The interruption of the pulmonary gas exchange for> 5 min leads to irreversible damage to major organ systems, especially the brain. Cardiac arrest is almost always the result of not quickly restored respiratory function. However, an aggressive ventilation can have negative hemodynamic consequences, particularly in the acute setting and in other circumstances when the cardiac output is low. In most cases, the ultimate goal is an adequate ventilation and oxygenation without the preliminary cardiovascular situation further restrict recover.
Respiratory and cardiac arrest are different state images, but inevitably pass if untreated each other (see respiratory insufficiency in respiratory failure and mechanical ventilation, dyspnea in dyspnea and hypoxia in drop of the oxygen saturation.) The interruption of the pulmonary gas exchange for> 5 min resulting in a irreversible damage to major organ systems, especially the brain. Cardiac arrest is almost always the result of not quickly restored respiratory function. However, an aggressive ventilation can have negative hemodynamic consequences, particularly in the acute setting and in other circumstances when the cardiac output is low. In most cases, the ultimate goal is an adequate ventilation and oxygenation without the preliminary cardiovascular situation further restrict recover. Etiology respiratory arrest (and impaired respiration, which may progress to respiratory failure) can be caused by airway obstruction, decreased respiratory drive respiratory muscle weakness airway obstruction can Obstruction affect the upper respiratory tract lower respiratory tract infants before 3 months of age are seen physiologically nose breathers. Thus, it comes here to an obstruction of the upper airways as a result of a nose laying. At any age, however, muscular loss of tone may lead to obstruction of the upper airways due to displacement of the back of the tongue portions in the oropharynx in common with increasing consciousness. Other causes for a closure of the upper respiratory tract bleeding, mucus accumulation, vomit or foreign objects come into consideration. In addition, spasticity or edematous changes of the vocal cords, inflammation of the pharynx or larynx in the area (eg. As epiglottitis or Krupp), also tumor events or traumatic changes may be the cause. Patients with congenital developmental disorders often show abnormal anatomical conditions of the upper respiratory tract. In these patients, it can therefore more easily lead to obstructions these structures. A relocation of the lower respiratory tract can be (z. B. pneumonia, pulmonary edema, hemorrhage in the lungs) due to aspiration, bronchospasm or other airway occlusion disorders or drowning einstellen.Verminderter respiratory drive Decreased respiratory drive reflects an impairment of the central nervous system by one of the following points resist: CNS disorder adverse effect metabolic disorder CNS disorders, the brain stem (eg, stroke, infection, tumor.) concern, can cause hypoventilation. Medical conditions that increase intracranial pressure, initially usually lead to hyperventilation, but it can also develop hypoventilation when the brain stem is compressed. Drugs that reduce the respiratory drive, opioids and sedatives or hypnotics (z. B. barbiturates, alcohol, benzodiazepines rare). Usually, an overdose (iatrogenic, intentionally or unintentionally) involved, although a lower dose may reduce the drive in patients more sensitive to the effects of these drugs (eg. As the elderly, patients in poor physical condition, patients with chronic respiratory Insufficiency). CNS depression due to severe hypoglycemia or hypotension ultimately affect the Atemantrieb.Respiratorische muscle weakness The weakness may be caused by: neuromuscular diseases fatigue Among the neuromuscular causes include spinal cord injury, neuromuscular disorders (eg, myasthenia gravis, botulism, poliomyelitis, Guillain. -Barre syndrome) and neuromuscular blocking agents. Fatigue of the respiratory muscles can occur when the patient breathing over a long period with a respiratory minute volume, which reaches a maximum of about 70% of its maximum voluntary ventilation (z. B. because of severe metabolic acidosis or hypoxia). With the onset symptoms and complaints of the respiratory standstill or immediately thereafter, the patient is unconscious. Patients with hypoxemia may be cyanotic, but the cyanosis may mask the anemia or carbon monoxide or Zyanidintoxikation. Patients being treated with high-flow O2, may not hypoxaemic and therefore show no cyanosis or saturation until breathing stops for a few minutes. Conversely, patients with chronic lung disease and polycythemia cyanosis without showing respiratory arrest. If the apnea is left uncorrected, the cardiac arrest follows within minutes after the start of hypoxia and / or hypercapnia. Threatening respiratory arrest prior to complete formation of respiratory arrest can suddenly seem restless and confused and struggling for air the patients with normal neurological situation. There is tachycardia and pronounced sweating. Intercostal and sternoklavikuläre recoveries may be visible. Patients with CNS disorders or weakening of the respiratory muscles appear exhausted and show a wheezing or irregular breathing with paradoxical breathing movements. For foreign body airway obstruction, the patient may choke while point to his neck region showing inspiratory stridor or not. The monitoring of end-tidal CO2 can alert the practitioner of an impending respiratory failure in decompensated patients. Infants, especially at the age of less than 3 months of life can form an acute apnea without any sign. This situation is usually found as a result of severe infection, metabolic disorders or exhaustion of respiratory muscles. Asthmatics or patients with other chronic lung diseases show up after long periods of shortness of breath hypercapnic and exhausted and suddenly behaved without warning and apnoeisch, even with adequate oxygen saturation. Diagnosis Clinical evaluation An apnea is clinically recognizable always by clear signs. The treatment has always to start immediately with the establishment of the diagnosis. The first consideration is always a foreign body obstructs the airways excluded. If a foreign body is present, you will be able to find a breathing resistance combined with mouth-to-mouth resuscitation or ventilation with the ventilation bag on the mask. The foreign body material can then possibly under direct laryngoscopy for endotracheal intubation remove (for removal of foreign bodies Restoring and Backing up the airways: clearing and opening the upper respiratory tract). Treatment The treatment consists in clearing the respiratory tract or in the manufacture of an alternative airway and mechanical ventilation (mechanical ventilation at a Glance).