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Respiratory failure

Respiratory failure is a gas exchange disorder that requires emergency medical intervention. Definitions of respiratory failure based on arterial blood gas values ​​(Table 50-2) may not be correct for chronic lung diseases: for chronic hypercapnia, shortness of breath and progressive respiratory acidosis should be added to the criteria for respiratory failure listed in the table. There are several variants of changes in arterial blood gases in case of respiratory failure (Fig. 50-3). In one case, the transport of oxygen from the alveoli to the blood is mainly disturbed, which leads to hypoxemia (hypoxic respiratory failure); in the absence of a pronounced violation of ventilation-perfusion relationships, the elimination of CO2 is normal or even increased. In another embodiment, mainly eliminated CO2 (hypercapnic respiratory failure),

Fig. 50-3. Acute respiratory failure: PaO2 and PaCO2 when breathing in atmospheric air



leading to hypercapnia; ventilation-perfusion disturbances are absent or minimal.
It should be noted that even with hypercapnic respiratory failure hypoxemia occurs if PaCO2 reaches 75-80 mm Hg. century, and the patient breathes atmospheric air (see chapter 22, the equation of the alveolar gas). In most cases with respiratory failure, changes in arterial blood gases occupy an intermediate position between the two extreme options described above.

Treatment

Treatment should primarily be aimed at eliminating the symptoms of respiratory failure; in addition, whenever possible, they try to eliminate its cause. In case of hypoxemic respiratory failure, oxygen therapy and positive airway pressure are used (if FOE is reduced). With hypercapnic respiratory failure, mechanical ventilation is indicated. Other types of treatment: inhalation of bronchodilators, iv antibiotics, diuretics (with hyperhydration), optimization of cardiac function, adequate nutrition. Sometimes an infusion of aminophylline has a good effect, which can improve diaphragm function.
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Respiratory failure

  1. The mechanisms of respiratory failure in the pathology of the respiratory tract
    The development of DN in diseases of the respiratory tract is due to an increase in resistive resistance to air flow (RL). In this case, the ventilation of the affected areas of the lung is disturbed, the resistive work of breathing increases, and fatigue and weakness of the respiratory muscles can be the result of irreparable obstruction of the DP. Due to the fact that airway resistance (according to Poiseuille's law)
  2. Respiratory failure
    Despite the fact that respiratory disorders can occur at any stage of gas exchange, the development of respiratory failure as a clinical syndrome is associated exclusively with the pathology of external respiration. The simplest definition was given to her by A.P. Zilber (1996): “Respiratory failure (DN) is a condition of the body in which the ability of the lungs and ventilation apparatus to provide normal gas
  3. Acute respiratory failure
    There is no universally accepted definition of acute respiratory failure. It seems to us the most capacious, and at the same time not cumbersome definition proposed by V.L. Cassil et al. ONE is a rapidly growing severe condition due to the mismatch between the capabilities of the external respiration apparatus and the metabolic needs of organs and tissues, at which the maximum
  4. Acute respiratory failure
    Acute respiratory failure is a violation of gas exchange between the surrounding air and circulating blood with the presence of hypoxemia and / or hypercapnia, which develops over a period of time from several minutes to several days. ETHIOLOGY AND PATHOGENESIS, CLASSIFICATION The normal functioning of the respiratory system depends on the work of many of its components (respiratory center, nerves, muscles, chest,
  5. Acute respiratory failure
    Clinical characteristics of acute respiratory failure Acute respiratory failure (ARF) is a pathological condition in which the body cannot provide the necessary amount of oxygen to organs and tissues. A.P. Zilber (1978) defines ONE even easier: the inability of the lungs to turn venous blood into arterial blood. The most common causes of acute respiratory
  6. Pulmonary respiratory failure
    Pulmonary respiratory failure is caused by damage to the airways or a decrease in the respiratory surface of the lungs due to exposure to the lung or damage to the pulmonary parenchyma itself. Respiratory failure due to damage to the airways is called obstructive pulmonary respiratory failure. It should be noted that
  7. Respiratory failure
    Respiratory failure is a pathological condition of the body, in which the normal maintenance of the gas composition of the blood is not ensured or it is achieved due to the tension of the compensatory mechanisms of external respiration. There are five groups of factors that lead to impaired external respiration. 1. Damage to the bronchi and respiratory structures of the lungs: 1) damage to the bronchial tree: increase
  8. Acute respiratory failure
    Clinical characteristics in acute respiratory failure The most important sign of damage to the respiratory system in children is respiratory failure. Respiratory failure is understood as a pathological condition in which external respiration does not provide the normal gas composition of the blood or supports it at the cost of excessive energy costs. Respiratory failure
  9. Acute respiratory failure
    Respiratory failure is a condition in which the respiratory system is not able to provide oxygen and the removal of carbon dioxide, necessary to maintain the normal functioning of the body. Acute respiratory failure is characterized by rapid progression: after a few hours, and sometimes minutes, the patient may die. The main causes of acute
  10. Acute respiratory failure
    Respiratory failure is a pathological condition in which the normal gas composition of the blood is not supported or its provision is achieved by enhancing external respiration. In 20-30% of cases, acute respiratory failure leads to death. Pathophysiology • Respiratory failure occurs due to a violation of the structure of the alveolar-capillary membrane. • Changes in the membrane
  11. RESPIRATORY FAILURE
    In this section, we touch upon issues of relevance to the entire problem of artificial and assisted ventilation in anesthesiology and intensive care. By tradition, this section should begin with a brief description of the basics of the normal physiology of external respiration, however, these issues are adequately reflected in numerous manuals and monographs, and we can hardly
  12. Classification and pathogenesis of respiratory failure
    The literature offers many classifications of respiratory failure. In practical work, you can use the proposed Yu. N. Shanin and A. JI. Kostyuchenko (1975) dividing it into ventilation when the mechanics of breathing are disturbed, and parenchymal, which is caused by pathological processes in the lungs. Recently, a division of respiratory failure into
  13. Respiratory failure
    Respiratory (ventilation-pulmonary) insufficiency is characterized by such disorders in which pulmonary gas exchange is impaired or occurs at the cost of excessive energy costs. Types of respiratory failure: 1) ventilation; 2) distribution-diffusion (shuntodiffusion, hypoxemic); 3) mechanical. Clinic. I degree. Dyspnea varies without auxiliary
  14. ACUTE RESPIRATORY FAILURE
    Acute respiratory failure (ARF) is a syndrome based on symptoms of impaired external respiration (HFD), which have common anatomical, physiological and biochemical characteristics and lead to insufficient oxygen supply and / or carbon dioxide retention. This condition is characterized by arterial hypoxemia or hypercapnia, or both
  15. ACUTE RESPIRATORY FAILURE
    Acute respiratory failure (ARF) is a syndrome based on symptoms of impaired external respiration (VFD), which have common anatomical, physiological and biochemical characteristics and lead to insufficient oxygen supply and / or carbon dioxide retention. This condition is characterized by arterial hypoxemia or hypercapnia, or both
  16. Acute respiratory failure
    Acute respiratory failure complicates the course of many infectious diseases due to impaired pulmonary ventilation as a result of laryngospasm (tetanus, rabies) and acute inflammation of the larynx (diphtheria, viral croup), respiratory muscle paralysis (botulism, diphtheria), obstructing tracheobronchial and alveolar inflammatory edema (influenza, acute respiratory infections, measles
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