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 as a result of non-cardiogenic, that is, not associated with abnormal heart function, pulmonary edema.

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Causes distress syndrome

The most well-known causes of distress syndrome are:

1. Having suffered from severe infectious diseases (such as sepsis or pneumonia).
2. After inhalation of toxic substances (ammonia, phosgene).
3. If liquid (blood, vomit) gets into the lungs.
4. Chest trauma (bruise, rib fracture).
5. Development of pulmonary embolism.
6. After a massive blood transfusion.
7. After suffering a severe burn.
8. Under the influence of radiation.
9. After suffering shock (anaphylactic, traumatic, septic).

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Pathogenesis

The impact of a wide variety of factors (microorganism toxins, shock, chest trauma, poison ingestion, 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 oxygen deficiency develops in the body. After which the vital organs (lungs, heart, kidneys) stop working normally.

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Symptoms distress syndrome

The symptoms of distress syndrome (acute respiratory distress syndrome) vary greatly depending on what stage the disease is at.

Unfortunately, the first signs of distress syndrome begin to appear only at the second stage of the disease. The patient feels that it is becoming very difficult for him to breathe, severe shortness of breath appears, the heartbeat quickens, the skin turns blue. Under the influence of damaging factors, distress syndrome develops within six to twelve hours. Sometimes patients do not immediately consult a doctor, believing that these are manifestations of some other disease. If you notice such signs, you should immediately undergo an examination by a professional.

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Stages

Today, there are four of them:

1. Damage stage – occurs within six hours after the body has been exposed to a damaging factor. Unfortunately, there are no symptoms of the disease development during this period, so it is quite difficult to diagnose distress syndrome at the first stage.
2. Initial changes – the stage develops up to 12 hours after the body is damaged. Now you can notice the first signs of the disease:
   • dyspnea;
   • breathing becomes more rapid and shallow;
   • heartbeats also become more frequent;
   • the skin, in particular the lips and tip of the nose, turns blue;
   • Sometimes a cough with foam and a small amount of blood appears.
3. Respiratory failure and the first clinical manifestations of the disease - symptoms intensify within 24 hours after the injury. Pronounced symptoms of respiratory failure appear:
   • shortness of breath becomes more pronounced;
   • the patient feels that he does not have enough air;
   • breathing becomes even more rapid;
   • the person is breathing very loudly;
   • auxiliary muscles are included in the breathing process;
   • pinkish foam appears during coughing;
   • the whole body turns blue;
   • heart rate increases sharply;
   • blood pressure is reduced.
4. Terminal stage – the body experiences a marked decrease in the amount of oxygen. Many organs begin to function incorrectly or fail:
   • shortness of breath becomes more frequent;
   • the body turns blue;
   • blood pressure continues to decrease;
   • the skin takes on a yellowish tint;
   • urine is not excreted or there is very little of it;
   • cough with pink foam;
   • loss of consciousness (even to the point of coma).

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Forms

Acute distress syndrome also affects the lungs due to primary disruption of microcirculation in the pulmonary vessels. The alveoli are damaged (especially their walls), which increases alveolar-capillary permeability. Acute distress syndrome usually develops in patients who have recently suffered severe traumatic shock due to severe blood loss. Gas exchange in the lungs is disrupted and acute respiratory failure occurs.

Today, there is no clear understanding of how exactly acute distress syndrome develops. Sometimes it is the final stage of lung damage.

Respiratory distress syndrome, according to the majority of domestic scientists, appears not after a traumatic lung injury (as an acute form), but due to various infectious diseases, exposure to toxic substances, after shock conditions. Sometimes respiratory distress syndrome appears after any liquid gets into the lungs.

The impact of the above-mentioned causal factors leads to the accumulation of large amounts of formed elements of the blood in the capillaries (which are located in the lungs and lung tissue). Many biologically active substances are released, which leads to the manifestation of a pathological reaction of the body.

Respiratory distress syndrome of the newborn is a severe disease that usually occurs in premature babies. It usually appears immediately after birth. Gradually, the symptoms of the disease become more severe. As a rule, after two to four days, the child either fully recovers or dies.

Premature distress syndrome occurs because premature babies have poorly developed surfactant systems in their lungs (this is a special lubricant that keeps the alveoli from "collapsing"). This means that when exhaling, the alveoli collapse and the baby has to make an effort to inflate them again. Such actions are quite difficult for a newborn, so the baby's strength gradually depletes and respiratory failure develops.

Postprandial distress syndrome is one of the clinical variants of functional dyspepsia. The first is considered to be epigastric pain syndrome. Previously, postprandial distress syndrome was called dyskinetic. It is characterized by the fact that several times a week after eating, the patient feels too much fullness in the epigastric zone. Despite the fact that the amount of food remains the same, early satiety occurs. Usually, this pathology is often accompanied by nausea or vomiting.

Distress syndrome in children is usually caused by impaired microcirculation in the pulmonary capillaries, tissue necrosis, and hypoxia. Sometimes it develops after serious chest injuries, after large amounts of blood loss, with hypovolemia and sepsis, after poisoning. If distress syndrome has caused shock, its first signs will appear only on the second day after the patient is brought out of this condition.

Hypertension develops in the pulmonary vessels. The liquid part of the blood gradually sweats into the interstitial tissue, through which it penetrates into the alveoli. This leads to the fact that the lungs cease to stretch sufficiently, the amount of secreted surfactant decreases, which leads to a violation of the rheological properties of bronchial secretions and metabolic characteristics of the lungs. As a result, blood shunting increases, ventilation-perfusion relationships are disrupted, and the progress of microatelectasis of tissue in the lungs begins. In the last stages of distress syndrome in children, hyaline begins to penetrate into the alveoli, which forms the so-called hyaline membranes. This disrupts the diffusion of gas that passes through the alveolocapillary membrane.

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Complications and consequences

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

The most common complications of distress syndrome are:

1. Difficulty breathing, development of shortness of breath, deterioration of heart function, decreased blood pressure.
2. Distress syndrome can become a risk factor for the development of lung infections, including pneumonia.
3. This disease is quite serious and in many cases can lead to the death of the patient.

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Diagnostics distress syndrome

Diagnosis of distress syndrome includes the following examinations:

1. Conducting an analysis of complaints received from the patient (usually shortness of breath, the feeling that the person is short of air, coughing up pink or bloody foam, increased heart rate).
2. Taking a medical history: the doctor asks the patient when the symptoms began, how they began and developed, what factors could have caused the disease (injuries, inhalation of poisons, pneumonia).
3. Next, the specialist conducts a general examination of the patient: is there a blue discoloration of the skin, how noisy is the breathing, does the blood pressure drop, is there arrhythmia, does a yellow tint appear on the skin.
4. The lungs are listened to with a phonendoscope. This is done to hear possible noises and wheezing. In the last stages, a "silent lung" may appear, when breathing cannot be heard at all.
5. Conducting a biochemical blood test.
6. The doctor performs a chest X-ray: this will help to see all the changes that are characteristic of distress syndrome.
7. Blood gas test.

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Tests

Tests for distress syndrome include:

1. Blood chemistry: If kidney and liver function is impaired, this test can show an increase in bilirubin and transaminase (these are substances that indicate the proper functioning of liver cells), uric acid and creatinine (these are substances that indicate the proper functioning of the kidneys).
2. Blood is also tested for its gas composition. If there is a noticeable sharp decrease in the amount of oxygen in the blood, while carbon dioxide increases, this indicates the development of distress syndrome.

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Instrumental diagnostics

Instrumental diagnostics of distress syndrome includes:

1. Computer tomography of the lungs - this method is based on sequential irradiation of the lungs. Thanks to it, you can see a complete picture of the internal organ and understand what kind of treatment should be prescribed in this case.
2. A chest X-ray is a non-invasive diagnostic test that helps to obtain images of the lungs 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 carried out with:

• DIC syndrome,
• pneumonia,
• pulmonary edema of cardiogenic genesis.

Treatment 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 toxic substances).
2. The patient is treated in the intensive care unit.
3. Oxygen therapy – this method is based on saturating the body with sufficient oxygen. Oxygen is supplied through special masks and devices.
4. Prescribing antibiotics will help prevent the development of pneumonia or cure it if it has already developed.
5. Prescribing glucocorticosteroid hormones will help relieve shock and tissue swelling in the lungs.
6. Prescribing diuretics to relieve swelling.
7. Use of anticoagulants – substances that prevent blood clotting.
8. Sometimes, if necessary, painkillers are prescribed.
9. Prescribing medications that help improve the functioning of the kidneys, heart, and liver.
10. If the patient suffers from severe respiratory failure, ventilation of the lungs is performed.

Medicines

Azithromycin. A broad-spectrum antibiotic used to treat pneumonia. Sometimes prescribed for distress syndrome to prevent or treat pneumonia and improve the patient's general condition.

It is active against the following 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. The dosage is determined according to the individual characteristics of the disease. Usually the duration of therapy is from three to five days.

Side effects of the drug include: vomiting, nausea, diarrhea, abdominal pain, allergic rash, headache, dizziness, chest pain, candidiasis, arthralgia.

The main active ingredient is azithromycin. The drug should not be used if you are hypersensitive to this substance.

Should not be prescribed to patients with impaired liver function.

Prednisolone. Glucocorticosteroid hormone, the active ingredient of which is prednisolone. Usually available in the form of tablets, solutions, drops. This is a synthetic glucocorticosteroid, which has a well-defined anti-inflammatory effect. Due to this, the drug copes well with the inhibition of the inflammatory process in the lungs. The dosage of the drug is prescribed individually, but the usual recommended dose is 1 tablet once a day. The dose is gradually reduced after achieving a positive result. An overdose of prednisolone is possible if taken in large quantities.

Side effects include: possible fluid retention, high blood pressure, muscle weakness, osteoporosis, the possibility of developing a steroid ulcer, skin atrophy, allergies, acne, glaucoma, symptoms that mimic schizophrenia.

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

Furosemide. A diuretic drug that is prescribed for distress syndrome to relieve pulmonary edema and remove fluid from the body. The main component is furosemide. The drug has a rapid and short-term diuretic effect. Tablets are taken on an empty stomach with plenty of water. Small doses of the drug are usually prescribed. The maximum dose is 1500 mg per day. The duration of therapy is determined by the doctor. Overdose may cause 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, and sometimes acute urinary retention.

Do not use in cases of acute renal failure, hepatic coma, aortic or mitral stenosis, digitalis intoxication, during pregnancy and breastfeeding, or in children under three years of age.

Canephron N. This is a well-known herbal preparation that helps improve the work and functioning of the kidneys. The main components are plant substances: centaury herb, lovage root, rosemary leaves. The dosage is prescribed individually.

Side effects include only possible allergic reactions. It should not be used in cases of alcoholism, children under six years of age, or individual intolerance to the components of the drug.

Prevention

Prevention of distress syndrome is manifested 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 factors that can lead to the development of the disease: do not inhale toxic substances, try to stay away from radiation, avoid chest injuries.
3. When transfusing blood, careful medical supervision of the process is necessary.

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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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