How it works
The purpose of breathing is to bring oxygen into the blood and remove carbon dioxide. Failure is possible at any stage: air does not reach the alveoli when the bronchi narrow, gas exchange is disrupted when the alveoli are filled with liquid or pus, blood flow through the pulmonary vessels suffers during thromboembolism, the respiratory muscles weaken during neuromuscular diseases, and the respiratory center is depressed during an overdose of sleeping pills. Depending on the mechanism, a form with a lack of oxygen and a form with the accumulation of carbon dioxide are distinguished, and treatment depends on this.
- Airway obstruction
- Filling of the alveoli with fluid or pus
- Impaired blood flow through the vessels of the lungs
- Weakness of the respiratory muscles
- Depression of the respiratory center
- Combined mechanisms
Reasons
Acute respiratory failure most often develops with severe pneumonia, exacerbation of bronchial asthma and chronic obstructive pulmonary disease, pulmonary edema, thromboembolism, chest injury, as well as with poisoning and overdose of drugs that depress breathing. Chronic is formed with long-term lung diseases, severe obesity, chest deformities, and progressive neuromuscular diseases. Very often, several factors are combined in one person, and an aggravation of any of them throws the system out of balance.
- Chronic obstructive pulmonary disease
- Severe pneumonia and other infections
- Bronchial asthma in exacerbation
- Pulmonary edema and heart failure
- Pulmonary embolism
- Obesity and hypoventilation syndrome
- Neuromuscular diseases
- Poisoning and overdose of sleeping pills
Symptoms
The main symptom is shortness of breath, which first appears with exertion and then at rest. Breathing becomes frequent and shallow, auxiliary muscles of the neck and shoulder girdle are activated, and it is difficult for a person to speak in long phrases. With a lack of oxygen, lips, nails and fingertips turn blue, and the pulse quickens. When carbon dioxide accumulates, the picture is different: a headache in the morning, redness of the face, sweating, trembling, drowsiness during the day, and then confusion. In the elderly and children, the manifestations are blurred, so pulse oximetry is important.
- Shortness of breath on exertion, then at rest
- Frequent shallow breathing
- Participation of neck muscles in breathing
- Blueness of lips and nails
- Rapid heartbeat
- Morning headache and daytime sleepiness
- Confusion in severe cases
Diagnostics
The first assessment is pulse oximetry: the device shows the oxygen saturation of the blood. A steady decrease in the indicator requires clarification, but it is important to remember that with poor blood circulation, nail polish and cold hands, the device makes mistakes. Blood gas analysis provides accurate information: it shows the level of oxygen, carbon dioxide and acidity, that is, it distinguishes between forms of deficiency. Then they look for the cause: X-ray or CT scan of the chest, spirometry, ECG and EchoCG, blood tests. If nocturnal breathing disorders are suspected, a sleep study is performed.
- Pulse oximetry at rest and during exercise
- Analysis of blood gases and acid-base status
- X-ray or CT scan of the chest
- Spirometry
- ECG and EchoCG
- Complete blood count, cultures if necessary
- Sleep study for suspected hypoventilation
Treatment
The main thing is to eliminate the cause: treat pneumonia, relieve bronchospasm, remove excess fluid during pulmonary edema, dissolve or remove a blood clot. At the same time, oxygen is provided, and its flow is adjusted by the doctor: in chronic obstructive pulmonary disease, excess oxygen can depress breathing, so self-medication with balloons is dangerous. In severe cases, non-invasive ventilation through a mask or artificial ventilation is used. For chronic deficiency with persistently low oxygen levels, long-term home oxygen therapy is prescribed, which prolongs life if the regimen is followed. Pulmonary rehabilitation plays the most important role: breathing exercises, dosed exercise, training in economical breathing.
- Treatment of the underlying disease
- Oxygen therapy in a doctor-selected mode
- Non-invasive ventilation
- Long-term home oxygen therapy according to indications
- Pulmonary rehabilitation and breathing exercises
- Quitting smoking
- Vaccination against influenza and pneumococcus
- Weight loss for obesity