In respiratory insufficiency, decreased ventilation of the alveoli occurs due to a disorder of external respiration. Sufferers experience shortness of breath, coughing and poor performance.
What is respiratory insufficiency?
Respiratory insufficiency is also known as respiratory failure. Gas exchange in the lungs is impaired. This results in abnormally altered blood gas levels. A distinction can be made between acute and chronic insufficiency. The symptoms of acute insufficiency are similar to those of chronic insufficiency. However, they have a much more sudden onset and are therefore often accompanied by a severe panic reaction. In addition, insufficiencies can be divided into partial and global insufficiencies according to their extent. Respiratory insufficiencies are not independent diseases, but rather a symptom complex caused by various other diseases. Therefore, the insufficiency is always treated by treating the underlying disease. However, oxygen administration can improve symptoms.
Causes
Causes of respiratory insufficiency include obstructive and restrictive ventilatory disorders of the lungs. In restrictive ventilation disorders, the lungs are no longer sufficiently expandable, and this can be equally true of the chest. This leads to a reduced lung volume. In particular, vital capacity, functional residual capacity, and residual volume are reduced. Restrictive ventilatory disorders can occur with deformities of the thorax. Common causes of such thoracic deformity are trauma or scoliosis. Reduced ventilation of the alveoli in pneumonia can also lead to a restrictive ventilation disorder. Adhesions in the chest (for example, pleural nodes), pulmonary edema, or neuromuscular disease can also decrease the distensibility of the lungs and chest. In obstructive ventilation disorder, airway resistance is increased. As a result, airway resistance, functional residual capacity, and residual volume are increased. The alveoli are not evenly ventilated, so the lungs become overinflated in the long term. Furthermore, the entire pulmonary and bronchial system is mechanically damaged. In the long run, this reduces the vital capacity of the lungs. Obstructive ventilation disorders are associated with bronchial asthma, cystic fibrosis, emphysema or chronic obstructive pulmonary disease (COPD), among others. Acute respiratory failure is usually caused by pneumonia, aspiration of water or foreign bodies, or injury to the lungs and chest. Dysfunction of the respiratory center in the brain can also cause acute respiratory insufficiency. Chronic respiratory insufficiencies are more likely to be caused by chronic lung disease or cancer. Respiratory insufficiency can also develop after surgical removal of a lung lobe (pneumectomy) or a lobe of the lung (lobectomy).
Symptoms, complaints, and signs
In partial insufficiency, the partial pressure of oxygen in the arterial blood system decreases. However, the partial pressure of carbon dioxide can still be compensated, resulting in only hypoxemia but not hypercapnia. In respiratory global insufficiency, hypoxemia is joined by hypercapnia. This means that the oxygen content in the blood is reduced, while the partial pressure of carbon dioxide is increased. In acute respiratory insufficiency, the symptoms appear suddenly. The affected person suffers from attack-like shortness of breath with a feeling of suffocation. The acute asthma attack with coughing and difficult exhalation is also a temporary respiratory insufficiency. In contrast, when the respiratory center is damaged, shortness of breath does not occur. Instead, affected individuals immediately become unconscious and die quite quickly without treatment. Chronic respiratory insufficiency occurs far more frequently than the acute form. Here, too, shortness of breath and coughing occur. Due to the chronic lack of oxygen, patients are no longer able to perform as well. A blue discoloration of the skin (cyanosis) may be observed. In longer courses, symptoms such as drumbeat fingers or clock glass nails may appear.
Diagnosis and course of the disease
At the beginning of diagnosis, patients are thoroughly examined. Auscultation and percussion of the lungs are performed.Attenuated breath sounds, secondary sounds, or rales may be heard here. Percussion may reveal air-filled or dead air spaces. Further clarity is provided by imaging techniques such as chest X-ray or computed tomography. Magnetic resonance imaging or lung scintigraphy may also be performed. With the aid of an endoscope, the bronchi (bronchoscopy) and the mediastinal space (mediastinoscopy) can be imaged. Pulmonary function diagnostic procedures can be used to determine the performance of the lungs. Important pulmonary function diagnostic procedures include spirometry and bodyplethysmography. In the laboratory, partial insufficiency shows a partial pressure of oxygen below 75 mmHg on blood gas analysis. In global insufficiency, the partial pressure of carbon dioxide is also above 45 mmHg. Blood gas analysis is performed from capillary blood after sampling from the earlobe.
Complications
Respiratory insufficiency is a serious complication of pulmonary or cardiac disease. It results in an undersupply of oxygen to the body and especially to the brain. As a result, severe and often life-threatening complications occur. Severe respiratory distress can lead to impaired consciousness and even coma. Initially, the disturbances of consciousness are noticeable by states of confusion. Furthermore, there may be a sharp drop in blood pressure. The heart rate is often greatly reduced. In addition, a coarse tremor of the hands (flapping tremor) is often observed. These complications can only be prevented by artificial respiration. Chronic respiratory insufficiency is not curable, since it is based on incurable lung diseases such as emphysema, COPD or pulmonary fibrosis. In the chronic form of the disease, long-term therapy with oxygen ventilation must therefore be carried out. Otherwise, there is permanent impairment of brain and heart function, which can lead to long-term damage or even death. The course of acute respiratory failure can be moderate or severe, depending on the cause. Causes of severe acute courses include sepsis, severe heart disease, pneumonia, or acute pancreatitis. Mechanical ventilation must be used to prevent severe disturbances of consciousness up to coma, cardiac arrhythmias and sudden cardiac death. Otherwise, the underlying diseases play a major role in the prognosis.
When should one go to the doctor?
As a rule, this condition should always be treated by a physician. In the worst case, it can lead to the death of the affected person if the disease is not treated in time. The earlier it is detected, the higher the probability of a complete cure. A doctor should be called if the affected person suffers from severe breathing difficulties. There is a cough, and the patient also appears very tired. Furthermore, the air breathed may also taste of carbon. The affected person may also lose consciousness completely due to the discomfort. If the skin turns blue or the affected person becomes unconscious, an emergency doctor should be called or the hospital visited immediately. First aid should be administered until the emergency physician arrives. The disease is usually treated by an internist. A complete cure cannot be guaranteed.
Treatment and therapy
Respiratory insufficiency can be treated only by therapy of the underlying disease. Oxygen can be administered to help affected patients breathe more easily. Patients may need permanent artificial respiration.
Prevention
Not all lung diseases that can cause respiratory failure can be prevented. However, there are preventable factors that can promote the development of lung disease. Avoiding these harmful factors can protect against pulmonary disease. The main risk factor for lung disease is smoking. There are more than 90 harmful substances in cigarette smoke. These not only weaken the immune system, they also reduce the self-cleaning abilities of lung tissue. Another risk factor for lung disease is indoor radon. Radon is a radioactive noble gas that occurs naturally in soil and rocks. Radon can enter living spaces through leaks in the floor area of the house.Poorly insulated old buildings and houses without a foundation slab are particularly at risk. If radon levels in the house are elevated, the insulation should be replaced.
Aftercare
After successful therapy for respiratory insufficiency, it is elementary to continue treatment to prevent recurrence of the disease. Respiratory aids that provide oxygen uptake and delivery should therefore continue to be used even if symptoms decrease. However, the supply of oxygen should always be adjusted to the oxygen content in the blood. This must be measured regularly by a physician. If another disease was the trigger for respiratory insufficiency, it must continue to be treated even after the respiratory insufficiency has subsided. Depending on the underlying disease, this may require the lifelong use of certain medications. Follow-up treatment should be specific to the underlying disease and discussed with the physician. If a lung tumor was the cause of the respiratory insufficiency, regular lung function tests by the responsible specialist and checks of the oxygen values in the blood are also necessary after its treatment. In addition, the development of respiratory insufficiency should be a warning signal, especially to smokers. For follow-up treatment, it is absolutely necessary to refrain from smoking under all circumstances, as this permanently worsens lung function and oxygen uptake in the blood, as well as blood circulation. In addition, sports and exercise can improve lung function and blood flow and are highly recommended for post-treatment, as is weight loss in overweight patients.
Here’s what you can do yourself
Regardless of the cause of respiratory failure, patients should strictly follow the doctor’s recommendations. This means taking medications according to schedule. If the respiratory condition worsens, the next doctor’s appointment is due. By getting a flu shot, sufferers can protect themselves from additional symptoms. It also makes sense to take certain safety precautions for everyday situations in the car and for travel. This way, a panic attack will not occur even during longer trips. Smokers suffering from respiratory insufficiency should definitely stop smoking, because nicotine aggravates the symptoms. If the shortness of breath causes constant headaches or decreases the ability to concentrate, it makes sense to properly assess one’s own complaints and clarify them at the next doctor’s appointment. Often respiratory insufficiency is related to another disease. Therefore, it can be treated successfully only together with the cause. Taking the prescribed medication correctly will reduce the symptoms. In the case of an acute attack, a light breathing exercise may help to fight the rising panic. If this does not work, artificial respiration must be given as soon as possible. For prolonged, chronic breathing difficulties, transportable liquid oxygen systems are available and patients should have them with them at all times.
