Respiratory paralysis is a cessation of breathing. This condition always occurs without outside influence or interference.
What is respiratory paralysis?
In respiratory paralysis, respiratory activity stops. Respiratory activity, in common parlance, is the activity of the lungs. Gas exchange takes place in the lobes of the lungs. Oxygen is inhaled during inspiration, and carbon dioxide is exhaled during expiration. When respiration is paralyzed, this process no longer works. In respiratory paralysis, the volume of gas that is in the lungs initially remains unaffected. The exchange of gas within the lungs also remains unimpaired for the time being. Within a short time, however, a life-threatening oxygen deficiency develops in the blood. This results in hypoxemia, which can lead to a failure of various vital functions. Respiratory paralysis also leads to an oxygen deficiency in the brain. Respiratory paralysis is not caused by external factors such as strangulation or inhaled foreign bodies. It results from internal factors. Respiratory paralysis is divided into central and peripheral respiratory paralysis. While central respiratory paralysis is caused by damage to the respiratory center, peripheral respiratory paralysis results from a disorder of the respiratory muscles.
Causes
The respiratory center is located in the afterbrain in the medulla oblongata. It is a brain area that unconsciously and noninfluentially regulates inhalation and exhalation. Accordingly, respiratory paralysis can be caused by damage to the respiratory center in the medulla oblongata. One possible cause of such central respiratory paralysis is thrombosis of the basilar artery. In basilar artery thrombosis, a blood clot forms in the basilar artery, one of the arteries that supplies oxygenated blood to the brain. As a result, the vessel is blocked and there is reduced blood flow (ischemia) in the area of the brain stem. This reduced blood supply can also affect the respiratory center. Hemorrhage into the brainstem can also cause central respiratory paralysis. Very rarely, central respiratory paralysis occurs during an episode of multiple sclerosis. Only one to two percent of all affected individuals show inflammatory demyelinating foci in the respiratory center. In peripheral respiratory paralysis, the cause of the paralysis is a failure of the respiratory muscles. Thus, respiratory paralysis may occur after the administration of muscle relaxants. Most commonly, such incidents occur during anesthesia. Another cause of peripheral respiratory paralysis is myasthenia gravis pseudoparalytica. This is a neurological disorder in which there is impaired signal transmission between the muscle and nerves. Poliomyelitis, an infectious disease known as polio, can also cause peripheral respiratory paralysis in isolated cases. Polyneuropathies are diseases that affect the peripheral nervous system. Common causes of polyneuropathies include diabetes mellitus, Guillan-Barré syndrome, or infectious diseases such as Lyme disease or diphtheria. Polyneuropathies can also affect the nerves that supply the respiratory muscles, so that paralysis can also occur here. In addition, respiratory paralysis can result from paraplegia above the C4 spinal segment.
Diseases with this symptom
- Thrombosis
- Polio
- Diabetes mellitus
- Ischemia
- Myasthenia gravis pseudoparalytica
- Lyme disease
- Cerebral hemorrhage
- Multiple sclerosis
- Paraplegia
Diagnosis and course
Respiratory paralysis can develop suddenly or slowly. It is accompanied by symptoms such as shortness of breath, blue lips, blue fingers, insomnia, anxiety, or fatigue. Often, respiratory paralysis also announces itself by shortness of breath. One consequence of respiratory paralysis is a condition called asphyxia. The term asphyxia refers to the impending suffocation caused by a drop in oxygen levels in the arterial blood system accompanied by a rise in carbon dioxide levels. The increase in carbon dioxide content is also referred to as hypercapnia. This hypercapnia is registered in the brainstem. As a result, the affected person suffers from a significant fear of suffocation. Asphyxia is manifested by central cyanosis. Cyanosis is a bluish discoloration of the skin and mucous membranes.If the asphyxia persists and the cause of the respiratory paralysis cannot be corrected, clouding of consciousness or even coma will occur. There is often not enough time for a detailed diagnosis in sudden respiratory paralysis. Respiratory paralysis is an emergency that must be treated immediately. Otherwise, complete respiratory paralysis threatens to reduce the supply of oxygen to the brain. This can result in death within minutes.
Complications
In respiratory paralysis, breathing comes to a halt without external intervention. The paralysis, which can already be seen in the name, occurs either in the area of the respiratory muscles or in the area of the respiratory center in the brain. To name complications in the context of respiratory paralysis is difficult at first. This is because respiratory paralysis is an acute condition that persists for a very short time. If respiratory paralysis is not treated immediately with intensive care, it leads to death by suffocation within a few minutes. However, this death by suffocation is not a “complication” of respiratory paralysis in the strictest sense, but the logical consequence. Untreated respiratory paralysis always leads to death by suffocation. Death is preceded by a reduced supply of oxygen to the brain and organs. Since no breathing occurs in the presence of respiratory paralysis, no more oxygen is absorbed that could be distributed throughout the body. The organs, including the brain, can therefore not be supplied with sufficient oxygen. To prevent these compelling consequences of respiratory paralysis, immediate medical intervention is necessary. Death by suffocation can only be avoided if ventilation or respiratory donation is performed immediately as the first measure. In summary, respiratory paralysis means that oxygen can no longer be absorbed, resulting in a reduced supply of oxygen to the brain and other organs. Death by suffocation then occurs within a few minutes unless counteracted medically.
When should you go to the doctor?
Respiratory paralysis must be distinguished between acute and gradual respiratory paralysis. If emergency care is necessary due to the cessation of breathing, a recourse to first aid techniques takes place. If a sudden progression is present, an emergency medical service should be contacted immediately. At the same time, it is recommended to initiate rescue breathing for the affected person. Since death by suffocation is imminent, mouth-to-mouth resuscitation should be initiated immediately until the emergency medical technician arrives. If the progression is gradual, a physician should be consulted as soon as the shortness of breath persists for several hours. If blue lips and blue fingers are already noticeable in the affected person, urgency is already required. If there are signs such as persistent insomnia or permanent fatigue, a doctor should also be consulted. Usually, these symptoms are not associated with respiratory paralysis for the inexperienced. Nevertheless, they are the first signs of respiratory paralysis with a gradual progression. Many sufferers report a feeling of constant fear of suffocation. They, too, should be intensively examined by a medical professional. Symptoms such as discoloration of the skin or clouding of consciousness are further indications that a visit to the doctor is necessary. Since a gradual respiratory paralysis can develop into an acute respiratory arrest at any time, the lack of oxygen supply threatens a life-threatening condition.
Treatment and therapy
Breath donation as part of first aid is suitable as an immediate therapeutic measure. Breath donation is one of the immediate life-saving measures. In breath donation, the missing oxygen is supplied to a person with respiratory paralysis by the rescuer’s ventilation. According to the guidelines of the European Resuscitation Council, mouth-to-mouth resuscitation is the standard for breath donation. Breath donation is performed with the patient’s head hyperextended. The nose is closed and air is supplied through the mouth. Alternatively, ventilation can also be given through the nose. This variant is called mouth-to-nose ventilation. Breathing is continued until the patient is breathing on his or her own again, until a rescuer from the emergency medical services arrives, until the rescuer is exhausted, or until another rescuer can take over. Ventilation is then administered as part of emergency medicine. Positive and negative pressure ventilation, bag ventilation or ventilators can be used.The aim is to supply the patient’s body with oxygen to prevent permanent damage. Once patients are stable, the cause of the respiratory paralysis must be found and corrected if possible.
Outlook and prognosis
If respiratory paralysis is not treated directly by an emergency physician, death usually results. Therefore, if respiratory paralysis occurs, a physician must be called or the hospital must be visited immediately in any case. The patient must be given emergency ventilation. This is done by mouth-to-mouth resuscitation, in which the nose is held shut so that the air cannot escape from the lungs. The longer the respiratory paralysis lasts, the more the organs are damaged by the reduced oxygen supply. The brain may also take damage here, with later disabilities or limitations in thinking or coordination. After about 15 minutes, death due to suffocation occurs after respiratory paralysis. The physician must also give the patient emergency artificial respiration. Whether or not the patient can be resuscitated depends greatly on the cause of the respiratory paralysis and cannot be universally predicted. In some cases, resuscitation is also necessary for the patient to wake up. Especially after an accident, the emergency physician must arrive very quickly to prevent the patient’s death.
Prevention
In most cases, respiratory paralysis is an unpredictable event for which no preventive measures exist.
This is what you can do yourself
There is no self-help for respiratory paralysis. A doctor or an emergency physician must be consulted immediately to treat the respiratory paralysis. If the respiratory paralysis is prolonged, it will lead to death. Respiratory paralysis always occurs when the respiratory arrest takes place even without external action on the chest. In this case, it is a serious health problem that can be properly treated only in a hospital. In any case of respiratory paralysis, first aid must be given immediately. Here, mouth-to-mouth ventilation is required to provide oxygen to the affected person. This ventilation should continue until the emergency physician arrives. As a rule, the emergency physician can perform resuscitation in the event of respiratory paralysis and thus revive the patient. However, this is only possible in cases in which no fatal or serious accident has occurred. If respiratory paralysis occurs briefly and temporarily, a doctor should still be consulted. Other first aid measures include placing the victim on his or her back. The chin is lifted to clear airways. During mouth-to-mouth ventilation, the patient’s nose must remain closed at all times to prevent the air from escaping. This ventilation should be continued until the patient is breathing again or the emergency physician has arrived.
