Providing emergency care for respiratory failure. Acute respiratory failure Degrees of respiratory failure in children table

Acute respiratory failure It is the inability of the respiratory system to provide the supply of oxygen and the removal of carbon dioxide necessary to maintain the normal functioning of the body.

Acute respiratory failure (ARF) is characterized by rapid progression, when after a few hours, and sometimes minutes, the patient may die.

Causes

• Respiratory tract disorders: retraction of the tongue, foreign body obstruction of the larynx or trachea, laryngeal edema, severe laryngospasm, hematoma or tumor, bronchospasm, chronic obstructive pulmonary disease and bronchial asthma.

• Injuries and diseases: injuries of the chest and abdomen; respiratory distress syndrome or "shock lung"; pneumonia, pneumosclerosis, emphysema, atelectasis; thromboembolism of the branches of the pulmonary artery; fat embolism, amniotic fluid embolism; sepsis and anaphylactic shock; convulsive syndrome of any origin; myasthenia gravis; Guillain-Barré syndrome, erythrocyte hemolysis, blood loss.

• Exo- and endogenous intoxications (opiates, barbiturates, CO, cyanides, methemoglobin-forming substances).

• Injuries and diseases of the brain and spinal cord.

Diagnostics

According to the severity of ARF is divided into three stages.

• 1st stage. Patients are excited, tense, often complain of headache, insomnia. NPV up to 25-30 in 1 min. The skin is cold, pale, moist, cyanosis of the mucous membranes, nail beds. Arterial pressure, especially diastolic, is increased, tachycardia is noted. SpO2< 90%.

• 2nd stage. Consciousness is confused, motor excitation, respiratory rate up to 35-40 in 1 min. Severe cyanosis of the skin, auxiliary muscles take part in breathing. Persistent arterial hypertension (except in cases of pulmonary embolism), tachycardia. Involuntary urination and defecation. With a rapid increase in hypoxia, there may be convulsions. A further decrease in O2 saturation is noted.

• 3rd stage. Hypoxemic coma. Consciousness is absent. Breathing can be rare and superficial. Seizures. The pupils are dilated. The skin is cyanotic. Arterial pressure is critically reduced, arrhythmias are observed, often tachycardia is replaced by bradycardia.

They call the state when the breathing process is not able to provide the body with a sufficient amount of oxygen and remove the required amount of carbon dioxide.

Clinical picture

Such an ailment in children can cause serious consequences, so parents should know what factors affect the appearance of pathology. This condition can occur in childhood for a number of reasons. Doctors consider the main ones to be:

Types of respiratory failure in children

According to the mechanism of appearance, this problem is divided into parenchymal and ventilation.

Respiratory failure can also be acute (ARF) and chronic. The acute form develops within a short time, and chronic insufficiency can last several months and even years.

Degrees of respiratory failure

According to their severity, it is customary to distinguish 4 degrees of this pathology, which differ in clinical manifestations.

Respiratory failure in newborns

Respiratory failure can also occur in infants. The reasons for this may be:

Respiratory failure in newborn premature babies is caused by respiratory distress syndrome.

All principles of treatment are aimed at restoring airway patency, getting rid of bronchospasm and pulmonary edema, as well as positively affecting the respiratory function of the blood and eliminating metabolic disorders.

Symptoms of acute and chronic respiratory failure

Symptoms of the acute form of the disease are:

In chronic insufficiency, the same symptoms occur as in children, only they do not appear immediately, but gradually. But it is worth noting that in children this pathology develops much faster than in adults. This can be explained by the peculiarities of the anatomy of the child's body.

Children are more prone to swelling of the mucosa, their secretion is formed faster, and the muscles of the respiratory system are not as developed as in adults.

Children's oxygen requirements are much greater than those of adults, so the consequences of respiratory failure can be more severe. In chronic insufficiency, the child's voice timbre changes, a cough appears, and wheezing is heard when breathing.

Complications of pathology

Respiratory failure is a very serious disorder that can lead to serious consequences. From the side of the cardiovascular system, ischemia, arrhythmia, pericarditis, and hypotension may occur.

This condition also affects the nervous system. It can cause psychosis, polyneuropathy, decreased mental activity, muscle weakness, and even coma.

Also, respiratory failure can cause stomach ulcers, bleeding in the digestive tract, disruption of the liver and gallbladder. Acute respiratory failure even threatens the life of the child.

Treatment of respiratory failure in children

At first, all treatment is aimed at restoring pulmonary ventilation and freeing the airways. For this, oxygen treatment is used, which helps to normalize the gas composition of the blood. Oxygen is prescribed even for those patients who breathe themselves.

For the treatment of chronic insufficiency, in most cases, respiratory therapy is prescribed, which includes:

• inhalation;
• respiratory physiotherapy;
• oxygen therapy;
• aerosol therapy;
• intake of antioxidants.

If the breathing problems in young patients are caused by infections, then they are prescribed antibiotics. The choice of these drugs occurs only after a sensitivity test has been carried out.

In order to clear the bronchi from the secret accumulated there, the patient is prescribed expectorants - a mixture of Altai root, Mukaltin. Doctors can also remove sputum from the bronchi through the nose or mouth with an endobronchoscope.

After the child's breathing has returned to normal, doctors begin symptomatic therapy. If the child had pulmonary edema, then he is prescribed diuretics. The most commonly used is furosemide. To eliminate pain, the child is prescribed painkillers - Panadol, Ibufen, Nimesil.

Basic diagnostic methods

First of all, the doctor examines the patient's history and learns about disturbing symptoms. It is very important to establish if the child has diseases that can cause the development of insufficiency.

Next is a general inspection. During it, the specialist examines the patient's chest and skin, counts the frequency of breathing and heartbeat, and listens to the lungs with a phonendoscope.

Also a mandatory study in the diagnosis of this pathology is the analysis of the gas composition of the blood. It makes it possible to find out the degree of its saturation with oxygen and carbon dioxide. The acid-base balance of the blood is also studied.

Additional diagnostic methods are chest x-ray and magnetic resonance imaging. In some cases, the doctor may prescribe a pulmonologist consultation for the child.

First aid for children with acute respiratory failure

This dangerous pathological condition can develop very quickly, so every parent should know how to provide first aid to their child.

The baby needs to be put on the right side and free his chest from tight clothing. So that the tongue does not sunk and does not block the airways even more, the child's head must be tilted back. If possible, mucus and foreign bodies (if any) should be removed from the nasopharynx. You can do this with a gauze pad. Next, you need to wait for an ambulance.

Doctors will perform airway aspiration, tracheal intubation, or other procedures to allow the child to start breathing again. Then the baby can be connected to a ventilator and continue treatment in the hospital.

Preventive measures

Since respiratory failure is not a separate disease, but a symptom of other serious diseases and a consequence of mechanical influences, the prevention of this condition consists in the timely treatment of these causes. It is also very important to limit the child from contact with allergens and toxic substances.

In addition, you need to regularly undergo examinations with the child by specialists so that they can identify any pathologies of the respiratory system as early as possible.

Respiratory failure is a very serious pathological condition that can lead to hypoxia and even death. Therefore, everyone needs to know what to do with this disease. If all measures are taken on time, then this symptom can be eliminated quite easily. The main thing is to pay attention to all the complaints of the child and not to delay going to the doctor.

Acute respiratory failure - a pathological condition in which the normal function of the respiratory apparatus does not provide the necessary gas exchange. Respiratory insufficiency is divided into primary, associated with damage directly to the apparatus of external respiration; and secondary, which is based on diseases and injuries of other organs and systems.

Respiratory failure may be acute And chronic.

Etiology : the reasons are manifold, are classified according to the main pathogenetic mechanisms of development this syndrome.

1. ODN of central origin(due to depression of the respiratory center):
- 1. anesthesia;
- 2. poisoning (barbiturates, morphine, tranquilizers, etc.);
- 3. compression or hypoxia of the brain (strokes, tumors and oedema of the brain).

2. ARF due to restriction of movement of the chest, diaphragm, lungs:
- 1. chest trauma;
- 2. hemothorax (accumulation of blood in the pleural cavity), pneumothorax (accumulation of air in the pleural cavity), hydrothorax (accumulation of water in the pleural cavity);
- 3. kyphoscoliosis (violation of posture);
- 4. flatulence.

3. ARF due to lung injury:
- 1. lobar pneumonia;
- 2. water aspiration (drowning).

4. ARF due to impaired neuromuscular conduction:
- 1. polio;
- 2. tetanus;
- 3. botulism.

5. ARF due to airway obstruction:
- 1. aspiration by foreign bodies;
- 2. swelling of the mucosa with burns;
- 3. bronchial asthma.

6. ARF due to acute inflammation and toxic diseases:
- 1. cardiogenic, hemorrhagic, traumatic shock conditions;
- 2. peritonitis, pancreatitis, uremia;
- 3. hyperketadcedotic coma;
- 4. typhoid fever, etc.

The speed of development and increase in clinical signs of ARF depends on the reason that caused it, for example, mechanical asphyxia, shock lung, laryngeal stenosis, laryngeal edema, chest trauma, pulmonary edema, and so on.

Stages of ODN:
1. Stage of compensated breathing . Clinic : consciousness is preserved, feeling of lack of air, anxiety. NPV 25 - 30 per minute, skin moisture, pallor. Mild cyanosis is noted, blood pressure depends on the cause of ARF, heart rate is 90-120 per minute.

2 . Stage of incomplete respiratory compensation . Clinic : excitation is noted, possibly a delusional state, hallucinations, profuse sweat, cyanosis of the skin, NPV 35 - 40 beats / min. with the participation of auxiliary muscles, blood pressure is increased, heart rate is 120 - 140 per minute.

3 . Stage of respiratory decompensation . Clinic : pallor of the skin, moisture is noted. Acrocyanosis, diffuse cyanosis, rare respiratory movements (6-8 per minute), heart rate increases to 130-140 per minute. Pulse thready, arrhythmic. Hell is lowered, consciousness is absent, seizures may occur. Pupils are dilated. The pre-agonial state is quickly replaced by agony. The patient needs immediate resuscitation, but at this stage they are often ineffective, since the body has exhausted its compensatory capabilities.

The main factors in the regulation of respiration are dried :
1 . partial pressure of carbon dioxide in arterial blood (normal РСО2 35 - 45 mm Hg);
2 . partial tension of oxygen in the arterial blood (normal ZSch2 100 mm Hg);
3 . Blood pH is normal 7.4. With an increase, alkalosis occurs, with a decrease, acidosis;
4 . pulmonary receptors that respond to stretching of the alveoli.

Violation of external respiration leads to a disorder of gas exchange in the lungs, which manifests itself in the form of three main syndromes:
1 . hypoxia RO is reduced to 100 mm. rt. Art.;
2 . hypercapnia, RCO increased by 45 mm. rt. st;
3 . hypocapnia, RCO drops to 35 mm. rt. Art.

Until the cause of ARF is clarified, it is strictly forbidden to administer sleeping pills, sedative or neuroleptic drugs, as well as drugs to the patient.

Emergency measures at the prehospital stage :
1 . examine the oral cavity;
2 . in the presence of foreign bodies (for example, when drowning - sand, vomit), remove them;
3 . eliminate the retraction of the tongue;
4 . IVL if the victim is unconscious
5 . in case of respiratory arrest, purplish skin color, rapid breathing above 40 per minute, mechanical ventilation and chest compressions are performed continuously during the patient's transportation.

Drug and other care depends on the etiology of ARF:
I. Restoration and maintenance of airway patency:
1. removal of a foreign body with a bronchoscope;
2. tracheotomy (effective for acute edema of the larynx, compression of its tumor, hematoma);
3. postural drainage (raise the foot end of the bed to 30 degrees, 30 minutes to 2 hours, auxiliary cough - vigorous chest massage, vibration massage);
4. aspiration of contents from the respiratory tract through a nasal catheter;
5. liquefaction of sputum with 10 ml of 10% sodium iodide solution intravenously, ambroxom 15-30 mg. intravenously;
6. therapeutic bronchoscopy with lavage of the tracheobronchial tree;
7. microtracheotomy - puncture of the trachea through the skin with a needle and insertion of a catheter into it for systematic installation into the respiratory tract 5 - 10 ml, isotonic sodium chloride solution with antibiotics;
8. conitoconia - dissection of the cone-shaped ligament between the thyroid and cricoid cartilages;
9. bronchodilators - eufillin intravenously drip 10 - 20 ml. 2.4% solution in 150 ml. isotonic sodium chloride solution.
II. oxygen therapy- inhalation with an oxygen-air mixture with an oxygen content of not more than 60 - 70%
Hyperbolic oxygenation is possible.
III. Stimulation of breathing (with the most severe degree of ARF or coma, when there is a threat of respiratory arrest - inject cordiamin intramuscularly 4 ml).
IV. Symptomatic therapy:
1. anesthesia (local and general), with the introduction of analgesics: 2 ml. 50% solution of analgin, neuroleptics; narcotic analeptics: 1-2 ml. 1-2% solution of promedol with 2 ml. 2% suprastin solution);
2. stimulation of cardiovascular activity: 0.5 ml of a 0.025% solution of strophanthin intramuscularly with high blood pressure ( used only in hospitals in the treatment of pulmonary edema), 0.5 - 1 ml. 0.1% solution of clonidine intramuscularly. In mild cases, 5 ml. 24% solution of aminophylline intramuscularly;
3. infusion therapy.
V. Tracheal intubation, mechanical ventilation - with a sudden cessation of breathing, agony and clinical death.

Respiratory failure is a pathology that complicates the course of most diseases of internal organs, as well as conditions caused by structural and functional changes in the chest. To maintain gas homeostasis, the respiratory section of the lungs, airways and chest must work in a stressful mode.

External respiration provides oxygen to the body and removal of carbon dioxide. When this function is disturbed, the heart begins to beat hard, the number of red blood cells in the blood increases, and the level of hemoglobin rises. Strengthened work of the heart is the most important element of compensation for insufficiency of external respiration.

In the later stages of respiratory failure, compensatory mechanisms fail, the functional capabilities of the body decrease, and decompensation develops.

Etiology

Pulmonary causes include a disorder in the processes of gas exchange, ventilation and perfusion in the lungs. They develop with lobar, lung abscesses, cystic fibrosis, alveolitis, hemothorax, hydrothorax, water aspiration during drowning, traumatic chest injury, silicosis, anthracosis, congenital malformations of the lungs, chest deformities.

Extrapulmonary causes include:

Alveolar hypoventilation and bronchial obstruction are the main pathological processes of respiratory failure.

At the initial stages of the disease, compensation reactions are activated, which eliminate hypoxia and the patient feels satisfactory. With severe disorders and changes in the gas composition of the blood, these mechanisms do not cope, which leads to the development of characteristic clinical signs, and in the future - severe complications.

Symptoms

Respiratory failure is acute and chronic. The acute form of pathology occurs suddenly, develops rapidly and poses a threat to the life of the patient.

In primary insufficiency, the structures of the respiratory tract and the respiratory organs are directly affected. Its reasons are:

1. Pain with fractures and other injuries of the sternum and ribs,
2. Bronchial obstruction with inflammation of the small bronchi, compression of the respiratory tract by a neoplasm,
3. Hypoventilation and lung dysfunction
4. Damage to the respiratory centers in the cerebral cortex - TBI, drug or drug poisoning,
5. Respiratory muscle damage.

Secondary respiratory failure is characterized by damage to organs and systems that are not part of the respiratory complex:

• blood loss
• Thrombosis of large arteries,
• Traumatic shock,
• intestinal obstruction,
• Accumulation of purulent discharge or exudate in the pleural cavity.

Acute respiratory failure is manifested by rather vivid symptoms. Patients complain of a feeling of lack of air, shortness of breath, difficulty inhaling and exhaling. These symptoms appear before the others. Tachypnea usually develops - rapid breathing, which is almost always accompanied by respiratory discomfort. The respiratory muscles are overstrained, it requires a lot of energy and oxygen to work.

With an increase in respiratory failure, patients become excited, restless, euphoric. They cease to critically assess their condition and the environment. Symptoms of "respiratory discomfort" appear - whistling, remote wheezing, breathing is weakened, tympanitis in the lungs. The skin becomes pale, tachycardia and diffuse cyanosis develop, the wings of the nose swell.

In severe cases, the skin turns grayish and becomes sticky and moist. As the disease develops, arterial hypertension is replaced by hypotension, consciousness is depressed, coma and multiple organ failure develop: anuria, gastric ulcer, intestinal paresis, kidney and liver dysfunction.

The main symptoms of the chronic form of the disease:

1. Shortness of breath of various origins;
2. Increased breathing - tachypnea;
3. Cyanosis of the skin - cyanosis;
4. Strengthened work of the respiratory muscles;
5. compensatory tachycardia,
6. Secondary erythrocytosis;
7. Edema and arterial hypertension in the later stages.

Palpation is determined by the tension of the muscles of the neck, contraction of the abdominal muscles on exhalation. In severe cases, paradoxical breathing is revealed: on inspiration, the stomach is pulled inward, and on exhalation it moves outward.

In children, pathology develops much faster than in adults due to a number of anatomical and physiological features of the child's body. Babies are more prone to swelling of the mucous membrane, the lumen of their bronchi is rather narrow, the process of secretion is accelerated, the respiratory muscles are weak, the diaphragm is high, breathing is more shallow, and the metabolism is very intense.

These factors contribute to the violation of respiratory patency and pulmonary ventilation.

Children usually develop an upper obstructive type of respiratory failure, which complicates the course, paratonsillar abscess, false croup, acute epiglotitis, pharyngitis, and. The timbre of the voice changes in the child, and "stenotic" breathing appears.

The degree of development of respiratory failure:

• First- difficult breathing and restlessness of the child, hoarse, "cock" voice, tachycardia, perioral, intermittent cyanosis, aggravated by anxiety and disappearing when breathing oxygen.
• Second- noisy breathing that can be heard from a distance, sweating, constant cyanosis on a pale background, disappearing in an oxygen tent, coughing, hoarseness, retraction of the intercostal spaces, pallor of the nail beds, lethargic, adynamic behavior.
• Third- severe shortness of breath, total cyanosis, acrocyanosis, marbling, pallor of the skin, drop in blood pressure, suppressed reaction to pain, noisy, paradoxical breathing, weakness, weakening of heart sounds, acidosis, muscle hypotension.
• Fourth the stage is terminal and is manifested by the development of encephalopathy, asystole, asphyxia, bradycardia, seizures, coma.

The development of pulmonary insufficiency in newborns is due to an incompletely mature surfactant system of the lungs, vascular spasms, aspiration of amniotic fluid with primordial feces, and congenital anomalies in the development of the respiratory system.

Complications

Respiratory failure is a severe pathology requiring urgent therapy. The acute form of the disease is difficult to treat, leads to the development of dangerous complications and even death.

Acute respiratory failure is a life-threatening pathology that leads to the death of the patient without timely medical care.

Diagnostics

Diagnosis of respiratory failure begins with the study of the patient's complaints, the collection of an anamnesis of life and illness, and the clarification of comorbidities. Then the specialist proceeds to examine the patient, paying attention to the cyanosis of the skin, rapid breathing, retraction of the intercostal spaces, listens to the lungs with a phonendoscope.

To assess the ventilation capacity of the lungs and the function of external respiration, functional tests are carried out, during which the vital capacity of the lungs, the peak volumetric forced expiratory flow rate, and the minute respiratory volume are measured. To assess the work of the respiratory muscles, measure the inspiratory and expiratory pressure in the oral cavity.

Laboratory diagnostics includes the study of acid-base balance and blood gases.

Additional research methods include radiography and magnetic resonance imaging.

Treatment

Acute respiratory failure develops suddenly and rapidly, therefore you need to know how to provide emergency first aid.

The patient is laid on the right side, the chest is freed from tight clothing. To prevent the tongue from sinking, the head is thrown back, and the lower jaw is pushed forward. Then foreign bodies and sputum are removed from the pharynx using a gauze pad at home or an aspirator in a hospital.

It is necessary to call an ambulance team, since further treatment is possible only in the intensive care unit.

Video: first aid for acute respiratory failure

Treatment of chronic pathology is aimed at restoring pulmonary ventilation and gas exchange in the lungs, delivering oxygen to organs and tissues, pain relief, and eliminating the diseases that caused this emergency.

The following therapeutic methods will help restore pulmonary ventilation and airway patency:

After the restoration of respiratory patency, they proceed to symptomatic therapy.

Acute respiratory failure (ARF) is a condition in which the body is not able to maintain the normal maintenance of the gas composition of the blood. For some time it can be achieved due to the increased work of the respiratory apparatus, but its capabilities are quickly depleted.

Causes and mechanisms of development

Atelectasis can cause acute respiratory failure.

ARF is the result of various diseases or injuries in which pulmonary ventilation or blood flow disorders occur suddenly or progress rapidly.

According to the mechanism of development, there are:

• hypoxemic;
• hypercapnic variant of respiratory failure.

With hypoxemic respiratory failure, sufficient oxygenation of arterial blood does not occur due to a violation of the gas exchange function of the lungs. The following problems can cause its development:

• hypoventilation of any etiology (asphyxia, aspiration of foreign bodies, retraction of the tongue,);
• decrease in the concentration of oxygen in the inhaled air;
• pulmonary embolism;
• atelectasis of the lung tissue;
• airway obstruction;
• non-cardiogenic pulmonary edema.

Hypercapnic respiratory failure is characterized by an increase in the concentration of carbon dioxide in the blood. It develops with a significant decrease in pulmonary ventilation or with increased production of carbon dioxide. This can be observed in such cases:

• with diseases of a neuromuscular nature (myasthenia gravis, poliomyelitis, viral encephalitis, polyradiculoneuritis, rabies, tetanus) or the introduction of muscle relaxants;
• with damage to the central nervous system (traumatic brain injury, acute cerebrovascular accident, poisoning with narcotic analgesics and barbiturates);
• at or massive ;
• with a chest injury with its immobilization or damage to the diaphragm;
• with seizures.

Symptoms of ARF

Acute respiratory failure occurs within a few hours or minutes after the onset of exposure to a pathological factor (acute disease or injury, as well as exacerbation of a chronic pathology). It is characterized by impaired breathing, consciousness, circulation and kidney function.

Respiratory disorders are very diverse, they include:

• tachypnea (breathing at a frequency above 30 per minute), irregular polypnea and apnea (stopping breathing);
• expiratory dyspnea (with difficulty exhaling, often accompanies hypercapnic DN);
• stridor breathing with retraction of the supraclavicular spaces (occurs with obstructive airway diseases);
• pathological types of breathing - Cheyne-Stokes, Biot (occur with brain damage and drug poisoning).

The severity of disorders in the functioning of the central nervous system directly depends on the degree of hypoxia and hypercapnia. Its initial manifestations can be:

• lethargy;
• confusion;
• slow speech;
• motor anxiety.

An increase in hypoxia leads to stupor, loss of consciousness, and then to the development of coma with cyanosis.

Circulatory disorders are also caused by hypoxia and depend on its severity. It could be:

• severe pallor;
• marbling of the skin;
• cold extremities;
• tachycardia.

As the pathological process progresses, the latter is replaced by bradycardia, a sharp drop in blood pressure and various rhythm disturbances.

Kidney dysfunctions appear in the late stages of ARF and are caused by prolonged hypercapnia.

Another manifestation of the disease is cyanosis (cyanosis) of the skin. Its appearance indicates pronounced disturbances in the oxygen transport system.

Degrees of ODN

From a practical point of view, on the basis of clinical manifestations during ARF, 3 degrees are distinguished:

1. The first of them is characterized by general anxiety, complaints of lack of air. In this case, the skin becomes pale in color, sometimes with acrocyanosis and covered with cold sweat. The respiratory rate increases to 30 per minute. Tachycardia appears, unexpressed arterial hypertension, partial pressure of oxygen drops to 70 mm Hg. Art. During this period, DN is easily amenable to intensive care, but in its absence it quickly passes into the second degree.
2. The second degree of ARF is characterized by the excitation of patients, sometimes with delusions and hallucinations. The skin is cyanotic. The respiratory rate reaches 40 per minute. The heart rate increases sharply (more than 120 per minute) and blood pressure continues to rise. In this case, the partial pressure of oxygen drops to 60 mm Hg. Art. and lower, and the concentration of carbon dioxide in the blood increases. At this stage, immediate medical attention is necessary, since delay leads to the progression of the disease in a very short period of time.
3. The third degree of ODN is the limit. A coma with convulsive activity sets in, spotty cyanosis of the skin appears. Breathing is frequent (more than 40 per minute), superficial, may be replaced by bradypoea, which threatens with cardiac arrest. Blood pressure is low, the pulse is frequent, arrhythmic. In the blood, limiting violations of the gas composition are revealed: the partial pressure of oxygen is less than 50, carbon dioxide is more than 100 mm Hg. Art. Patients in this condition need urgent medical care and resuscitation. Otherwise, ODN has an unfavorable outcome.

Diagnostics

Diagnosis of ARF in the practical work of a doctor is based on a combination of clinical symptoms:

• complaints;
• medical history;
• objective examination data.

Auxiliary methods in this case are the determination of the gas composition of the blood and.

Urgent Care

All patients with ARF must receive oxygen therapy.

The therapy of ARF is based on dynamic monitoring of the parameters of external respiration, the composition of blood gases and the acid-base state.

First of all, it is necessary to eliminate the cause of the disease (if possible) and ensure the patency of the airways.

All patients with acute arterial hypoxemia are shown oxygen therapy, which is carried out through a mask or nasal cannulas. The goal of this therapy is to increase the partial pressure of oxygen in the blood to 60-70 mm Hg. Art. Oxygen therapy with an oxygen concentration of more than 60% is used with extreme caution. It is carried out with the obligatory consideration of the possibility of the toxic effect of oxygen on the patient's body. With the ineffectiveness of this type of exposure, patients are transferred to mechanical ventilation.

Additionally, such patients are assigned:

• bronchodilators;
• drugs that thin sputum;
• antioxidants;
• antihypoxants;
• corticosteroids (as indicated).

With depression of the respiratory center caused by the use of narcotic drugs, the use of respiratory stimulants is indicated.