Respiratory distress syndrome

Description:

Respiratory distress syndrome of adults ("wet lung") — an acute form of respiratory insufficiency of preferential hypoxemic type. The name of a syndrome reflects a certain similarity of clinical, morphological and functional changes with respiratory a distress syndrome of newborns. However disturbances of synthesis of surfactant and its vshcheleniye on a surface of alveolotsit, and also an excess pliability of a thorax are the main reasons for the last (unlike a distress syndrome of adults).

Symptoms Respiratory distress syndrome:

The distress syndrome develops, as a rule, in 20 — 40 h after action of a causative factor and is characterized by the progressing current.

The following manifestations are most characteristic.
• Asthma. For a distress syndrome it is characteristic a tachypnea.
• Increase in FASHION.
• Reduction of pulmonary volumes (general capacity of lungs, residual lung volume, ZhYoL, functional residual capacity of lungs).
• Anoxemia, acute respiratory alkalosis.
• Increase in cordial emission (in a syndrome end-stage — decrease).

Reasons Respiratory distress syndrome:

- Diffusion nfektion of lungs
- Sepsis
- Liquid aspiration
- States after change of lungs and heart
- Inhalation of toxic gases
- Fluid lungs
- Diseases of an immune autoaggression
- Shock

Treatment Respiratory distress syndrome:

Treatment of RDSV represents a complex of actions of an intensive care in three main directions: 1) treatment of the reason of development of a syndrome if it is possible; 2) elimination of an anoxemia – the main component of acute respiratory insufficiency; 3) treatment of multiorgan insufficiency.

All factors of direct injury of lungs are eliminated whenever possible. Vigorous antibacterial therapy at sepsis, bacterial pneumonia is carried out. Adequate treatment of injuries, burns is performed. Glucocorticoids are shown at autoimmune diseases of connecting fabric.

Elimination of an anoxemia is carried out, first, by means of correctly picked up oxygenotherapy mode, secondly, by impact on links of a pathogeny, the lungs leading to disturbance of diffusion capacity.

The oxygenotherapy at early stages of development of RDSV is carried out by means of inhalations through nasal cannulas, a mouth-nose mask. Dynamic control at the same time of blood gases, especially PO2 is desirable. Size it needs to be supported at the level of 60 mm hg as in this situation hemoglobin saturation by oxygen (saturation) it is equal to about 90-92%. Oxygen at the same time moves with rather small speed and its fraction in the inhaled air has to be lowered to 0,5-0,6. In particular, the increased concentration of oxygen can lead disturbance of these conditions in turn to damage of pulmonary fabric and aggravate a condition of the patient. If against the background of the specified methods of an oxygen therapy it is not possible to achieve adequate oxygenation of an arterial blood, the intubation of a trachea and carrying out IVL is shown. It is reasonable to IVL to carry out in the supertension mode at the end of an exhalation (PDKV). Control of the carried-out therapy is exercised also by means of a pulsoksimetriya method which allows to carry out hemoglobin saturation monitoring by oxygen – SPO2. Very important circumstance for increase in efficiency of an oxygenotherapy is the choice of optimum position of the patient in a bed. Degree of manifestation of changes in various parts of a lung can be different therefore it is recommended that the patient lay on one side and less affected lung has to be below. It leads to reduction of intra pulmonary shunting in less affected lung and improves oxygenation.