Syndromes of defeat of the respiratory system syndrome of respiratory failure. Respiratory failure in children and adults - types, causes, symptoms, diagnosis, treatment

Acute respiratory failure is a syndrome that is very dangerous for human health. In the lungs of the patient, gas exchange is disturbed, the level of oxygen in the blood decreases and the amount of carbon dioxide increases. Oxygen starvation or, in medical terms, hypoxia begins.

Classification of respiratory failure is carried out according to the type of development, due to the onset and stage of the disease. In addition, insufficiency can be acute or chronic.

According to the type of development, the following types of insufficiency are found: hypoxemic and hypercapnic.

hypoxemic

In this case, the level of oxygen is greatly reduced - most often with a severe form of pneumonia and pulmonary edema. The patient may benefit from oxygen therapy.

Hypercapnic

And with hypercapnic respiratory failure, the level of carbon dioxide in the patient's blood is greatly increased. This happens after chest injuries and with weak respiratory muscles. The oxygen content, of course, is also reduced, and in such cases, oxygen therapy helps and is widely used.

Diagnostics

The correct diagnosis of respiratory failure is, first of all, the determination of the cause of its development.

First of all, during the examination, the doctor pays attention to the color of the patient's skin. Then evaluates the frequency and type of breathing.

Examination of the circulatory and respiratory systems will help to make an accurate diagnosis. It is carried out in a hospital with the help of laboratory blood tests, as well as x-rays.

The reasons

There are five main causes of respiratory failure.

First reason- impaired regulation of breathing. It happens:

with edema or brain tumors;
with a stroke;
with a drug overdose.

The second reason-, that is, complete obstruction or significant narrowing of the airways. This happens:

with blockage of the bronchi with sputum;
if vomiting enters the respiratory tract;
with pulmonary bleeding;
with the retraction of the tongue;
with spasms of the bronchi.

Third reason- impaired function of the lung tissue. This usually happens when:

atelectasis - the collapse of the walls of the lung (it can be congenital and acquired);
postoperative complications;
severe bronchopneumonia.

Fourth- the biomechanics of respiration is disturbed. It happens:

due to fractures of the ribs and other injuries;
with myasthenia gravis (constant weakness and rapid muscle fatigue).

Fifth- insufficient blood supply to the heart and blood vessels. Occurs with a long course of cardiopulmonary diseases.

Stages of the disease

There are three stages of acute respiratory failure. They differ in severity.

In the initial stage, a person develops shortness of breath during physical exertion, a rapid heartbeat. The pressure rises, the pulse becomes frequent. There is a slight blue of the skin (in medicine, this phenomenon is called cyanosis).
The skin is evenly colored in a bluish color, the effect of marble may appear. Lips also turn blue, breathing and heart rate increase sharply. Dyspnoea is severe even at rest.
Hypoxic coma. The patient loses consciousness, the pressure drops, breathing becomes rare and labored. This condition can lead to respiratory arrest, there are cases of death.

Symptoms

Acute respiratory failure develops rapidly and can lead to death. Diagnosis of this disease, as a rule, does not cause difficulties, since its symptoms are very characteristic. And you need to pay attention to them immediately in order to have time to provide first aid to the patient.

The main symptom of the onset of the disease is shortness of breath and frequent noisy breathing, sometimes intermittent. The voice may be lost or hoarse.
The skin is pale, then becomes bluish due to lack of oxygen in the blood. Under artificial lighting, it is easy to make a mistake in assessing skin color, so it is worth comparing the patient's skin and your own.
The patient experiences suffocation, he does not have enough air, tachypnea develops.
Often a person involuntarily leans with both hands on the surface on which he sits with all his might. It is on this basis that acute respiratory failure can be distinguished from diseases of the nervous system, when patients can also experience suffocation.
A person constantly feels weak, he tends to sleep.

First aid rules

Emergency care for acute respiratory failure is extremely important, as deterioration can be rapid. How can you help a suffering person until a doctor arrives?

Place the patient on the floor or other flat surface and turn him on his side.
If possible, open windows to let in fresh air and unfasten the casualty's clothing.
Tilt the patient's head back as much as possible, and push his lower jaw forward so that the person does not choke on his own tongue.
Try to clear the patient's mouth and throat of mucus and debris.
Resuscitation advises to perform artificial respiration when the respiratory function stops. Further treatment should be carried out only in a hospital.

How to do artificial respiration

Artificial respiration is carried out to ensure the flow of oxygen into the patient's body and remove excess carbon dioxide from it.

First you need to throw back the patient's head, putting his hand under the back of his head. The chin and neck of the patient should be in a straight line - so the air will pass freely into the lungs.
Make sure your mouth is not clogged with mucus and vomit. Pinch the patient's nose between your fingers.
Inhale very deeply and make a sharp exhalation of air into the patient's mouth. Lean back and take another breath. At this time, the patient's chest will descend and passive exhalation will occur.

Air blows should be sharp, with an interval of 5-6 seconds. That is, they need to be done 10-12 times per minute and continue until the patient recovers normal breathing.

Treatment of acute respiratory failure is prescribed by a doctor, after diagnosing and finding out the cause of this condition.

Chronic form of the disease

Against the background of diseases of the lungs and bronchi, chronic respiratory failure may develop. Some types of diseases of the central nervous system also contribute to this.

If the syndrome of respiratory failure is treated incorrectly, then it can also become chronic.

Her signs:

shortness of breath even with slight physical exertion;
fast onset fatigue;
constant pallor.

Chronic respiratory failure can cause cardiovascular disease because the heart does not receive the necessary amount of oxygen.

In children

Alas, often in children there is also an acute form of respiratory failure. A small child does not understand what is happening to him, and cannot complain of suffocation, so you need to pay extra attention to the dangerous signs that have appeared.

Symptoms of acute respiratory failure are:

dyspnea;
lethargy and capriciousness, or, conversely, severe anxiety;
blue nasolabial triangle, swollen wings of the nose;
pallor and marbling of the skin.

Classification of respiratory failure in children is carried out according to the same principles as in adult patients.

The most common causes:

obstruction of the airways by nasopharyngeal secretion;
proliferation of adenoids;
entry into the respiratory tract of a foreign object;
impaired ventilation of the lungs during birth trauma;
complication after pneumonia;
consequences of poliomyelitis.

Artificial respiration

If you have to give artificial respiration to an infant, be sure to remember that this process has its own characteristics.

It is necessary to throw back the baby's head with the utmost care, because at this age the neck is very fragile.
Having typed air into the lungs, an incomplete and not sharp exhalation should be made into the child's mouth in order to avoid rupture of the alveoli.
Blowing into the mouth and nose at the same time, with a frequency of 15 - 18 times per minute. This is more common than during emergency care for acute respiratory failure in adults, because children have a much smaller lung volume.

Treatment

conclusions

Acute respiratory failure is a condition of pathological changes in the body. It can result in a number of serious complications and even death.
Respiratory insufficiency can be caused by various reasons, ranging from the ingestion of a foreign object or vomit into the lungs and ending with inflammation of the bronchi and lungs.
Watch out for shortness of breath, especially in children.
When symptoms of respiratory failure appear, it is necessary to call a doctor very quickly and be sure to provide the patient with first aid: in such cases, it often takes minutes.
Learn the basics of resuscitation and especially the technique of artificial respiration. It can save the lives of your loved ones.

When gas exchange is disturbed in the lung matter, the level of oxygen decreases, then the amount of carbon dioxide, on the contrary, increases. This anomaly leads to insufficient provision of tissues with O2, oxygen starvation of the organs develops, as well as the heart muscle and the central nervous system.

Respiratory failure in children in the initial phase is compensated by additional body reactions:

The heart muscle works hard;
There is an increase in the amount of hemoglobin;
The ratio of erythrocytes increases;
Blood circulation increases minute volume.

In severe situations of respiratory failure, compensatory reactions cannot fully normalize gas exchange and eliminate hypoxia, then a decompensated stage occurs.

Causes

With the development of respiratory failure in children, the following factors affect the pulmonary region:

Malfunctions of the central nervous system - trauma to the head and spinal skeleton, swelling of the brain, impaired cerebral microcirculation, electric shock, overdose of narcotic components;
Weakness of the pectoral muscles - toxic infections (tetanus, botulism, poliomyelitis), innervation failure, myasthenia gravis (own antibodies attack muscle tissue), an overdose of drugs for muscle relaxation;
Deformation of the respiratory cell - kyphoscoliosis, pneumo- and hemothorax, inflammation of the pleura, congenital pathologies, rickets;
Embolism of the lumen of the respiratory tract - swelling and spasm of the larynx, ingress of foreign objects, fracture of the laryngeal cartilage, compression of the bronchial or tracheal canal from the outside, bronchitis, asthma, chronic;
Alveolar anomalies - pneumonia, pneumosclerosis, alveolitis, pulmonary edema, tuberculosis.

In addition, some pathologies of the heart and blood vessels lead to pulmonary insufficiency. Then all the respiratory organs work in full mode, but the heart muscle is not able to carry O2 to the tissues. With some ailments of the hematopoietic system, air easily penetrates through the respiratory channels, but does not bind to the cells of the blood fluid . Such an anomaly occurs with a decrease in the concentration of hemoglobin, with various types of anemia.

Classification by degrees and severity

The type of pathology is detected during diagnosis, the formulation is indicated when making a diagnosis.

According to the strength of the spread of the process, DN is divided into 2 basic types: acute and chronic.

These types differ in signs, causes, therapeutic measures:

(ONE) - happens abruptly, suddenly, is considered an emergency situation, poses a mortal threat. Compensatory mechanisms do not turn on, the condition becomes heavier in a short time. All babies need resuscitation. This type occurs when injured, with blockage of the respiratory canals;
Chronic (CDN) - increases slowly for many months and years, the anomaly occurs in young and older children with chronic pulmonary, cardiovascular, hematopoietic diseases. The negative effect is successfully extinguished by compensatory mechanisms.

When complications arise or therapeutic measures do not give the desired result, the disease progresses and the chronic stage is replaced by an acute phase that threatens the life of a small patient.

Degrees of DN

1 degree - blood pressure remains full, partial pressure of O2 decreases to 61-78 mm Hg;

2 degree - the volume of DD per minute increases, the O2 pressure decreases to 50-60 mm Hg, the CO2 pressure is normal or increases slightly;

Grade 3 - the frequency of respiratory movements decreases due to irregular heart rhythm and frequent stops, O2 pressure is less than 70% of normal.

Clinical signs in children depend on the degree of respiratory failure. ODN necessarily requires hospitalization of the child. CRD of the first and second degree can be treated at home.

How does ODN manifest itself in childhood?

Shortness of breath syndrome in children develops for various reasons. In older children, the culprit is bronchial asthma. In younger children, the most common cause of ARF is a narrowing of the lumen of the larynx or trachea. This complication occurs after the flu or other respiratory infections.. The syndrome of stenotic tracheolaryngitis appears on the first or second day of an infectious disease. The trachea and bronchi become clogged with large amounts of mucus or phlegm.

Often, ODN in a baby develops due to the inattention of parents. When swallowed, a small object becomes an obstruction to breathing. It is not always possible to extract the object on your own, which leads to serious consequences.

Signs of the onset of acute respiratory failure in children are characterized by a rapid origin, the symptoms increase at lightning speed. From the development of the first signals to the danger of death, several minutes or hours pass.

Breathing becomes more frequent - the lungs try to compensate for the lack of oxygen, but due to a decrease in air volume, less air enters during inspiration. As a result, the level of CO2 increases.

This syndrome happens within a few hours. With laryngospasm, edema increases in minutes, with complete closure of the canal, respiratory movements stop.

During pleurisy or pneumonia, breathing quickens over several days as fluid gradually accumulates in the lung vesicles. Sometimes there is no increase. On the contrary, it decreases if the respiratory center is damaged or the weakness of the respiratory muscles increases. In this case, the compensatory forces do not work;

Tachycardia appears - the heartbeat becomes frequent due to an increase in blood pressure in the pulmonary circulation. To push blood fluid out of the lungs, the heart functions harder and beats faster;
The child loses consciousness - the nervous matter experiences air hunger, the brain cells do not support the basic viable functions, the brain turns off.

When a child develops an asthma attack, the mind is restored after relaxation of the smooth muscles of the bronchi after a few minutes. In case of injury, edema of the pulmonary matter, the child, without recovering, may die;

Blood pressure decreases - an increase in pressure in a small circle is directly combined with hypotension in a large circle. This is due to the fact that gas exchange slows down, and the blood stays longer in the vessels of the pulmonary regions;
There is a cough, shortness of breath - due to lack of air, the rhythm and frequency of respiratory movements are disturbed, control over them is lost, the child cannot take a deep breath, he does not have enough air. With ARF, the syndrome is growing rapidly, and medical attention is required to restore a normal rhythm.

With an embolism of the respiratory canals (sputum accumulates, bronchospasm occurs, a foreign body enters), the nerve fibers of the mucous epithelium of the bronchi are irritated, which leads to coughing;

There are uncoordinated movements of the chest region during breathing - sometimes one of the lungs does not participate in breathing, or lags behind in movement. Auxiliary muscles are connected to the mechanism to increase the volume of inhalation;
The veins on the neck swell, the skin turns blue - the blood stagnates in the large veins leading to the heart, they expand.

The cervical veins are located on the surface, their expansion is more noticeable. Most often, the areas supplied with small vessels and the most distant from the heart turn blue - these are the ends of the fingers, nose, earlobes (acrocyanosis).

There is a fear of death - ARF syndrome causes a deadly panic, respiratory fear, anxiety, agitation of a psychomotor nature develop;
It hurts inside the chest area - a painful symptom occurs when foreign bodies are swallowed, they scratch the mucous epithelium of the bronchi and trachea. Soreness sometimes appears with inflammatory anomalies of the pleura and with a lack of nutrition of the heart muscle. With tuberculosis or abscess of the lung matter, even with significant destruction of the lung tissue, pain does not occur, since the lung matter does not have pain receptors;

Lack of breathing ends the acute stage. Without professional help, compensatory reactions are exhausted, the respiratory center is suppressed, which leads to a fatal outcome. Modern resuscitation has sufficient measures to eliminate the condition in order to return the child to life.

ARF in newborns

Neonatal malnutrition occurs more often in those children who were born with low birth weight. Hypoxia of the embryo during fetal development also plays a role. As a result of hypoxia, vasospasm develops, which leads to a lack of oxygen.

ARF in newborns occurs when internal water, meconium, blood fluid,

And also with malformations of organs for breathing:

underdevelopment of the lungs;
closing of the nasal passages;
communication between the esophagus and the tracheal tube.

This pathological condition occurs in the first days or hours after birth. Often intrauterine or postnatal pneumonia leads to acute insufficiency.

After the first signs of respiratory distress appear, oxygen therapy is performed. In the severe stage of insufficiency, a ventilator is connected. The complex of therapeutic measures includes the intravenous administration of the necessary medicines.

Video

Video - medical help for respiratory failure

emergency treatment measures

Emergency care for the appearance of acute respiratory failure will depend on the type and severity of violations. Medical measures at different stages are aimed at eliminating the cause, restoring normal gas exchange, relieving pain and preventing the development of infection.

At the 1st degree of DN, the child is freed from tight clothing, fresh air is supplied to the room;
At the 2nd degree, the passage of the respiratory canals should be restored. For this, the child is laid on the surface with raised legs, you can lightly tap on the chest while exhaling;
To eliminate broncholaryngospasm, a solution of aminophylline is administered intramuscularly or intravenously. But with low pressure and frequent heart rate, Eufillin is contraindicated;
To thin the sputum, inhalations or medicines for expectoration are used. If there is no result, the contents of the respiratory canals are removed by an electric suction;
If breathing is still not restored, artificial respiration is used by mouth-to-mouth or mouth-to-nose, or a special apparatus is used directly;
When spontaneous breathing is restored, hyperventilation is used by the method of maintaining gas mixtures. Oxygen therapy is carried out using a nasal tube or mask;
Alkaline inhalations in a warm state are used to improve air permeability, as well as bronchodilators, such as Novodrin, Alupent, Izadrin.

If pulmonary edema occurs, the child should be given a semi-sitting position, legs down, while diuretics are prescribed: Lasix, Furosemide, Uregit. If the spasm of the larynx is severe, muscle relaxants are used.

used to eliminate hypoxia Sibazon, Riboflavin, Sodium oxybutyrate. For injuries, painkillers are administered: Omnopon, Promedol, Novocain, Analgin, Droperidol, Fentanyl.

To eliminate carbon dioxide toxins, sodium bicarbonate, Trisamine IV are administered. These systemic agents increase the blood reserve, penetrate the cell membrane and have an osmotic diuretic effect.

To correct metabolic processes, a polarizing cocktail with vitamin B6, Panangin, Glucose, Cocarboxylase is administered intravenously.

Together with emergency measures, a set of therapeutic measures is used to eliminate the signs of the underlying ailment.

For the treatment of CRD, the elimination of the cause is the first priority. To do this, all measures are taken to prevent exacerbations of the disease of the bronchopulmonary system.

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Acute respiratory failure in children is a condition in which their lungs cannot cope with maintaining normal blood gases, i.e. tissues receive less oxygen and an excess of carbon dioxide accumulates in them. Therefore, the main mechanisms of damage in respiratory failure are hypoxemia (lack of oxygen) and hypercapnia (an excess of carbon dioxide), leading to metabolic shifts.

Respiratory failure syndrome is a consequence of various conditions and diseases in childhood:

Bronchial asthma (this is the most common cause in older children)
Stenosing laryngotracheitis (most common cause in young children)
Epiglottitis
Obstructive bronchitis
Foreign bodies entering the oropharynx or nasopharynx and lowering them below
Aspiration of vomit
Prematurity, in which there is a true deficiency of surfactant (a substance that helps the lungs expand and not stick together when you exhale)
Congenital malformations of the lungs and heart
Respiratory tract infections
Heart disease.

Stenosing laryngotracheitis is a major cause of acute respiratory failure in children ages 1 to 6. It often complicates influenza and other respiratory infections. Symptoms of stenosing laryngotracheitis appear on the 1st or 2nd day of an infectious disease.

Anatomical features of children predispose to a frequent complication of the underlying disease of acute respiratory failure.
These features are:

Raised position of the ribs, giving the chest an "expiratory" appearance, i.e. she is in a state of exhalation
Initially reduced tidal volume
Rapid breathing (compared to adults)
Narrowness of the airways
Rapid fatigue of the respiratory muscles
Decreased surfactant activity.

Therefore, parents should always be alert for the timely detection of acute respiratory failure if the child has any causative factor (primarily respiratory infections).

Types of respiratory failure

Depending on the developing disorders of the gas composition of the blood, three main degrees of respiratory failure:

hypoxemic, in which there is a lack of oxygen in the blood (the voltage of carbon dioxide may be normal, or it may be slightly elevated). This type of insufficiency develops due to a violation between the alveoli and capillaries.
Hypercapnic- occurs due to sharply rapid breathing (an excess of carbon dioxide prevails over a lack of oxygen)
Mixed.

Degrees

The degree of respiratory failure in children determines the severity of his condition. At the first degree the child's consciousness is clear, the skin is of a normal color, but anxiety and shortness of breath appear, the heartbeat quickens (by 5-10% of the norm).
The second degree is characterized by a greater severity of symptoms:

Retraction of the intercostal spaces, supraclavicular regions and the area above the jugular notch
Noisy breathing heard in the distance
Bluish color of the skin that appears when the child is excited
The increase in heart rate is 10-15% more than normal for a given age.

The third degree poses a serious danger to the health of the child. Its characteristics are:

Arrhythmia of breathing against the background of suffocation
Intermittent drop in pulse
Paroxysmal palpitations
Constant (not only when excited, but also at rest) cyanosis of the skin and mucous membranes.

Diagnostics

The final diagnosis of acute respiratory failure in children is made after the determination of blood gases. One of the two signs is enough(determined in arterial blood):

Oxygen tension 50 mmHg and less
Carbon dioxide voltage 50 mm Hg. and more.

But often it is not possible to determine the gas composition. Therefore, doctors (and parents) are guided by clinical manifestations available for research in any situation.
Clinical signs of respiratory failure are:

Increased breathing, which is replaced by its slowdown
Irregular pulse
No breath sounds
Stridor and wheezing
Intercostal retraction
Participation of additional muscles in the act of breathing
Bluish discoloration of the extremities, tip of the nose and nasolabial triangle
Pre-fainting state, which can be replaced by loss of consciousness.

Treatment

Treatment of respiratory failure in childhood is carried out in several directions:

Restoration of air patency through the respiratory tract (extraction of a foreign body that has got there, removal of inflammatory edema, etc.)
Correction of metabolic disorders that have developed against the background of hypoxia
Prescription of antibiotics to prevent infectious complications.

However, such treatment is possible only in a hospital. At home, parents should know first aid rules, which should be immediately provided to the child:

Before starting to follow these rules, you should contact the ambulance service!

Removal of a foreign object from the throat or aspirated vomit
Inhalation of a bronchodilator drug for bronchial asthma (it should always be in the home first aid kit)
Ensuring the flow of oxygenated air (open windows)
Steam inhalation for laryngeal edema, which is the main symptom of stenosing laryngotracheitis
foot baths
Warm drink in large quantities.

In children, it is impossible to remove foreign bodies blindly, because. this can lead to complete airway obstruction. It is recommended to put your hands on the epigastric region and push up. The foreign body that appears can be removed.

Late appeal of parents for medical care when symptoms of respiratory failure appear in children is the reason for the low effectiveness of pharmacological therapy. Therefore, in pediatric practice, there are often indications for conicotomy (dissection of the larynx) and artificial ventilation of the lungs using tracheal intubation.

Respiratory failure (RD) is a disorder in the body caused by a failure of gas exchange in the lungs. Appears in adults and children. The intensity of symptoms and the nature of the course of the disease depends on the severity and form of DN.

How is respiratory failure classified according to severity?

The main criteria on which the classification is based is the measurement of blood gas balance, primarily partial pressure oxygen(PaO2), carbon dioxide in arterial blood, as well as blood oxygen saturation (SaO2).

When determining the severity, it is important to identify the form in which the disease occurs.

DN shapes depending on the nature of the flow

There are two forms of DN - acute and chronic.

Differences between the chronic form and the acute form:

chronic form DN - develops gradually, may not have symptoms for a long time. Usually appears after an undertreated acute form;
acute DN - develops quickly, in some cases, symptoms appear in a few minutes. In most cases, the pathology is accompanied by hemodynamic disturbances (indicators of blood flow through the vessels).

The disease in a chronic form without exacerbations requires regular monitoring of the patient by a doctor.

Respiratory failure in the acute form is more dangerous than chronic, and is subject to urgent treatment.

Classification by severity includes 3 types of chronic and 4 types of acute forms of pathology.

Severity of chronic DN

As DN develops, the symptoms become more complicated and the patient's condition worsens.

Diagnosing the disease at an early stage simplifies and speeds up the treatment process.

Degrees of DN	Types	Symptoms
I	Asymptomatic (hidden)	absent at rest, appear only during physical exertion; the functional reserves of the respiratory system decrease: shortness of breath appears, the indicator of the depth and frequency of breathing changes at rest with a normal pulse
II	Compensated	the balance of gases in the arterial blood remains normal due to compensatory processes (hyperventilation, the formation of an additional amount of hemoglobin and erythrocytes, the acceleration of blood flow); decompensation is formed during physical exertion (a tendency to tachycardia, the depth of breathing decreases, cyanosis is clearly manifested)
III	Decompensated	the influence of compensatory processes is not enough to maintain a normal gas balance in the blood; symptoms appear at rest: significant cyanosis and tachycardia, persistent shortness of breath

Symptoms in chronic insufficiency are not as intense as in the acute form.

How is acute respiratory failure classified?

There are 4 degrees of severity of acute DN:

I degree. It is characterized by shortness of breath (may appear on inhalation or exhalation), increased heart rate.

PaO2 - from 60 to 79 mm Hg;
SaO2 - 91-94%.

II degree. Skin of a marble shade, cyanosis. Convulsions are possible, consciousness is darkened. When breathing, even at rest, additional muscles are involved.

PaO2 - 41-59 mm Hg;
SaO2 - from 75 to 90%.

III degree. Shortness of breath: sharp shortness of breath is replaced by bouts of respiratory arrest, a decrease in the number of breaths per minute. Even at rest, the lips retain a rich bluish tint.

PaO2 - from 31 to 40 mm Hg;
SaO2 - from 62 to 74%.

IV degree. The state of hypoxic coma: breathing is rare, accompanied by convulsions. Respiratory arrest is possible. Cyanosis of the skin of the whole body, blood pressure at a critically low level.

PaO2 - up to 30 mm Hg;
SaO2 - below 60%.

IV degree corresponds to the terminal state and requires emergency assistance.

In the body of a healthy person, PaO2 is above 80 mm Hg, the level of SaO2 is above 95%.

The output of indicators outside the normal range indicates a high risk of developing respiratory failure.

How the severity of pathology in children is determined

DN in a child usually resolves in an acute form. The main differences between pathology in adults and children are other levels of blood gas indicators.

Severity	Indicators (in mm Hg)	Symptoms
I	- Ra oxygen drops to 60-80	dyspnea; increased heartbeat; the nasolabial triangle and the skin tone as a whole acquire a bluish tint; tension of the wings of the nose
II	Ra of carbon dioxide is normal or slightly increased (up to 50); PaO2 - underestimated (from 51 to 64)	shortness of breath and palpitations appear even in a calm state; blood pressure rises; the phalanges of the fingers turn blue; the general condition of the child changes: lethargy and constant fatigue are possible, or arousal and restlessness; increased breathing volume per minute up to 145-160%
III	the level of PaO2 drops to 55-50; Pa of carbonic acid can rise up to 100;	severe shortness of breath; when breathing, auxiliary muscles are involved; the rhythm of breathing is disturbed; heart rate increases and blood pressure decreases; the skin is pale, acquires marbling with a hint of cyanosis; the child is in a state of lethargy and lethargy; the ratio of the number of breaths and contractions of the heart per minute - 1:2
IV (hypoxic coma)	blood pressure is either too low or not monitored at all; oxygen partial pressure falls below 49; partial pressure of carbon dioxide exceeds 100	the skin on the child's body acquires an earthy color, the face becomes cyanotic; spots of purple-bluish color appear all over the body; the child is unconscious; breathing is convulsive, unstable, frequency - up to 10 per minute

If signs of DN 3 and 4 severity are detected, the child needs emergency hospitalization and intensive care. Treatment of children with mild DN (stages 1 and 2) is possible at home.

How to determine the severity of respiratory failure

To finally diagnose the disease and its stage, it is enough to determine the level of blood gases.

Early diagnosis of DN includes the study of external respiration, the detection of obstructive and restrictive disorders.

Examination for suspected DN necessarily includes spirometry and peak flowmetry, arterial blood is taken for analysis.

The algorithm for determining respiratory failure consists of the following diagnostic criteria:

tension (Pa) of oxygen is lower than 45-50;
carbon dioxide tension - higher than 50-60 (indicators in mm Hg).

There is a low probability that the patient will undergo a blood gas analysis without good reason. Most often, the diagnosis is made only when the pathology has manifested itself in the form explicit signs.

How to recognize respiratory failure

Common clinical symptoms of DN include:

If at least a few symptoms of DN appear, the patient should undergo an examination, find out the causes of the development of the pathology, and follow the doctor's recommendations.