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47. Respiratory failure. Clinical picture
Respiratory failure
Respiratory (ventilatory 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 (shunt-diffusion, hypoxemic);
3) mechanical.
Clinic.
I degree. Shortness of breath varies without the participation of auxiliary muscles in the act of breathing; at rest, as a rule, is absent. Perioral cyanosis, intermittent, aggravated by anxiety, disappearing when breathing 40-50% oxygen; pallor of the face. Arterial pressure is normal, rarely moderately elevated. The ratio of the pulse to the number of breaths is 3,5-2,5: 1; tachycardia. Behavior is restless or not disturbed.
II degree. Shortness of breath at rest is constant, with the participation of auxiliary muscles in the act of breathing, retraction of compliant places of the chest; it can also be with a predominance of inhalation or exhalation, i.e., wheezing, grunting exhalation. Perioral cyanosis of the face, hands is permanent, does not disappear when breathing 40-50% oxygen, but disappears in an oxygen tent; generalized pallor of the skin, sweating, pallor of the nail beds. Arterial pressure is increased. The ratio of the pulse to the number of breaths is 2-1,5: 1, tachycardia. Behavior: lethargy, somnolence, adynamia, followed by short periods of excitement; decrease in muscle tone.
III degree. Severe shortness of breath (respiratory rate - more than 150% of the norm); shallow breathing, intermittent bradypnea, respiratory desynchronization, paradoxical breathing.
Decrease or absence of respiratory sounds on inspiration. Cyanosis is generalized; there is cyanosis of the mucous membranes, lips, does not go away when breathing 100% oxygen; generalized marbling or pallor of the skin with blue; sticky sweat. Arterial pressure is reduced. The ratio of pulse to number of breaths varies. Behavior: lethargy, somnolence, consciousness and reaction to pain are suppressed; muscular hypotension, coma; convulsions.
Causes of acute respiratory failure in children.
1. Respiratory - acute bronchiolitis, pneumonia, acute laryngotracheitis, false croup, bronchial asthma, congenital malformations of the lungs.
2. Cardiovascular - congenital heart disease, heart failure, pulmonary edema, peripheral dyscirculatory disorders.
3. Neuromuscular - encephalitis, intracranial hypertension, depression, poliomyelitis, tetanus, status epilepticus.
4. Injuries, burns, poisoning, surgical interventions on the brain, chest organs, poisoning with sleeping pills, narcotic, sedative drugs.
5. Renal failure.
Author: Pavlova N.V.
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