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Classification of acute respiratory failure

It is the state of the organism in which normal 0₂ and C0₂ tensions in arterial blood are achieved either at the expense of increased functioning of external respiration (by means of excessive energy losses), leading to a decrease of functional potentialities of the organism, or maintained artificially or not provided.

Classification of ARF (Treshchinsky A.I.) Ventilational (mechanics of respiration is disturbed).

A) Central:

— ADCC;

— Bulbar poliomyelitis;

— CC1, dislocation syndrome;

— Overdosage of narcotics.

B) Neuromuscular (disturbance of transmission of nerve impulse to
respiratory muscles and disturbance of their function):

— spinal column injury;

— Guillain-Barre syndrome;

— poliomyelitis;

— myasthenia;

— tetanus;

— disseminated sclerosis;

— amyotrophic lateral sclerosis;

— hypokalemia;

— hypomagnesemia;

— poisonings with POC;

C) Thoracodiaphragmatic:

— pain syndrome;

— chest injury;

— pneumo-, hemo-, - hydrothorax;

— exudative pleurisy;

— obesity;

— kyphoscoliosis.

Parenchymatous (pathologic process in the lungs). A) Obstructive (bronchial asthma).

A) Restrictive (pneumonia).

B) Diffusional (pulmonary edema, RDSA, lymphostasis). Clinical picture of ARF.

1. Tachypnea is one of the components of dyspnea. Bradypnea and respiratory arrhythmia may be as well.

2. Dyspnea.

3. Paradoxical respiration.

4. Anxiety, euphoria.

5. Tachy- and bradycardia.

6. AP is elevated or lowered.

7. Cyanosis.

8. Hypoxemia, hypercapnia.

Ventilational ARF is conditioned by insufficient ventilation of the majority of respirons that makes difficult blood oxygenation, carbon dioxide elimination and manifested by arterial hypoxemia and hypercapnia. Parenchymatous ARF arises in case of discrepancy between ventilation of respirons and blood circulation in pulmonary capillaries and is manifested by arterial hypoxemia.

Four degrees of ARF are distinguished:

1-st degree is characterized by hurried respiration up to 25 per minute, tachycardia. Arterial pressure is normal. Signs of hypoxia and hypercapnia are absent.

2-nd degree — aggravation of dyspnea (RR 35-40 per minute), auxiliary musculature takes part in the act of respiration. Arterial hypertension, tachycardia up to 140 beats per min., and skin cyanosis are observed. Disorder of CNS functions: euphoria, excitation. Pa0₂ — 80-60 mm Hg; PaC0₂ — 60 mm Hg; Sat 0₂ — 90-85%.

3-rd degree — tachypnea up to 45 per min, HR — up to 180 per min, arterial hypotension. An excitation is replaced by inhibition. Pa0₂ — 60-40 mm Hg; PaC0₂ — 70 mm Hg and more; Sat 0₂ — 80-75%; pH decreases down to 7.2. Skin cyanosis. At this stage the assisted pulmonary ventilation is necessary.

4-th degree — hypoxic and hypercapnic coma. RR is over 45 per min or 8-4 per min, pathologic types of respiration. Arterial hypotension (60 mm Hg and lower), bradycardia or tachycardia, arrhythmia are noted. Pa0₂ — 40 mm Hg and lower; PaC0₂ — 100 mm Hg and more; Sat 0₂ — 75% and lower; pH decreases down to 7.15 and lower. APV is necessary at this stage.

Patients with ARF should be carried out intensive observation, monitoring of respiration, hemodynamics, as well as laboratory control of AAB and blood gas composition.

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