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Respiratory failure
Respiratory failure classified by etiology
Respiratory failure can be classified according to its causes into four types. The first type involves diseases of the airway such as bronchial inflammation, bronchiectasis, and foreign body obstruction, leading to insufficient ventilation. The second type is due to lung tissue diseases, such as pneumonia, severe tuberculosis, emphysema, diffuse pulmonary fibrosis, adult respiratory distress syndrome, etc., causing a state of hypoxia and carbon dioxide retention due to ventilatory defects. The third type includes pulmonary vascular diseases, such as pulmonary vascular embolism and pulmonary infarction, which cause part of the venous blood to flow into the pulmonary veins, resulting in hypoxia. The fourth type involves diseases of the thoracic cage such as chest trauma, surgical trauma, pneumothorax, and pleural effusion, which affect daily activities and lung expansion, leading to insufficient lung ventilation and resulting in respiratory failure.
Is respiratory failure serious?
Respiratory failure is a common and critical condition in the respiratory system, and it is very serious. Respiratory failure manifests as a severe decline in respiratory function, often with significant damage to the lungs' ventilation and gas exchange capabilities. Patients often experience severe chest tightness, difficulty breathing, obvious hypoxic cyanosis, and may even present with symptoms such as convulsions and coma, which can be fatal. Treatment usually requires oxygen therapy and often the assistance of a ventilator. Therefore, respiratory failure is considered a very serious condition clinically and requires proactive management to save the patient's life.
Is respiratory failure serious?
Respiratory failure is a relatively severe disease, with the most common causes being chronic obstructive pulmonary disease (COPD) or heart failure, which are frequently seen in clinical settings. Respiratory failure can be definitively diagnosed by performing blood gas analysis. Clinically, patients will exhibit symptoms of breathing difficulty, such as orthopnea or wheezing. In blood gas analysis, oxygen saturation is often below 90%, and the partial pressure of oxygen is less than 60 mmHg. These indicators can diagnose respiratory failure. Although respiratory failure is a serious condition, it can be recoverable through active symptomatic treatment, identifying the underlying cause, and eliminating aggravating factors.
What is acute respiratory failure?
Respiratory failure refers to the severe dysfunction in pulmonary ventilation and gas exchange in the respiratory system caused by various reasons under normal conditions. This dysfunction leads to ineffective gas exchange during respiration, resulting in hypoxia in the body and retention of carbon dioxide, thereby causing a series of physiological and metabolic disorders. Typically, under resting conditions at sea-level atmospheric pressure, respiratory failure is defined when arterial oxygen tension falls below 60 mmHg, accompanied by carbon dioxide retention, with carbon dioxide tension exceeding 50 mmHg, or without an increase in carbon dioxide tension. It is categorized into acute respiratory failure and chronic respiratory failure.
Classification of Causes of Respiratory Failure
Respiratory failure, if categorized by its cause, can be divided into pump failure and lung failure. Pump failure refers to the failure of the respiratory pump, which comprises the central nervous system that drives or regulates respiratory movement, the peripheral nervous system, neuromuscular tissues, and the thoracic cage, collectively known as the respiratory pump. Respiratory failure caused by dysfunction of these components is called pump failure. Another type is lung failure, which results from airway obstruction, pulmonary tissue and vascular pathology, and is termed lung failure. Lung failure can lead to type I or type II respiratory failure, whereas pump failure typically presents as type II respiratory failure.
How to treat respiratory failure?
Treatment of patients with respiratory failure is primarily medical, focusing on suppressing or relieving the causes and triggers of respiratory failure, improving lung ventilation and gas exchange as much as possible, and treating and improving the function and condition of various vital organs. First, it is important to actively treat the primary disease causing respiratory failure. If there is a concurrent bacterial infection, sensitive antibiotics should be used, and triggers should be removed as much as possible. Simultaneously, maintaining airway patency and effective ventilation volume is necessary, which can involve administering bronchodilators and expectorants such as salbutamol, terbutaline sulfate, acetylcysteine, and ambroxol. When necessary, corticosteroids can be administered intravenously. If internal medicine treatment does not improve symptoms, tracheotomy and mechanical ventilation may be necessary to assist breathing. (Medications should be taken under the guidance of a physician, based on the actual situation.)
Can respiratory failure be cured?
Respiratory failure can potentially be cured, and the key lies in identifying the cause of the respiratory failure. For instance, acute inflammatory infections, such as severe pneumonia and other infectious diseases, can lead to dysfunction in lung ventilation and gas exchange, manifesting as respiratory failure. With the aggressive use of antibiotics and anti-infection drugs, once the infection is controlled, respiratory failure can also be corrected accordingly. Furthermore, if it is a complication of other diseases, such as acute left heart failure, respiratory failure can also occur. This type of respiratory failure will quickly improve once heart function is corrected. However, in the case of chronic diseases such as chronic obstructive pulmonary disease, bronchiectasis, asthma, and other causes, respiratory failure can only be managed with medication to alleviate symptoms, and it cannot be completely cured.
The earliest clinical symptoms of respiratory failure
The clinical symptoms of respiratory failure mainly manifest as hypoxemia and carbon dioxide retention. Looking at their clinical manifestations, mild hypoxia may not show any clinical symptoms. As the severity of the disease increases, there can be signs of increased respiratory drive, such as rapid breathing or difficulty breathing, along with symptoms of sympathetic nervous system activation, such as anxiety and sweating. Hypoxemia can cause dilation of peripheral arteries and constriction of veins, leading to an increased heart rate, or even severe arrhythmias. Furthermore, considering the clinical manifestations of carbon dioxide retention, they are directly related to the levels of carbon dioxide in the body, mainly depending on the rate of occurrence. Clinically, this primarily affects myocardial contractility, the contractile ability of respiratory muscles, and increases in intracranial blood flow. In mild to moderate cases, it can stimulate the respiratory center causing increased and shallow breathing, but in severe cases, it may suppress the respiratory center.
Is respiratory failure uncomfortable?
Respiratory failure is quite uncomfortable, and clinically, the symptoms feel severe, and the patient's own state is also very affected. Respiratory failure is mainly caused by a decrease in oxygen partial pressure, during which time the patient may experience wheezing, chest tightness, and even a feeling of being near death. There are many causes of respiratory failure, with severe infections being common, such as severe pneumonia or sepsis. A systemic inflammatory response can lead to respiratory failure. Another situation is when heart failure occurs, which can also accompany pulmonary congestion, causing pulmonary ventilation dysfunction that can also lead to respiratory failure. The treatment of respiratory failure focuses on removing the causative factors and selectively choosing different treatment plans, which can start with oxygen therapy or the use of a ventilator in severe cases to correct hypoxemia and sustain life.
Care of Patients with Respiratory Failure
In the nursing care of patients with respiratory failure, it is important to strictly monitor vital signs daily, as respiratory failure is considered an emergency and critical condition clinically. Observe the patient's blood pressure, consciousness state, and respiratory rate. At the same time, good skin care and oral care should be maintained to prevent aspiration pneumonia and bedsores. Most importantly, secretions should be cleared in a timely manner, including phlegm. Conscious patients should be encouraged to cough forcefully. For patients who are weak in coughing, assist them in turning and patting their backs regularly to facilitate the expulsion of phlegm. For comatose patients, mechanical suction can be used to maintain airway patency. It is advisable to avoid factors that may cause breathing difficulties, such as cold wind and poor air circulation. Pay attention to enhancing physical exercise appropriately, preventing colds, and maintaining a regular lifestyle.