Respiratory Failure in Chronic Pulmonary Diseases, August 9, 1999

Respiratory Failure in Chronic Pulmonary Diseases, August 9, 1999

When chronic pulmonary diseases lead to acute respiratory failure, it is usually due to obstructive airway ventilation disorders. In such cases, there are typically two pathological changes:

1. Blue Swelling

The lung damage is largely confined to the airways, and patients are predominantly characterized by hypoxia and hypercapnia. At this stage, the lung tissue appears blue and swollen due to oxygen deprivation, and the optimal treatment involves high-concentration oxygen therapy and sedatives.

2. Red Swelling

The lung damage is mainly due to emphysema, with relatively little tracheal obstruction. The primary symptom is dyspnea, and respiratory obstruction is not prominent. The PCO2 partial pressure exceeds 6.4 mmHg. Since the lungs exhibit mainly blood stasis, the swelling appears pink. Treatment for respiratory failure includes: ① oxygen administration; ② antibiotics; ③ bronchodilators such as salbutamol and aminophylline; ④ respiratory center stimulants like nikethamide, administered intermittently at 1–2.5 g, possibly via intravenous drip. Nicethamide is also an option, with the same dosage regimen.