompensation, nails, extra large longitudinal stripes...
1. According to arterial blood gas analysis
(1) Type I respiratory failure
Hypoxia without CO2 retention, or with CO2 reduction (type I) is seen in cases of ventilation dysfunction (ventilation/blood flow imbalance, diffuse dysfunction, and pulmonary-venous-like shunt). Oxygen therapy is an indication.
(2) Type II respiratory failure
O2 deficiency and CO2 retention (type II) are caused by lack of O2 and CO2 retention caused by insufficient alveolar ventilation. The lack of ventilation alone is parallel to the degree of O2 and CO2 retention. If the ventilation function is impaired, the lack of O2 is more serious. Only increase the alveolar ventilation, if necessary, add oxygen therapy to solve.
2. Classification by lesion
Can be divided into central and peripheral respiratory failure. According to the course of the disease, it can be divided into acute and chronic.
Acute respiratory failure means that the respiratory function is normal. Due to the sudden causes of the above five types of causes, the ventilation is caused, or the ventilation function is seriously damaged. The clinical manifestations of sudden respiratory failure, such as cerebrovascular accident, drug poisoning, inhibition of respiratory center, and breathing Muscle paralysis, pulmonary infarction, ARDS, etc., because the body can not be compensated quickly, if not rescued in time, it will endanger the patient's life.
Chronic respiratory failure is more common in chronic respiratory diseases, such as chronic obstructive pulmonary disease, severe tuberculosis, etc., and its respiratory function damage is gradually aggravated. Although there is a lack of O2, or with CO2 retention, it can still engage in personal life activities through the body compensation. It is called compensatory chronic respiratory failure. Once a respiratory infection is complicated, or a compensatory disorder is caused by an increase in respiratory physiology due to other reasons, a clinical manifestation of severe O2 deficiency, CO2 retention, and acidosis occurs, which is called decompensated chronic respiratory failure.
Examine
Respiratory failure check
History
There are many history of bronchi, lung, pleura, pulmonary blood vessels, heart, neuromuscular or severe organic diseases.
2. Symptom
In addition to the symptoms of primary disease, mainly due to hypoxia and carbon dioxide retention, such as dyspnea, urgency, mental and neurological symptoms, etc., with pulmonary encephalopathy, there may be gastrointestinal bleeding.
3. Blood gas analysis
At the resting state, the arterial partial pressure of oxygen (PaO2)<8.0Kpa (60mmHg) is divided into 6.7Kpa (50mmHg) for type II respiratory failure. Resurgence.
4. Electrolyte inspection
Respiratory acidosis combined with metabolic acidosis is often accompanied by hyperkalemia; respiratory acidosis with metabolic alkalosis often has hypokalemia and hypochloremia.
5. Sputum examination
The results of examination of sputum smear and bacterial culture are conducive to guiding medication.
6. Physical examination findings
There may be cyanosis, disturbance of consciousness, conjunctival hyperemia, edema, flapping tremor, optic nerve head edema.
7. Other inspections
Such as pulmonary function examination chest imaging examination, etc. according to the original disease, there are corresponding findings.
Diagnosis
Diagnosis and diagnosis of respiratory failure
The main diagnosis basis of the disease, acute such as drowning, electric shock, trauma, drug poisoning, serious infection, shock; chronic multiple secondary to chronic respiratory diseases, such as chronic bronchitis, emphysema, etc., combined with clinical manifestations, blood gas analysis Helps diagnose.
Differential diagnosis
1. Airway obstructive disease tracheal-bronchial inflammation, sputum, foreign body, tumor, fibrotic short marks, such as chronic obstructive pulmonary disease, severe asthma, etc. cause airway obstruction and lack of pulmonary ventilation, and associated with ventilated blood flow imbalance. Causes hypoxia and carbon dioxide to stay, causing respiratory failure.
2. Lung tissue lesions of alveolar and interstitial lesions. Such as pneumonia, emphysema, severe pulmonary tuberculous pulmonary fibrosis, pulmonary edema, pneumoconiosis, etc., can lead to alveolar reduction, effective diffusion area to reduce the reduction of the government, the proportion of ventilation flow imbalance, resulting in hypoxia and carbon dioxide , causing respiratory failure.
3. Pulmonary vascular disease, pulmonary embolism, pulmonary vasculitis, etc., reduce pulmonary capillary perfusion, ventilation, imbalance of airflow, or partial intravenous dK without oxygenation directly into the pulmonary vein, leading to respiratory failure.
4. Thoracic and pleural lesions caused by chest trauma, severe spine deformity, pleural thickening adhesion caused by various reasons, severe spontaneous or traumatic pneumothorax, massive pleural effusion, etc., can affect thoracic activity, chest and fat In contrast, the expansion of the lungs is limited, resulting in insufficient gas and small distribution of inhaled gas, leading to pulmonary ventilation and ventilation dysfunction, resulting in respiratory exhaustion.
5. Neuromuscular diseases, cerebrovascular diseases, craniocerebral trauma, encephalitis and sedative and hypnotic poisoning can inhibit the respiratory center; spinal cord metastasis, interferon neuritis, myasthenia gravis and potassium metabolism disorders, etc., can affect respiratory muscle function, Causes respiratory muscle weakness, paralysis, decreased respiratory motility and insufficient lung ventilation.
