Respiratory Insufficiency

Respiratory distress

Respiratory insufficiency is a cause of breathing difficulty (dyspnea), which can be extremely frightening for patients. For this reason, when administering out-of-hospital ventilation, every detail must be just right, so as to provide fast and safe assistance – and to calm the fears of the person affected. 

For the emergency medical services, ventilation is one of the most demanding, but also most important tasks. WEINMANN takes up this challenge and offers on-the-spot support with intuitive ventilators. 

What is respiratory insufficiency?

Respiratory insufficiency is a medical condition that impairs the lungs' ability to effectively take in oxygen or release carbon dioxide from the blood. This condition is caused when there is a disturbance of pulmonary gas exchange, pulmonary blood flow or ventilation. Pulmonary and ventilatory insufficiency can also occur in combination.

How exactly does respiratory insufficiency manifest itself?

Respiratory insufficiency usually manifests through serious difficulty in breathing. In light-skinned people, this can lead to a bluish discoloration of the skin, known as cyanosis. In dark-skinned people, this symptom manifests through a gray or whitish tinge in the mouth, around the eyes and under the nails. In addition, signs such as drowsiness and confusion can be an indicator of respiratory failure.

What are the causes of respiratory insufficiency?

Respiratory insufficiency has many different causes, but it is generally brought about by an existing serious pulmonary disorder that rapidly worsens. These illnesses include COPD, pneumonia and asthma, for example. However, neuromuscular diseases, heart disease or disorders of the hematopoietic (blood-forming) system are also possible triggers.

Essentially, the cause of respiratory insufficiency can be attributed to the following two types:

  • Hypoxemic respiratory insufficiency: The oxygen content in the blood is too low.
  • Hypercapnic respiratory insufficiency: The carbon dioxide content in the blood is too high.

Hypoxemic and hypercapnic respiratory insufficiency may also occur simultaneously.

Hypoxemic respiratory insufficiency

Hypoxemic respiratory insufficiency is characterized by the oxygen content in the arterial blood being too low. It is present when the partial pressure of oxygen is below 60 mmHg, with a simultaneously normal or reduced partial pressure of carbon dioxide. Respiratory partial insufficiency is an older name for this type of insufficiency.

The most frequent cause of hypoxemic respiratory insufficiency is a disturbance of gas exchange in the lungs, which is why it is also referred to as pulmonary insufficiency. Possible triggers include anomalies or scar formation in the lung tissue, as well as a pulmonary embolism.

A comprehensive medical examination and possibly blood gas analysis are required for making a precise diagnosis.

Hypercapnic respiratory insufficiency

Hypercapnic respiratory insufficiency is characterized by an elevated carbon dioxide content in the arterial blood, with a partial pressure of carbon dioxide above 45 mmHg. In the past, this form was also called global respiratory insufficiency.

It is characterized by a decrease in ventilation of the alveoli (air sacs of the lungs) which leads to an increase in the carbon dioxide level (paCO₂)1 .The cause of this insufficiency is normally disturbed respiratory mechanics, where insufficient oxygen is inhaled and insufficient carbon dioxide is exhaled. Therefore, this is a case of ventilatory insufficiency.

A consequence of hypercapnic respiratory insufficiency is respiratory acidosis2, in which the pH value of the blood falls below 7.36. This is usually treated with artificial ventilation.

What types of respiratory insufficiency are there?

Respiratory insufficiency can be divided into two different types, depending on the progression of the disorder:

Chronic respiratory insufficiency

Chronic respiratory insufficiency occurs with persistent breathing problems. It is caused by a long-standing lung disease, such as chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis. Chronic respiratory insufficiency should be carefully monitored.

Acute respiratory insufficiency

Acute respiratory insufficiency describes serious, acute lung damage, which progresses rapidly. It requires immediate medical attention and treatment in an intensive care unit. There can be many different causes of acute respiratory insufficiency, including acute respiratory infections such as pneumonia, inhalation of foreign bodies, or water and severe allergic reactions (anaphylaxis).

(Emergency) treatment for respiratory insufficiency

The treatment of respiratory insufficiency is primarily dictated by the causes and any existing illnesses. The following points are assessed when it comes to correcting respiratory insufficiency:

  • Diagnosis of underlying disorders,
  • Differentiation between pulmonary and ventilatory insufficiency,
  • Assessment of whether short-term or long-term ventilation is required,
  • Assessment of whether invasive or non-invasive ventilation is required.

Depending on the results, various treatment options are available:

Oxygen therapy

Oxygen therapy is a non-invasive ventilation method, whereby patients are given additional oxygen to rectify an oxygen deficiency. 
This is done using an oxygen mask or nasal cannula.

Non-invasive ventilation

Non-invasive ventilation (NIV) is administered via a ventilator to assist breathing if the patient is conscious. Oxygen is supplied via a face mask with positive pressure. If invasive ventilation is not absolutely necessary, non-invasive ventilation is preferred.

Invasive ventilation with MEDUVENT Standard

Invasive ventilation

Invasive ventilation is initiated if non-invasive ventilation is not effective enough, or if the patient is unconscious. A tracheal tube is usually inserted into the windpipe (trachea) in order to deliver oxygen directly to the lungs (intubation).

WEINMANN ventilators for breathing difficulty

Respiratory insufficiency represents one of the greatest challenges in emergency medical treatment. WEINMANN ventilators provide crucial support with their versatility and adaptability.

MEDUMAT Standard² makes an important contribution to improving patient outcome in cases of respiratory insufficiency. In particular, this is achieved by integrating CPAP therapy. The clear and easy-to-follow display presents all important respiratory parameters and shows ventilation graphs comprehensively and intuitively. For this reason, it is an indispensable instrument in emergency medicine.

Especially in emergency situations where no external gas or power supply is available, MEDUVENT Standard is essential for treating respiratory insufficiency. It can autonomously ventilate patients for up to ten hours. Furthermore, ventilation can be initiated quickly and in a controlled manner, without having to set several parameters. This can save lives in critical moments when every second counts.