Distress syndrome in adults and children

Distress syndrome is also called acute respiratory distress syndrome.

This is a complex disease characterized by the development of acute respiratory failure. The latter occurs due to non-cardiogenic, that is, not related to the malfunction of the heart, lung edema.

[1], [2], [3], [4]

Causes of the distress syndrome

The most well-known causes of the development of a distress syndrome are:

1. Transfer of severe infectious diseases (eg, sepsis or pneumonia).
2. After inhalation of toxic substances (ammonia, phosgene).
3. If liquid has entered the lungs (blood, vomit).
4. Injury of the chest (bruise, fracture of the ribs).
5. Development of thromboembolism of the pulmonary artery.
6. After a massive blood transfusion.
7. After suffering a severe burn.
8. Under the influence of radiation.
9. After a shock (anaphylactic, traumatic, septic shock).

[5], [6], [7], [8]

Pathogenesis

The impact of a wide variety of factors (toxins of microorganisms, shock transfer, chest trauma, ingestion of poison, etc.) damages the structure of the respiratory system. This leads to the development of edema in the lungs, which can no longer perform the function of gas exchange. A rather serious deficiency of oxygen in the body develops. After that, vital organs (lungs, heart, kidneys) cease to function normally.

[9], [10], [11],

Symptoms of the distress syndrome

Symptoms of a distress syndrome (acute respiratory distress syndrome) strongly depend on the stage at which the disease is located.

Unfortunately, the first signs of a distress syndrome begin to appear only in the second stage of the disease. The patient feels that it becomes very difficult for him to breathe, there is severe shortness of breath, palpitation becomes faster, the skin becomes blue. Under the influence of damaging factors, the distress syndrome develops within six to twelve hours. Sometimes patients do not immediately go to the doctor, believing that they are manifestations of some other disease. If you notice these symptoms, you should immediately check with a professional.

[12], [13], [14], [15], [16], [17]

Stages

To date, there are four:

1. The stage of damage - occurs within six hours after the body has been exposed to a damaging factor. Unfortunately, there are no symptoms of the disease development in this period, therefore it is rather difficult to diagnose the distress syndrome at the first stage.
2. Initial changes - the stage develops up to 12 hours after damage to the body. Now you can see the first signs of the disease:
   • dyspnea;
   • breathing becomes more frequent and becomes more superficial;
   • cardiac contractions also become frequent;
   • Skin, in particular the lips and the tip of the nose, turn blue;
   • Sometimes there is a cough with foam and a small amount of blood.
3. Respiratory failure and the first clinical manifestations of the disease - the symptoms intensify within 24 hours after getting the damage. There is a marked symptom of respiratory failure:
   • dyspnea manifests itself more sharply;
   • the patient feels that he does not have enough air;
   • breathing becomes more intense;
   • man breathes very loudly;
   • In the process of breathing, auxiliary muscles are included;
   • during the cough appears pinkish foam;
   • the whole body turns blue;
   • cardiac contractions increase dramatically;
   • blood pressure is decreased.
4. Stage terminal - in the body there is a marked decrease in the amount of oxygen. Many bodies start to work incorrectly or refuse:
   • dyspnea becomes more frequent;
   • the body turns blue;
   • blood pressure continues to decline;
   • Skin covers are painted in a yellowish hue;
   • Urine is not excreted or becomes very small;
   • cough with pink foam;
   • loss of consciousness (up to a coma).

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Forms

Acute distress syndrome also affects the lungs due to a primary impairment of microcirculation in the pulmonary vessels. There is a defeat of the alveoli (especially their walls), which increases the alveolar-capillary permeability. Usually acute distress syndrome develops in those patients who have recently suffered severe traumatic shock due to severe blood loss. In the lungs, gas exchange is disrupted and acute respiratory failure occurs.

Today there is no unambiguous idea of how exactly acute distress syndrome develops. Sometimes it is the final stage of lung damage.

Respiratory distress syndrome, in the opinion of most domestic scientists, manifests itself not after traumatic lung disability (as acute form), but because of various infectious diseases, exposure to toxic substances, after shock conditions. Sometimes a respiratory distress syndrome occurs after any liquid enters the lungs.

The influence of the above causative factors leads to the accumulation of uniform elements of blood in large quantities in the capillaries (which are located in the lungs and lung tissue). A lot of biologically active substances are released, which leads to the manifestation of a pathological reaction of the organism.

Respiratory distress syndrome of newborns is a serious disease, which is usually manifested in premature infants. Usually it appears immediately after birth. Gradually there is a weighting of the symptoms of the disease. As a rule, after two or four days the child either recovers completely or dies.

The distress syndrome in premature infants is due to the fact that preterm infants have poorly developed surfactant system in the lungs (this is a special lubricant, due to which the alveoli do not "subside"). This leads to the fact that with exhalation the alveoli collapse and the child needs to make an effort to inflate them again. Such actions are quite difficult for a newborn, so gradually the baby's strength is depleted, and respiratory failure develops.

Postprandial distress syndrome is one of the clinical variants of functional dyspepsia. The first is the syndrome of epigastric pain. Previously, postprandial distress syndrome was called dyskinetic. It differs in that, several times a week after eating, the patient feels too much overcrowding in the epigastric region. Despite the fact that the amount of food remains the same, there is an early saturation. Usually, this pathology is often accompanied by nausea or vomiting.

Distress syndrome in children is usually caused by a violation of microcirculation in the capillaries of the lungs, tissue necrosis, hypoxia. Sometimes it develops after severe chest injuries, after losing blood in large quantities, with hypovolemia and sepsis, after poisoning. If the distress syndrome is the cause of the shock, then its first signs will manifest only on the second day after removal of the patient from this condition.

Hypertension develops in the pulmonary vessels. The liquid part of the blood gradually swells into the interstitial (interstitial) tissue, through which it penetrates into the alveoli. This leads to the fact that the lungs cease to expand sufficiently strongly, the amount of surfactant released decreases, which leads to a violation of the rheological properties of the bronchial secretion and metabolic features of the lungs. As a result, the blood shunting increases, the ventilation-perfusion ratio is violated, the progress of micro-teleclactasia of the tissue in the lungs begins. At the last stages of the syndrome distress, the hyaline begins to penetrate the inside of the alveoli, which forms the so-called hyaline membranes. This violates the diffusion of the gas that passes through the alveolocapillary membrane.

[21], [22], [23]

Complications and consequences

Distress syndrome is considered an urgent condition, therefore, when the first symptoms appear, you should immediately consult a doctor. Often this disease leads to improper operation of many internal organs (liver, heart, kidneys), the death of lung tissue, and in some cases leads to death.

The most common complications of a distress syndrome are:

1. Difficulty in breathing, development of shortness of breath, worsening of the heart, lowering of blood pressure.
2. Distress syndrome can become a risk factor for the development of infection in the lungs including the pneumonia.
3. This disease is quite serious and in many cases can lead to the patient's death.

[24], [25], [26],

Diagnostics of the distress syndrome

Diagnosis of the distress syndrome includes the following examinations:

1. Carry out an analysis of complaints that have been received from the patient (usually shortness of breath, the feeling that a person lacks air, cough with pink or bloody foam, increased heart rate).
2. Carrying out an anamnesis of the disease: the doctor asks the patient when the symptoms started, how they started and developed, what factors could cause the disease (trauma, inhalation of poisons, pneumonia).
3. Next, the specialist conducts a general examination of the patient: if blue skin, how noisy breathing, whether blood pressure falls, whether there is an arrhythmia, whether a yellow tinge appears on the skin.
4. With the help of a phonendoscope, the lungs are heard. This is done in order to hear possible noises, rattles. In the latter stages, a "mute lung" can manifest, when breathing can not be heard at all.
5. Conducting a biochemical blood test.
6. The doctor performs a chest x-ray: this will help to see all those changes that are characteristic of the distress syndrome.
7. Blood test for gases.

[27], [28], [29]

Analyzes

Analgesies for distress syndrome include:

1. Biochemical blood test: if the kidneys and liver work is disrupted, with this examination one can see an increase in the amount of bilirubin and transaminase (these are substances that indicate the proper functioning of the liver cells), uric acid and creatinine (those substances that indicate the proper functioning of the kidneys ).
2. Also a blood test for its gas composition is carried out. If there is a noticeable sharp decrease in the amount of oxygen in the blood, and carbon dioxide increases, this indicates the development of a distress syndrome.

[30], [31], [32], [33], [34], [35], [36], [37]

Instrumental diagnostics

Instrumental diagnosis of the distress syndrome includes:

1. Computer tomography of the lungs - this method is based on sequential lung irradiation. Thanks to him you can see a full picture of the internal organ and understand what kind of treatment should be appointed in this case.
2. X-ray examination of the lungs is a non-invasive diagnosis, helps to obtain images of the lung and respiratory system.
3. Pulse oximetry is a non-invasive method that helps determine the level of oxygen in the blood. The method is based on the spectrophotometric method of determining hemoglobin, which is in the blood.

Differential diagnosis

As a rule, differential diagnosis of distress syndrome is conducted with:

• DIC-syndrome,
• pneumonia,
• pulmonary edema of cardiogenic origin.

Treatment of the distress syndrome

Treatment of distress syndrome is carried out using various methods:

1. First, it is necessary to eliminate the factor (s) that caused the disease (stop contact with poisonous substances).
2. The patient is treated in the intensive care unit in the intensive care unit.
3. Oxygen therapy - this method is based on the saturation of the body with sufficient oxygen. Give oxygen through special masks and apparatus.
4. The appointment of antibiotics - they will help prevent the development of pneumonia or cure it if it has already developed.
5. The appointment of glucocorticosteroid hormones - they will help to remove the shock and swelling of tissues in the lungs.
6. The purpose of diuretics is to remove swelling.
7. Use of anticoagulants - substances that interfere with blood coagulability.
8. Sometimes, if necessary, prescribe painkillers.
9. Appointment of funds that help improve the functioning of the kidneys, heart, liver.
10. If the patient suffers severe respiratory failure, ventilation is carried out.

Medications

Azithromycin. A broad-spectrum antibiotic that is used to treat pneumonia. Sometimes it is prescribed for a distress syndrome to prevent or treat pneumonia and improve the general condition of the patient.

It is active in such bacteria: Streptococcus spp. , Staphylococcus aureus, Haemophilus influenzae, Haemophilus ducreyi, Haemophilus parainfluenzae, Moraxella catarrhalis, Bordetella pertussis, Escherichia coli, Borrelia burgdorferi, Bordetella parapertussis, Campylobacter spp. , Neisseria gonorrhoeae, Bacteroides fragilis, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia trachomatis, Treponema pallidum, Toxoplasma gondii, Mycoplasma hominis. Dosage is established in accordance with the individual characteristics of the disease. Usually the duration of therapy is from three to five days.

Among the side effects of the drug are: vomiting, nausea, diarrhea, abdominal pain, allergic rash, headache, dizziness, chest pain, candidiasis, arthralgia.

The main active ingredient is azithromycin. The drug can not be used for individual intolerance to this substance.

Do not administer to patients with impaired liver function.

Prednisolone. Glucocorticosteroid hormone, whose active ingredient is prednisolone. Usually available in the form of tablets, solutions, drops. It is a synthetic glucocorticosteroid, which has a pronounced anti-inflammatory effect. Thanks to this, the drug perfectly copes with inhibition of inflammation in the lungs. Dosage of the drug is prescribed individually, but the usual recommended dose is 1 tablet once a day. The dose gradually decreases after reaching a positive result. An overdose of prednisolone, if taken in large quantities.

Among the side effects can be identified: a possible fluid retention in the body, high blood pressure, muscle weakness, osteoporosis, the possibility of developing a steroid ulcer, atrophy of the skin, allergies, acne, glaucoma, symptoms that mimic schizophrenia.

Contraindicated in fungal infections and individual intolerance of the drug components.

Furosemide. A diuretic drug that is prescribed for a distress syndrome to relieve swelling of the lungs and remove fluid from the body. The main component is furosemide. The drug leads to a rapid and short-term diuretic effect. Tablets are taken on an empty stomach with plenty of water. Usually prescribed small doses of the drug. The maximum dose is 1500 mg per day. The duration of therapy is determined by the doctor. When an overdose is possible, high blood pressure, shock, collapse, acute renal failure, apathy, flaccid paralysis.

The main side effects of the drug are: tachycardia, muscle cramps, headache, dizziness, paresthesia, weakness, fatigue, anorexia, diarrhea, vomiting, nausea, visual impairment, urine may sometimes be severely retarded.

It can not be used in acute kidney failure, hepatic coma, aortic or mitral stenosis, digitalis intoxication, during pregnancy and lactation, children under three years old.

H Kanefron. This is a known phytopreparation that helps improve the functioning and functioning of the kidneys. The main components are herbal substances: a herb of gold-thousandths, a root of medicinal love, leaves of rosemary. Dosage is assigned individually.

Among the side effects, only possible allergic reactions are isolated. Do not use in alcoholism, children under six years of age, with individual intolerance to the components of the drug.

Prevention

Prevention of distress syndrome manifests itself in the following:

1. It is very important to treat infectious inflammatory processes in the lungs (pneumonia) in a timely manner.
2. Try to avoid the factors that can lead to the development of the disease: do not inhale poisonous substances, try to stay away from radiation, avoid injuries of the chest.
3. When blood transfusion requires careful medical monitoring of the process.

[38], [39], [40], [41], [42], [43], [44], [45],

Forecast

With timely diagnosis of the disease, distress syndrome can be cured even in newborns. Incorrect or untimely treatment can lead to death.

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