Acute respiratory failure is defined by physicians as sudden onset of shortness of breath, also known by the English term “adult respiratory distress syndrome” or ARDS for short.
What is acute respiratory distress syndrome?
Shock lung, or acute respiratory failure, describes the condition of sudden shortness of breath. This is caused by damage to the lungs. This so-called shock lung is caused by an inflammation of the lung tissue, which can be caused by different impacts. The consequences if not treated in time can be: shock conditions, unconsciousness up to organ failure and heart failure. Shock lung, or acute respiratory failure, describes the condition of sudden shortness of breath. This is caused by lung damage. The patient gets very little air, so that the carbon dioxide content in the blood steadily increases and the oxygen content decreases. The clinical picture of acute respiratory failure may also include organ failure, shock, unconsciousness and heart failure.
Causes
As a rule, acute respiratory failure is always preceded by a preexisting condition that damages the lung tissue. However, these prior conditions can be quite varied in nature, ranging from pneumonia to injury to poisoning. The main causes include either inhalation of harmful substances such as smoke or aspiration of substances such as gastric fluid. But indirect effects can lead to shock lung such as injuries and clotting disorders. The result is pulmonary edema as blood vessel permeability increases within the alveoli. This leads to a drop in pressure in some vascular areas with a simultaneous increase in pressure in other parts of the lung tissue. In addition, proteins leak out. As a result, the oxygen supply to the blood decreases sharply and the carbon dioxide content increases.
Symptoms, complaints, and signs
Acute lung failure usually announces itself through several warning signs. Because of the damage to the lung tissue, breathing becomes difficult at first. To counteract this, affected individuals increase their respiratory rate, eventually leading to hyperventilation and hyperventilation. As a result, acute respiratory distress occurs, usually associated with a panic attack that manifests itself in dizziness, sweating, and acute fear of death. Accompanying this, the fingernails and lips of the affected person turn blue. As the disease progresses, various symptoms may occur, depending on the phase of lung failure. In the first phase, tissue damage occurs and may be associated with an increase in respiratory distress, as well as bleeding and coughing. In the second phase, the initial symptoms increase in intensity and the affected person usually becomes unconscious. In the third and final phase, shock occurs and organ failure or shock may result. First responders recognize acute respiratory failure by the fact that the affected person has difficulty breathing or is already severely hyperventilating. An elevated pulse as well as the characteristic wheezing also indicate acute respiratory failure, which must be treated immediately by an emergency physician.
Diagnosis and course
In most cases, shock lung begins with the following symptoms: due to the damage to the lung tissue, patients initially experience difficult breathing. To counteract this, they begin to breathe faster, leading to hyperventilation. After some time, the fingernails and lips of the affected person may turn blue. In the further course, experts distinguish among three different phases: Within the first phase, the biochemical process already listed under “Causes” is set in motion by the tissue damage. In the second phase, the symptoms intensify, so that in the third and final phase, the patient only has the lung volume of an infant, because the majority of the lung tissue has ceased to function due to the inflammation. Depending on how long the state of shock respiration persists, the low oxygen level can lead to unconsciousness , shock, organ failure or heart failure. Medical professionals then usually make the diagnosis of ARDS in light of the previous illness. Ideally, before the patient shows the first signs, he or she should be classified as a patient at risk for shock lung. The first signs then become apparent when listening to the lungs in the form of a rattling noise.An x-ray examination can provide a more accurate diagnosis in this case, as it highlights deposits in the alveoli, which may indicate the onset of shock lung.
Complications
Acute respiratory failure is a very dangerous condition for the human body and therefore must be treated immediately. Even if the lung failure occurs only for a short time, it is essential to call an emergency physician or go to the hospital. In the worst case, lung failure here can lead to death, as the patient’s organs are not supplied with sufficient oxygen. The longer the undersupply of oxygen lasts, the more severely the organs are damaged. The brain, in particular, takes severe damage, so that after the lung failure, the patient may experience disabilities, balance problems and speech disorders. A few minutes after acute respiratory failure, the patient’s extremities turn blue. If the patient has fainted, he or she must be artificially ventilated. This is done by mouth-to-mouth ventilation until the emergency physician arrives or the patient wakes up. During this ventilation, the nose must be held shut so that the air cannot escape. If the lung failure is not treated immediately, death will occur after about 13 minutes. For this reason, rapid assistance and treatment by the emergency physician is necessary. If the patient is still awake and hyperventilating, he should be reassured.
When should you go to the doctor?
If acute respiratory failure is suspected, an emergency physician should be consulted immediately. Medical help is needed if symptoms such as hyperventilation or shortness of breath occur. In addition, emergency medical services should be called if breathing is difficult for several minutes or signs of hyperacidity are observed. Sufferers of acute respiratory failure usually experience mild breathing problems initially, which eventually lead to hyperventilation and a loss of consciousness. If one or more of these symptoms occurs, a physician must be consulted. Another alarm sign is a blue coloration of the lips or fingernails, which usually occurs in the second phase of acute respiratory failure and requires immediate emergency medical treatment. Ideally, however, patients at risk should be classified as at risk for shock lung even before the first warning signs appear. Accordingly, a visit to the doctor is already recommended if rales occur when breathing or the general condition decreases for no apparent reason. People with other pre-existing conditions, as well as smokers and other at-risk groups, should see a doctor immediately with lung symptoms.
Treatment and therapy
To treat acute respiratory failure in the best possible way, physicians resort to ventilation therapy as a first step. This is because the most important thing at first is to re-stabilize the oxygen supply to the blood, and this is where technical support is provided by ventilators. Depending on how far the lung failure has already progressed, however, additional oxygen supply via a respiratory mask is no longer sufficient and the patient must be intubated. Here, a tube is inserted directly into the trachea via the mouth or nose. This should be accompanied by a PEEP. This so-called “exhalation phase pressure” ensures that the alveoli are expanded during exhalation, thus improving oxygen uptake. However, it is also essential to treat the cause that led to the damage to the lung tissue in the first place. This is usually treated with medication.
Outlook and prognosis
In acute respiratory failure, the patient may die in the worst case scenario. In this case, patients usually suffer from severe shortness of breath, panic attacks or sweating. If there is no immediate treatment, the affected person may also lose consciousness and possibly injure himself in a fall. Hyperventilation also occurs. In the further course, the internal organs are not supplied with enough oxygen and blood, so that in the worst case they die or are irreversibly damaged. The brain is also damaged by the reduced supply, so that paralysis or mental impairment can occur later. The further course of acute respiratory failure depends to a large extent on the cause and on the treatment. Mouth-to-mouth resuscitation can be used to combat the symptoms until an emergency physician arrives.The latter can then carry out causal treatment. The patient’s life expectancy may be significantly reduced by the acute lung failure. The patient may also experience significant limitations in his or her further daily life.
Prevention
The surest way to prevent shock lung is to intensively treat the underlying conditions that can lead to it, even before it causes respiratory failure. If lung failure nevertheless occurs, it should be detected as early as possible to prevent serious consequences. Here, it is important that physicians consider the possibility of shock lung at the first signs of unexplained respiratory distress. Acute respiratory failure is potentially life-threatening. Patients usually need immediate emergency treatment with airway intubation.
Follow-up
Many patients with shock lung die of multiorgan failure due to lack of oxygenation. Only 50-60 percent of patients survive acute respiratory failure. These people must be given follow-up medical care. This treats any after-effects of ventilation, as well as any pulmonary fibrosis that may develop after ventilation. This can regress under medical treatment. However, this can take several months. During this time, appropriate aftercare measures are essential. However, pulmonary fibrosis can also result in permanent lung damage if it does not regress. Acute lung failure is often described as “Acute Respiratory Distress Syndrome” or shock lung. This symptomatology is often accompanied by systemic inflammatory processes. These are described as “Systemic Inflammatory Response Syndrome”. Depending on the severity of the respiratory problems, more or less intensive follow-up measures are necessary. The drama of lingering lung damage can lead to serious breathing problems for the rest of one’s life. Without comprehensive care-permanently requiring ventilation, if necessary-the patient is helpless despite survival. As a bedridden or wheelchair-bound pulmonary patient, he is more susceptible to thrombosis or embolism. He is also more at risk than others for respiratory infections or pneumonia after acute respiratory failure.
Here’s what you can do yourself
If you have acute respiratory failure, call an emergency physician immediately. Until the ambulance arrives, first aid measures should be initiated. First, the affected person should be immobilized or left in a position that he or she considers comfortable. If the affected person becomes unconscious, pulse and respiration must be checked regularly to detect circulatory arrest at an early stage. If circulatory arrest occurs, immediate resuscitation measures must be initiated. Suitable measures include cardiac massage or mouth-to-mouth resuscitation. Resuscitation measures should be continued until circulation resumes or the ambulance arrives. If pulmonary failure is suspected, the ambulance service should also be contacted. Typical warning signs include difficulty breathing, pain in the chest area, a rapid pulse and inner restlessness. Sometimes there is also a bloody cough and a feeling of dizziness. If one or more of these symptoms occur, a physician must be consulted. Patients with a corresponding previous illness should discuss suspicious symptoms with the responsible physician. Home remedies and self-measures beyond first aid should be refrained from in any case of acute respiratory failure.
