Respiratory distress syndrome

Introduction Acute respiratory distress syndrome (ARDS) refers to acute progressive hypoxic respiratory failure caused by various intrapulmonary and extracranial factors other than cardiogenic, clinically manifested as acute respiratory distress, refractory hypoxemia Symptoms and pulmonary edema. ARDS is a continuous pathological process with an early stage of acute lung injury (ALI). ARDS can induce or combine MODS or MOF.

Cause

There are many primary diseases or underlying diseases or virulence factors that induce ARDS, which are summarized as follows:

1. Shock. Various types of shock, such as infectious, hemorrhagic, cardiogenic and allergic, especially septic shock caused by Gram-negative bacilli sepsis.

2. Trauma. Multiple trauma, pulmonary contusion, craniocerebral trauma, burns, electric shock, fat embolism, etc.

3. Infection. Severe infection of lungs or systemic bacteria, viruses, fungi, protozoa, etc.

4. Inhale toxic gases. Such as high concentration of oxygen, ozone, ammonia. Fluorine, chlorine, nitrogen dioxide, phosgene, aldehydes, smoke, etc.

5. Aspiration. Gastric juice (especially pH <2.5 water, amniotic fluid).

6. Overdose. Barbiturates, salicylic acid, hydrochlorothiazide, colchicine, arabinose, heroin, methadone, magnesium sulfate, terbutaline, streptokinase, fluorescein, and the like. The ADRS caused by poisoning of poisonous drugs has been reported in China and it is worth noting.

7. Metabolic disorders. Liver failure, uremia, diabetic ketoacidosis. Acute pancreatitis 2%-18% complicated by acute respiratory distress syndrome.

8. Blood system diseases. A large number of people lose blood and wrong blood type blood transfusion, DIC and so on.

an examination

Related inspection

Breathtaking test breath test amniotic fluid lecithin/sphingomyelin ratio amniotic fluid lecithin/sphingomyelin ratio (L/S) arterial blood gas analysis

Clinical manifestation

1. In addition to the corresponding clinical manifestations of diseases such as severe infection, aspiration, trauma, shock, pancreatitis, etc., the main manifestations are sudden progressive dyspnea, varying degrees of cough, sputum, and advanced hemoptysis. With irritability, anxiety, sweating, etc., most can be supine.

2. Lips and fingers are obviously blemishes, breathing fast, exerting force, nose flapping, may have inhalation "three concave signs", early no abnormal positive signs, late audible and tubular breath sounds, dry snoring sounds, snoring sounds or blisters .

3. The typical change in arterial blood gas analysis is a decrease in PaO2, a decrease in PaCO2, and an increase in pH. If PaCO2 rises, it indicates that the condition is critical. Early chest radiographs are often negative, and then interstitial pulmonary edema changes, the two lungs scattered in different sizes, blurred edges of patchy density, can be fused into a uniform and dense "glass-like shadow", visible Bronchial inflation sign." Pulmonary interstitial fibrosis can occur in the advanced stage.

4. After the disease develops, it can cause multiple organ failure.

Differential diagnosis

Diagnostic points

Any of the following five items can be diagnosed as ALI or ARDS.

1. High risk factors for morbidity, such as severe infection, trauma, shock and aspiration.

2. Acute onset, respiratory rate and/or respiratory distress.

3. Refractory hypoxemia, conventional oxygenation can not be alleviated: ALI oxygenation index (PaO2 / FiO2) 300mmHg; ARDS (PaO2 / FiO2) 200mmHg.

4. X-ray chest radiograph shows that the lungs have infiltration shadows.

5. Pulmonary capillary wedge pressure 18mmHg or clinically excluded cardiogenic pulmonary edema.

It needs to be distinguished from the following symptoms: shortness of breath: shortness of breath (shortness of breath), a clinically common respiratory symptom, often caused by respiratory diseases or early symptoms of respiratory insufficiency caused by organs or tissue lesions that affect breathing. The condition is further aggravated by respiratory distress or difficulty breathing, and even respiratory failure and life-threatening. Because of the anatomical and physiological characteristics of the respiratory system, infants are more prone to shortness of breath and respiratory distress once the disease affects breathing.

Acute Respiratory Distress Syndrome: Acute Respiratory Distress Syndrome (ARDS) is a type of acute respiratory failure that causes fluid exchange dysfunction in the lungs due to various causes (except left heart failure), resulting in increased lung water content, lungs Reduced compliance, alveolar collapse, ventilatory, imbalanced blood flow, with severe hypoxemia and extremely difficult breathing distress as typical symptoms.

Cardiogenic respiratory distress: refers to cardiogenic dyspnea caused by factors such as increased hydrostatic pressure, common in cardiac edema caused by left ventricular dysfunction, and thus caused by respiratory failure. Cardiac dyspnea is mainly caused by left heart and/or right heart failure. The mechanism of the two is different. The dyspnea caused by left heart failure is more serious. Breathing increases, difficulty, respiratory sputum often occurs immediately after birth or within a few hours, the upper and lower sternum inspiratory depression, the nose flaps. The extent of atelectasis and the severity of respiratory failure gradually worsen. In severe respiratory distress syndrome, fatigue of the diaphragm and intercostal muscles leads to CO2 retention and respiratory acidosis. Because blood can't be exchanged for oxygen through the atelectasis (such as right to left shunt in the lung), infants develop hypoxemia, leading to metabolic acidosis.

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