Acute Respiratory Insufficiency: Types, Symptoms, Causes, Diagnosis, Treatment and Prognosis

It occurs when fluid accumulates in the lungs’ alveoli, and as a result, the lungs cannot release oxygen in the blood.

At the same time, your organs may not work well because they do not get enough oxygen-rich blood.

If your lungs fail to remove carbon dioxide in the blood, acute respiratory failure can develop.

At the moment when the small blood vessels or capillaries that surround the air sacs are not able to exchange carbon dioxide for oxygen in the usual manner, respiratory failure arises.

This condition can be acute or chronic.

If you suffer from this condition, you will most likely feel immediate symptoms due to the lack of oxygen in the body.

If this failure is not treated immediately or quickly, it can, in many cases, cause death.

 

Types

The types of this condition, both acute and chronic, are known as hypercapnic and hypoxemic.

Both conditions can trigger severe complications and states often coexist.

  • Hypoxemic respiratory failure: in this type, you will have normal carbon dioxide levels, but you will not have enough oxygen in your blood.
  • Hypercapnic respiratory failure: this type of insufficiency is characterized by very little oxygen in the blood and too much carbon dioxide.

symptom

The symptoms of acute respiratory failure depend on its underlying cause and carbon dioxide and oxygen levels in your blood.

People with a high level of carbon dioxide can experience:

  • Fast breathing.
  • Confusion.

People with low oxygen levels may experience:

  • An inability to breathe.
  • The bluish coloration on the skin, fingertips, or lips.

People with acute lung failure and low oxygen levels may experience:

  • Restlessness.
  • Anxiety.
  • Drowsiness.
  • Loss of consciousness.
  • Rapid and superficial breathing.
  • Accelerated heart.
  • Irregular heartbeats (arrhythmias).
  • Abundant sweating.
  • Manifestations of a “stress response” include tachycardiahypertension, and diaphoresis .

Causes

Injury:

The amount of oxygen in your blood can be adversely affected due to an injury that impairs or compromises your respiratory system.

For example, an injury to the spinal cord or brain can immediately affect your breathing.

Who orders the lungs to breathe is the brain.

The lungs can not function properly if the brain cannot transmit messages due to injury or damage.

The breathing process can be hampered by a rib or chest injury.

These injuries can affect your ability to inhale enough oxygen in your lungs.

Obstruction:

If some elements block your throat, this can cause problems in receiving the necessary oxygen that your lungs need to process.

Obstruction can also occur in people with chronic obstructive pulmonary disease(COPD) or asthma when an exacerbation causes the airways to become narrow.

Acute respiratory distress syndrome (ARDS):

This syndrome (ARDS) is a severe disease. It is characterized by the high amount of fluids concentrated in the pulmonary air sacs, preventing the arrival of oxygen to other parts of the body.

ARDS affects you if you already have an underlying health problem, such as:

  • Severe trauma.
  • Pneumonia .
  • Pancreatitis (inflammation of the pancreas).
  • Septicemia.
  • Severe brain injuries.
  • Pulmonary injuries: are caused by the inhalation of smoke or chemicals.

While you are under treatment in a hospital, due to your underlying condition, the symptoms of ARDS may appear.

Drug or alcohol abuse:

The functioning of your brain can affect the process of inhalation and exhalation due to excessive consumption of alcoholic beverages and overdose with drugs.

Chemical inhalation:

Inhalation of toxic chemicals or fumes can also cause acute respiratory failure.

Pulmonary tissues, including capillary and air sacs, can be damaged by these chemicals.

Stroke:

A stroke occurs when your brain experiences death or tissue damage on both sides of the brain.

Generally, effusions only affect one side of the body.

Although it usually occurs quickly, a stroke may present some warning signs, such as confusion or difficulty speaking.

You can lose the ability to breathe correctly if you suffer from a stroke.

Infection:

Infections are a common cause of respiratory distress.

Pneumonia, in particular, can cause respiratory failure, even in the absence of ARDS.

According to the Mayo Clinic, in some cases, pneumonia affects the five lobes of the lungs.

Diagnosis

Immediate medical attention is required for acute respiratory failure.

To avoid the death of tissue from your organs and brain and help you breathe better, you are likely to receive oxygen.

After it is stabilized, your doctor will take some measures to diagnose your condition, among which are:

  • Ask you questions about your family or personal health history.
  • Perform a physical exam.
  • Your body’s oxygen and carbon dioxide levels will be controlled with an arterial blood gas test and a pulse oximetry device.
  • Order a chest x-ray: to look for abnormalities in your lungs.

Treatment

The treatment of acute respiratory failure can be divided into a phase of urgent resuscitation followed by a phase of continuous attention.

The goal of the emergency resuscitation phase is to stabilize the patient as much as possible and prevent any further deterioration that threatens his life.

Once these goals are achieved, the focus should shift toward diagnosing the underlying process, and then the institution of therapy aimed at reversing the primary etiology of the condition.

Urgent resuscitation:

  • Oxygenation
  • Control of the respiratory tract.
  • Management of fans.
  • Stabilization of the circulation.
  • Bronchodilators / steroids.

Continuous care:

  • Differential diagnosis and investigations.
  • A therapeutic plan adapted to the diagnosis.

Oxygenation:

Almost all patients with acute respiratory failure require supplemental oxygen.

All should be placed on a pulse oximeter, and oxygen saturation should generally stay above 90%.

Oxygen diffuses from the alveolus through the alveolar membrane to the capillary blood.

The oxygen partial pressure gradient drives the diffusion rate.

Therefore, increasing the diffusion rate with supplemental oxygen should improve the transfer of oxygen to the pulmonary capillary blood.

Several different devices can be used to administer oxygen.

Their effectiveness depends on whether they can supply enough oxygen at a sufficient flow to meet the demands of patients.

Non-intubated patients who breathe spontaneously through an open system will “sweep” the air from their surroundings with each breath.

Therefore, the maximum concentration of oxygen administered to them will depend on the amount supplied by the oxygen device and the amount of air retained in the room.

The smaller the flow delivered by the oxygen device and the greater the inspiratory flow of the patient, the more space will be retained, which will result in a lower oxygen concentration.

For example, a tachypneic patient will probably have a high respiratory impulse and inspiratory flow rate.

It will require a high flow system to avoid significant entrainment of ambient air and, therefore, dilution of the oxygen supplied.

  • Nasal cannula: low flow, low oxygen concentration, open device. 100% oxygen is administered through cannulas at 0.5 to 6 l / min. It can not be controlled accurately. The maximum oxygen concentration in the trachea is not likely to exceed 40 to 50%.
  • Venturi masks: these have variable oxygen concentrations, low to moderate flow, and available devices.
  • Reservoir masks: these are high flow and high oxygen level available devices designed to minimize air entrapment in patients with high inspiratory flow demands. The airbag should be at least partially distended throughout the respiratory cycle.
  • Resuscitation mask valve unit: high oxygen, high flow device. When using this device, the oxygen flow must be kept high (15 L / min).
  • Non-invasive positive pressure ventilation (NPPV): NPPV provides ventilatory assistance, positive pressure, and a controlled oxygen concentration using a tight-fitting mask as the interface between the patient and the ventilator rather than an endotracheal tube.

Forecast

The mortality associated with acute respiratory failure is often related to the general health of a person and the possible development of systemic organic dysfunction that can occur with a critical illness.

Patients with underlying chronic respiratory disease, including asthma, have a high risk of recurrence of respiratory failure and require active monitoring of the causative medical condition once their respiratory failure has been corrected.

Complications of treatment with continuous positive pressure in the airways, positive pressure of two levels in the airway, and endotracheal intubation require treatment once patients recover from their acute episodes.

If you receive the proper treatment for your underlying condition, you may see an improvement in your lung function.

In turn, your doctor may recommend pulmonary rehabilitation, including education, counseling, and exercise therapy.

Acute respiratory failure can cause long-term damage to your lungs.

Monitoring:

Patients who have recovered from respiratory failure require careful follow-up during the first week after the start of recovery.

This is to assess the development of any complication of continuous positive airway pressure, two-level positive pressure (BiPAP) (e.g., sinus infection, middle ear infection, and skin necrosis), or use of the endotracheal tube (eg, tracheal inflammation and nosocomial infection).

Additional follow-up of patients who have been intubated is necessary to evaluate chronic tracheal stenosis and nosocomial infection (delayed pneumonia and possible lung abscess).