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respiratory health

Respiratory failure

Curated by Luigi Ferritto (1), Walter Ferritto (2)

Breathing: As it happens

Respiration is the result of a chain of events that originates from the rhythmic activity of the respiratory centers located at the level of the IV ventricle floor, in response to information from central and peripheral chemoreceptors;

the set of these efferent signals generated at the central level (brain stem), is transmitted to the respiratory muscles through the pyramidal pathways, determining the movement of the thoracic cage, consequently of the lungs.

The purpose of breathing is to provide an adequate supply of oxygen to the tissues, at the same time guaranteeing an effective elimination of carbon dioxide deriving from the energy production processes that take place at the cellular level, through the combustion of energy substrates (carbohydrates, fats and proteins) in the presence of oxygen.

Both the respiratory system and the cardiovascular system contribute to achieving this goal. The respiratory system ensures gas exchange between the ambient air and the blood through a gas exchanger (the lung, the airways and the pulmonary vessels), and allows an adequate exchange of air through a mechanical or ventilatory pump (respiratory centers, respiratory muscles, chest wall).

What is Respiratory Failure?

Respiratory failure may result in the impairment of one or both of these elements; therefore it represents that pathological condition in which the respiratory system is no longer able to perform the function of transporting oxygen, in adequate quantities in the arterial blood, and of removing a corresponding share of carbon dioxide from the venous blood.

Considering the final result at the cellular level, specifically at the mitochondrial level, respiratory insufficiency can be defined as a cellular metabolism disorder secondary to reduced oxygen supply to the tissues, due to alteration of one or more stages of the respiratory process: ventilation, gas exchange intrapulmonary, gas transport, tissue gas exchange.

From a physiopathological point of view, the IR (short for respiratory failure) can be divided into:

  • Respiratory failure (type 1), mainly characterized by hypoxemia (PaO 2 <55-60 mmHg in ambient air) secondary to alteration of the Ventilation / Perfusion ratio, of alveolar-capillary diffusion or to shunt formation.
  • Respiratory failure (type 2), mainly hypoxemic / hypercapnic (PaCO 2 > 45 mmHg), secondary to pathologies of the CNS, thoracic cage or respiratory muscles, which determine alveolar hypoventilation.

Symptoms

To learn more: Symptoms Respiratory failure

The main physical signs of ventilatory fatigue are the vigorous use of accessory ventilator muscles, tachypnea, tachycardia, decreased respiratory volume, irregular or gasping breathing, and paradoxical movement of the abdomen. A certain alteration of the state of consciousness is typical, and confusion is common.

Chronic respiratory failure (IRC) determines a progressively increasing degree of disability, which limits the subjects' working skills and, in the long term, the development of a normal relationship life. The socio-economic implications of this chronic suffering are enormous - both in terms of social security costs (loss of working days, early retirement etc.), and in terms of pharmaceutical health expenditure or hospitalization (continuous use of drugs, recurrent hospitalizations with prolonged hospitalization). ) - and are accompanied by a progressive deterioration in the quality of life of the patient.

Respiratory failure:

  • PaO 2 <60 mmHg and / or
  • PaCO 2 > 45 mmHg
Respiratory failure

Without hypercapnia

With hypercapnia

Type I

  • Wet lung (EPA, ARDS / ALI)
  • Pneumonia
  • Acute asthma
  • COPD
  • Pulmonary embolism

Type II

  • COPD
  • Severe asthma
  • Chest deformities
  • Neuromuscular disorders
  • Pharmacological abuse
  • Type I + ventilatory pump deficit

Mismatch V / Q intrapulmonary shunt

Alveolar hypoventilation

  1. Administer oxygen to correct hypoxia: target SpO 2 > 90%, using mask with Venturi system or masks with reservoir;
  2. Evaluate possible use of CPAP, especially if the patient remains hypoxic or if you are forced to administer FiO 2 > 50%;
  3. Maintain adequate cardiac output and ensure oxygen transport to tissues;
  4. Basic disease therapy;
  5. Prevention of preventable complications
  1. Administer oxygen to correct hypoxia, using Venturi system mask, with lower FiO 2, target SpO 2 > 88%. Remember that oxygen is a drug (always indicate the type and liters of oxygen);
  2. Evaluate the possible use of NIV to correct both acidosis and / or hypercapnia and any hypoxia resistant by the application of PEEP;
  3. Maintain adequate cardiac output and ensure oxygen transport to tissues;
  4. Basic disease therapy.

Continue: Treatment and prevention ยป

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