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Respiratory failure

As often happens in any field of human knowledge, including medicine, further progress is based on at least two determining circumstances. First, the accumulation of factual material allows us to establish new patterns and find out the essence of the observed phenomenon. Secondly, the improvement of technology, and sometimes the introduction of new methods create the conditions for the practical use of the theoretical data. This provision explains the indisputable success of resuscitation, which has been achieved in recent years. An important role in this was played by the understanding of the fact that in emergency circumstances of a disease a doctor is obliged not only to help the patient, but also often take control of the main vital functions of the body. These include undoubtedly the function of external respiration.

Many works are devoted to respiratory failure and its treatment in the domestic literature. Nevertheless, we believe that the monograph offered to the reader’s attention, written jointly by an anesthesiologist, a therapist and an intensive care specialist, will be useful in solving the practical issues of treating patients with respiratory failure.

Relying on modern concepts of the pathogenesis of respiratory failure, the authors in an intelligible (but not primitive) form provided all the necessary information on the diagnosis, assessment of severity and treatment of this rather frequent and terrible complication of a wide variety of pathological conditions.

The essential advantages of the monograph include the close and justified attention to detail and the so-called trifles, which sometimes play a crucial role in the success of treatment. No less important is the sober assessment of existing treatments, such as oxygen therapy, its capabilities, limitations to its use and the dangers that can be avoided with the help of a competent and qualified use of the method.

Focusing on the basic principles of treatment of respiratory failure (maintaining the airway, moistening the inhaled gas, removing the secret, oxygen therapy, fighting infection, artificial lung ventilation), the authors formulate indications for the use of a particular method or their combination depending on the severity and etiology , pathogenesis, duration and prognosis of respiratory failure. This allowed them to distinguish four stages, or “steps,” of treatment with a gradual increase in its intensity and complexity.


Since the authors have considered almost all pathological conditions in which the occurrence of respiratory failure is possible, the monograph will be useful not only for anesthesiologists and resuscitators, but also for doctors of many other specialties.

It should be noted that during the translation we avoided any abbreviations, considering, for example, that even a description of the principle of operation of the most common foreign respirators would be beneficial.

All critical comments will be accepted by us with gratitude.

Table of contents
Part I. Diagnosis of respiratory failure
Chapter 1. Physiological background
Chapter 2. Evaluation of lung function by the voltage of carbon dioxide and oxygen in the respiratory gases and blood
Chapter 3. Causes of respiratory failure
Chapter 4. Signs of respiratory failure
Chapter 5. Diagnosis and clinical evaluation of respiratory failure

Part II. General principles of treatment of respiratory failure
Chapter 6. Removal of secretions from the respiratory tract
Chapter 7. Fight against infection
Chapter 8. Oxygenotherapy
Chapter 9. Endotracheal Intubation and Tracheostomy
Chapter 10. Apparatus artificial ventilation of the lungs

Part III. Treatment of individual diseases
Chapter 11. Respiratory failure in patients with healthy lungs (neurological diseases and poisoning)


This chapter outlines the treatment of respiratory failure in patients with healthy lungs, but with impaired respiratory regulation or neuromuscular dysfunction. In such patients, the problem of treating the underlying disease may be more complicated than the treatment of respiratory failure.

Neurological diseases

Chapter 12. Respiratory failure with injuries of the chest
Chapter 13. Postoperative respiratory failure
Chapter 14. Respiratory failure in pulmonary diseases
Chapter 15. Respiratory failure in newborns and children
Chapter 16. Drugs used in the treatment of respiratory failure
Chapter 17. Emergency resuscitation
Chapter 18. Sterilization Equipment
Chapter 19. Blood Gas Examination

Most often, therapists, neuropathologists, surgeons and anesthesiologists encounter respiratory failure. Therapists are found with respiratory failure in acute and chronic lung diseases, in case of poisoning with drugs that cause respiratory depression, neurologists - in paralysis, accompanying lesions of the central or peripheral nervous system. In surgical practice, respiratory failure often occurs in the early postoperative period. Finally, anesthesiologists deal mainly with acute respiratory failure, which is the result of exposure to a number of drugs or impaired airway patency.

Since the nature of respiratory failure depends on the reason why it arose, each specialist is looking for his own ways to solve the problem. For example, the majority of patients in therapeutic departments suffer from chronic diseases, and marked changes in their condition usually occur over a long time. On the other hand, during anesthesia, major changes often occur within a few minutes or seconds. In addition, the anesthesiologist constantly uses respiratory and electronic equipment, with which therapists are still not very familiar. The difference in positions is often accentuated by the lack of constant consultations of other specialists throughout the entire period of treatment. Therefore, the anesthesiologist is often called in to the patient only when the therapist comes to a conclusion about the urgent indications for using mechanical ventilation, which naturally causes a feeling of prejudice. Conflict can be resolved only by frequent joint consultations at all stages of the disease and careful examination of patients. In this monograph, an attempt was made to reconcile the different points of view and present a rational basis for the treatment of respiratory failure.

There are many definitions of respiratory failure. In this monograph, it is considered as the inability to ensure the normal homeostasis of blood gases. To understand the nature of respiratory failure, it is necessary to establish the links of the respiratory process in which there was a deviation from the norm. Therefore, first of all, the corresponding sections characterizing the normal physiology of respiration are presented. Special attention is paid to pathological changes caused by the disease, the vicious circle leading to respiratory failure and various forms of treatment.

Our goal was to create practical and concrete guidance that would allow general practitioners, surgeons and anesthesiologists to logically and effectively carry out treatment of respiratory failure in any situation that arose.

Although the term “respiratory failure” has been used for many years, it acquired a specific meaning only in the last 20–30 years, which was the result of a better understanding of the physiology of respiration.

Under normal conditions, the respiratory system provides effective gas exchange between the blood and the surrounding air, maintaining the tension of blood gases within certain limits. In the early stages of the disease, some aspects of lung function may be impaired without any change in the voltage of the blood gases.

As the disease progresses, the functional reserves of the lungs decrease, reaching the degree at which an increase in carbon dioxide tension in arterial blood (pCO 2 ) or a drop in oxygen tension (pO 2 ), or both of these shifts occurs simultaneously. This stage is characterized as respiratory failure.

Normal fluctuations in the voltage of blood gases for pCO 2 36-44 mm Hg. Art., for pO 2 80-100 mm Hg. st. However, it is more correct to speak about the presence of respiratory failure with pCO 2 above 50 mm Hg. st. or when pO 2 below 60 mm Hg. st. provided that the patient breathes air at rest at normal barometric pressure.

Unfortunately, the clinical recognition of mild respiratory failure is difficult. It is equally difficult to assess the effectiveness of treatment on the basis of clinical signs alone. Therefore, it is very important to be able to investigate the voltage of carbon dioxide, determine the oxygenation of arterial blood and establish the acid-base state.

Currently there is such an opportunity. The introduction into clinical practice and the wider dissemination of the mentioned research methods led not only to improving the results of treatment, but also to a better understanding of the mechanisms of respiratory failure. The aim of the authors was to present the basics of the physiology of respiration in combination with simple and more complex methods of diagnosis and treatment.

In conclusion, it should be noted that dyspnea and respiratory failure are not the same thing. Many patients with shortness of breath do not suffer from respiratory failure; many patients with respiratory failure do not have shortness of breath.