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1.5. ACUTE RESPIRATORY FAILURE (ONE)

Acute respiratory failure is understood as a syndrome characterized by the development of a patient’s serious condition within minutes, hours or days, due to the mismatch of the capabilities of the external respiration apparatus with the metabolic needs of organs and tissues, at which the maximum tension of the compensatory respiratory and circulatory mechanisms occurs, followed by their exhaustion. Most often, in the clinic of internal diseases, ODN develops when respiratory mechanics (pneumothorax, a foreign body, aspiration of gastric contents, laryngospasm, etc.) and parenchymal, which is caused by pathological processes in the lungs (pneumonia, bronchial asthma, respiratory distress syndrome), are impaired.



The criteria for ODN are: increased shortness of breath, worsening of the gas composition of arterial blood (Pa02 less than 60 mm Hg, PaCO 02 more than 45 mm Hg, Sa02 less than 90%, pH less than 7.35) (N pH-7.4) . Life-threatening signs are: cardiac or respiratory arrest, coma, Pa02 less than 50 mm Hg, PaC02 more than 70, pH less than 7.30.

All methods for the treatment of ODN can conditionally be divided as follows:

1. therapy aimed at eliminating the cause that led to the development of DN;

2. methods for maintaining airway patency;

3. oxygen therapy;

4. respiratory support (ventilation).

















To increase airway patency, bronchodilators beta2-agonists salbutamol are used (rd d / ing.
fl. 1 mg / ml, 2.5, 5, 10 and 50 ml), 2.5-5 mg through a nebulizer, atrovent, theophylline, as well as mucus-regulating drugs N-acetylcysteine ​​(granulate pac. 100 and 200 mg; tab. 600 mg ) in the pack. 400-600 mg / day in 1-3 doses or 1 table. (dissolved in 0.5 tbsp of water) 1 r / evening or ambroxol (tab. 30 mg), 30 mg 2-3 r / day.



Artificial lung ventilation (mechanical ventilation) is indicated for patients with ONE, in whom drug and other conservative therapy does not lead to further improvement of the patient's condition. Absolute indications for mechanical ventilation are:

1. expressed impaired consciousness (stupor, coma);

2. unstable hemodynamics (systolic blood pressure below 70 mm Hg. Art., Heart rate less than 50 in 1 min. Or more than 160 in 1 min.);

3. fatigue of the respiratory muscles: shallow breathing, inability to take a deep breath, when examining the auxiliary muscles of the chest, diaphragm and abdominal muscles, a special sign of paradoxical breathing is distinguished: the contraction of the diaphragm and muscles of the chest are in antiphase of the respiratory cycle.

Relative indications for mechanical ventilation are: respiratory rate more than 35 in 1 min .; arterial blood pH below 7.3; Pa02 less than 45 mm Hg. Art., despite carrying out oxygen therapy.
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1.5. ACUTE RESPIRATORY FAILURE (ONE)

  1. Acute Respiratory Failure Syndrome (ARF)
    ONE is a pathological condition of the body in which the normal function of the external respiration apparatus does not provide the necessary gas exchange. Etiology. The reasons leading to ONE are diverse. Classification of ODN depends on the main pathogenetic mechanisms of the development of the syndrome. 1. ONE of central origin (due to inhibition of the respiratory center): - anesthesia; - poisoning (barbiturates,
  2. 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
  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 (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
  5. 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
  6. ACUTE RESPIRATORY FAILURE
    Acute respiratory failure (ARF) is the state of the body in which external respiration does not provide a normal level of O2 and CO2 in the arterial blood or its maintenance is achieved by excessive enhancement of breathing, i.e., inadequate use of its reserves. They distinguish between primary ONE when pathological changes occur in any part of the external respiration system (respiratory
  7. Acute respiratory failure
    The anatomical, physiological and immunological characteristics of newborns and children under the age of 3 years contribute to the development of a number of pulmonary complications. If at the same time there are violations of the gas composition of the blood and (or) external respiration, which have a negative effect on the body, they speak of respiratory failure. There are 2 forms of acute respiratory failure (ONE) - compensated and
  8. Acute respiratory failure
    Acute respiratory failure is a violation of the gas exchange between the surrounding air and the 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,
  9. 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
  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. 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
  12. 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
  13. Acute respiratory failure
    1. Patient A., 54 years old, was admitted to the intensive care unit in an extremely serious condition. Contact is difficult. Sopor. Pulse 120 in min, HELL 70/20 mm Hg Spontaneous breathing, frequency 40 per min. Acrocyanosis. Auscultatory in the lungs, a sharp weakening of vesicular breathing, a mass of moist rales of different sizes in all parts of the lungs. T 35.7 C. According to those accompanying: ill 5 days ago, increased
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