What Causes Respiratory Failure?

Underlying reason	Cause
Airway obstruction	Chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, asthma, bronchiolitis, inhaled particles
Poor breathing	Obesity, sleep apnea, drug intoxication
Muscle weakness	Myasthenia gravis, muscular dystrophy, polio, Guillain-Barré syndrome, polyomyositis, stroke, amyotrophic lateral sclerosis, spinal cord injury
Abnormality of lung tissue	Acute respiratory distress syndrome, drug reaction, pulmonary fibrosis, fibrosing alveolitis, widespread tumors, radiation, sarcoidosis, burns
Abnormality of chest wall	Kyphoscoliosis, chest wound

Treatment

Almost always, oxygen is given initially. Usually, the amount given is more than is needed, unless the person has chronic respiratory insufficiency. Such people tend to slow their breathing when they're overtreated with oxygen.

The underlying cause also must be treated. An­tibiotics are used to fight infection, and bronchodilators are used to open the airways. Other medications may be given to decrease inflamma­tion or prevent blood clots.

Some very ill patients need mechanical venti­lation to aid breathing. A plastic tube is inserted through the nose or mouth and into the trachea; this tube is attached to a machine that forces air into the lungs. Exhalation occurs passively be­cause of the elastic recoil of the lungs. Many types of ventilators and modes of operation may be used, depending on the underlying disorder. If the lungs aren't functioning well, additional oxygen may be delivered through the ventilator. Mechan­ical ventilation can be lifesaving whenever pa­tients aren't able to move enough air in and out of their lungs.

The amount of fluid in the body must be care­fully monitored and adjusted to maximize lung and heart function. The acidity of the blood must be kept in balance both by adjusting the rate of breathing and using medications that buffer acid­ity. Medications are given to keep the person calm, thereby reducing the body's oxygen de­mands and making lung inflation easier.

When the lung tissue is severely damaged, as in acute respiratory distress syndrome, doctors often consider giving corticosteroids, medica­tions that decrease inflammation. However, the routine use of these medications isn't justified. Corticosteroids can cause many complications, including loss of muscle strength. In general, they're most beneficial to those suffering from conditions known to cause inflammation of the lungs or airways, such as vasculitis, asthma, and allergic reactions.

Notes:

respiratory failure дыхательная недостаточность

sleepiness сонливость

inflate надувать, наполнять газом, воздузом

congenital disorder врожденное расстройство

deteriorating consciouness нарушающий сознание

rid освобождать, избавлять

exhalation выдыхание, испарение

blood clot сгусток крови

 

Acute Respiratory Distress Syndrome

Text A. Introduction.

Acute respiratory distress syndrome (also called adult respiratory distress syndrome) is a type of lung failure resulting from many different disorders that cause fluid accumulation in the lungs (pulmonary edema).

Acute respiratory distress syndrome is a med­ical emergency that can occur in people who pre­viously had normal lungs. Despite the fact that it's sometimes called adult respiratory distress syn­drome, this condition can occur in children.

Causes

The cause can be any disease that directly or indirectly injures the lungs. About a third of the people, with the syndrome develop it as a conse­quence of a severe, widespread infection (sepsis).

When the small air sacs (alveoli) and capillaries of the lung are injured, blood and fluid leak into the spaces between the alveoli and eventually into the alveoli themselves. The inflammation that follows can lead to scar tissue formation. As a result, the lungs can't function normally.

Symptoms and Diagnosis

Acute respiratory distress syndrome usually develops within 24 to 48 hours of the original in­jury or illness. The person first experiences short­ness of breath, usually with rapid, shallow breathing. Through a stethoscope, a doctor may hear crackling or wheezing sounds in the lungs. Because of low oxygen levels in the blood, the skin may become mottled or blue, and other or­gans such as the heart and brain may malfunc­tion.

Arterial blood gas analysis indicates low levels of oxygen in the blood, and chest x-rays show fluid filling spaces that should be filled with air. Further tests may be needed to ensure that heart failure isn't the cause of the problem.

Complications and Prognosis

The oxygen deprivation caused by this syn­drome can produce complications in other or­gans soon after the condition starts or, if the sit­uation doesn't improve, days or weeks later.

Prolonged oxygen deprivation can cause such se­rious complications as kidney failure. Without prompt treatment, the severe oxygen deprivation from this syndrome causes death in 90 percent of patients. However, with appropriate treatment, about half of all people with severe acute respi­ratory distress syndrome survive.

Because people with acute respiratory distress syndrome are less able to fight lung infections, they commonly develop bacterial pneumonia sometime during the course of the illness.

Treatment

People with acute respiratory distress syn­drome are treated in an intensive care unit. Oxy­gen therapy is vital to correct low oxygen levels. If oxygen delivered by a face mask doesn't correct the problem, a ventilator must be used. The ven­tilator delivers oxygen under pressure through a tube inserted into the nose, mouth, or trachea; this pressure helps force oxygen into the blood. The pressure can be adjusted to help keep the small airways and alveoli open and to ensure that the lungs don't receive an excessive concentra­tion of oxygen - an important consideration be­cause an excessive concentration can damage the lungs and worsen acute respiratory distress syn­drome.

Other supportive treatment, such as intrave­nous fluid or food, is also important because de­hydration or malnutrition can increase the likeli­hood that several organs will stop functioning, a condition called multiple organ failure. Additional treatments crucial to success depend on the underlyng cause of acute respiratory distress syn­drome. For example, antibiotics are given to fight infection.

Those who respond promptly to treatment usu­ally recover completely with few or no long-term lung abnormalities. Those whose treatment in­volves long periods on a ventilator are more likely to develop lung scarring. Such scarring may im­prove over a few months after the patient is taken off the ventilator.

Notes:

wheezing sounds хрипящие звуки

consequence последствие

experience испытывать

mottled пятнистый, пестрый

deprivation лишение, нехватка

consideration рассуждение, анализ

excessive чрезмерный

promptly быстро

likelihood вероятность