Vittorio Cecchi Gori is hospitalized in intensive care at the Gemelli Polyclinic in Rome due to respiratory failure. What is that? What is it due to? It is “a pathological condition caused by the inability of the respiratory system to guarantee adequate exchanges of oxygen between the environment and the blood”, with consequent “inability to obtain adequate blood values of oxygen and carbon dioxide”.
Respiratory failure, what it is and causes
Respiratory failure “can be acute, when its onset is rapid and sudden, or chronic, when it occurs progressively to stabilize or evolve over time”. There are different causes at the origin, explains Laura Mancino, pulmonologist at the Angelo hospital in Mestre (Venice), in an in-depth analysis on the 'Let's take breath' portal, dedicated to breathing diseases.
“The most frequent causes of acute respiratory failure are acute pulmonary edema, massive pulmonary embolism, tension pneumothorax, asthmatic crisis, pneumonia causing acute respiratory distress syndrome such as Covid-19 related pneumonia”, i.e. associated with Sars-CoV-2 infection. Precisely due to pulmonary complications from Covid, Cecchi Gori had already been hospitalized at the beginning of 2022. The cause of acute respiratory failure can then be “traumas, intoxications from drugs or toxins”, lists the specialist. “The most common causes of chronic respiratory failure are” instead “chronic lung diseases such as chronic obstructive pulmonary disease (COPD) or interstitial lung diseases (pulmonary fibrosis), neurological diseases such as amyotrophic lateral sclerosis (ALS), obesity syndrome -hypoventilation (or Pickwick syndrome), cystic fibrosis, pulmonary hypertension, congenital or chronic worsening heart diseases”.
Symptoms
What are the symptoms? “Common manifestations of respiratory insufficiency are dyspnea, or shortness of breath – describes the pulmonologist – the reduction in oxygen saturation”, which is why Cecchi Gori arrived at Gemelli before having a respiratory crisis that left him led to hospitalization, or even “the use of the accessory muscles of ventilation, but also drowsiness to the point of coma”.
“Respiratory insufficiency can therefore” determine alterations in the values of oxygen in the blood, but also of carbon dioxide. In the sense of a decrease or, what is much more serious, an increase. This distinction – specifies Mancino – is necessary to keep in mind” when it comes to deciding on treatment.
“When the partial pressure of oxygen in the blood falls below 55 mmHg – explains the expert – then it is necessary to treat respiratory failure”. We begin with the administration of oxygen through simple nasal cannulas, if the oxygen requirement is low, then moving on to special masks, up to high flow oxygen therapy through nasocannulae if the oxygen requirement is very high. “These measures are useful in correcting respiratory failure defined as hypoxemic and normocapnic, i.e. with normal carbon dioxide values”.
However, “some pathologies (the most common is COPD) are characterized not only by low oxygen values but also by high carbon dioxide values” or hypercarbia. The accumulation of carbon dioxide in the blood “initially manifests itself with hyper-reactivity and agitation, and then leads to a reduction in the state of consciousness (the patient appears drowsy), up to coma”. In this case the administration of oxygen is not enough, the pulmonologist points out, in fact it must be controlled because “the excess would lead to a further increase in carbon dioxide. It will therefore be necessary to reduce the carbon dioxide values using non-invasive ventilation devices (patient in sub-intensive or home therapy) and in the most serious cases invasive (patient intubated in intensive care or tracheotomised)”.
Read also
