Signs and symptoms of respiratory failure (hypercapnia). Hypercapnia - symptoms, treatment, causes

HYPERCAPNIA(Greek hyper- + kapnos smoke) - overvoltage carbon dioxide in arterial blood and body tissues.

The normal tension of carbon dioxide in arterial blood in humans, denoted by the term "normocapnia", is 35-45 mm Hg. Art.

G.'s condition can be caused by exogenous and endogenous causes. G. of exogenous origin occurs when inhaling air containing increased amount carbon dioxide (see). This may be due to staying in small isolated rooms, in mines, wells, submarines, spacecraft cabins and autonomous diving and space suits in case of a malfunction of the atmosphere regeneration system, as well as during certain medical interventions, for example, in the event of a malfunction of anesthesia respiratory equipment or by inhalation of carbogen. G. can occur in conditions of cardiopulmonary bypass with insufficient removal of carbon dioxide, etc.

G. of an endogenous origin is observed at various patol, the states which are followed by insufficiency external respiration, violation of gas exchange (see), and is always combined with hypoxia (see).

Pathophysiological mechanisms and clinical manifestations

G.'s influence on an organism depends on speed, duration and extent of increase in concentration of carbon dioxide in blood and fabrics. With an increase in tension and carbon dioxide content in the body, physical and chemical shifts occur. composition internal environment, a metabolism and disturbance of many fiziol, processes. G. naturally leads to gas (respiratory) acidosis (see), which largely determines the overall pathophysiol, G.'s picture; at the same time, it has been established that the shifts in the internal environment of the body characteristic of G. cannot be wholly reduced to the consequences of acidosis. different authors, values 7.0-6.5.

When G. there is a redistribution of ionic gradients on cell membranes(eg, the Cl ion - moves into the erythrocytes, the K + ion from the cells passes into the plasma). G. is accompanied by a shift in the oxyhemoglobin dissociation curve to the right, which indicates a decrease in the affinity of hemoglobin for oxygen, leading to a decrease in oxygen saturation of arterial blood, despite the normal and even increased partial pressure of oxygen in the alveolar air.

In the initial stages of moderate G. (with the content of carbon dioxide in the inhaled air within 3-6%), the body's oxygen consumption increases, which is associated with chemical reactions. thermoregulation, aimed at compensating for the body's heat losses increased under the influence of carbon dioxide. With prolonged action of even a small increase in carbon dioxide, the body's oxygen consumption decreases. With severe G., it decreases from the very beginning of its development, which is due to neuro-endocrine regulatory mechanisms and the direct effect of an increased carbon dioxide content on metabolic processes. With G., a drop in body temperature is usually observed, which occurs mainly due to an increase in heat transfer; however, it is believed that significant G. leads to a breakdown of the entire system of thermoregulation, since carbon dioxide depresses metabolism. G.'s hypothermic effect, as a rule, is easily reversible.

The excitatory effect of carbon dioxide on the respiratory center is realized through specific receptors located in the reticular formation of the brain stem, as well as through an increase in the concentration of H+ ions, perceived by carotid and other chemoreceptor formations. With moderate G., the increased activity of the respiratory center can persist for a long time. With increasing G., the stimulating effect of carbon dioxide ceases and the initial phase of excitation of the respiratory center is replaced by its oppression, up to the complete cessation of breathing. Such a phase change can occur at different values of the partial pressure of carbon dioxide (pCO 2): from 75 to 125 mm Hg. Art. and more (corresponds to 10-25% of carbon dioxide in the inhaled air at normal atmospheric pressure). However, in most cases, G.'s inhibitory effect begins to manifest itself when pCO 2 exceeds 90-100 mm Hg. Art. The inhibitory effect of a high concentration of carbon dioxide is associated with G.'s influence and concomitant acidosis on the central nervous structures.

G. moderate degree (pCO 2 50-60 mm Hg) is often observed in patients with hron, respiratory failure, as well as during anesthesia (while maintaining spontaneous breathing) with the use of anesthetics that depress the respiratory center and reduce ventilation (halothane , cyclopropane, methoxyflurane). Such G. at the awake person leads to decrease in working capacity, and during anesthesia can cause complications (strengthening patol, reflexes, long postnarcotic depression), though after the termination of an anesthesia tension of carbon dioxide is normalized independently.

G. has a significant effect on the cardiovascular system. With moderate G., changes are associated with an increase in venous inflow to the heart, an increase in systolic volume as a result of an increase in the tone of the veins and skeletal muscles, redistribution of blood flow; significantly increases cerebral and coronary blood flow, may increase the blood supply to the kidneys and liver; slightly reduced blood supply to skeletal muscles. Pronounced G. leads to disturbances in the conduction system of the heart, a decrease in the tone of peripheral vessels and arterial hypotension going into collapse. The mechanisms of hemodynamic changes in G. are determined by the central and local effects of elevated concentrations of carbon dioxide, hydrogen ions, and in some cases, concomitant hypoxia.

G. has a predominantly depressive effect on the nervous system: the excitability of the spinal centers decreases, the conduction of excitation along the nerve fibers slows down, the threshold for convulsive reactions increases, etc. Excitation of some departments of c. n. the N of page observed at moderate G. is connected with the strengthened afferentation from the peripheral receptor formations irritated fiz.-chem. shifts in the internal environment; on the EEG, a desynchronization reaction is noted. However, one cannot exclude the possibility of a short-term increase in the excitability of neurons as a result of the direct depolarizing effect of G. At high concentrations of carbon dioxide (over 10%), motor excitation occurs with convulsions, and then this state is replaced by an ever-increasing depression - the so-called. narcotic action of carbon dioxide, the mechanism to-rogo is insufficiently found out.

The question of the limiting concentrations of carbon dioxide in the air, which allow a long stay without damage to health and without a decrease in working capacity, as well as the question of the possibility of adaptation to H. at first, acidosis after a few days is compensated by bicarbonate retention, increased erythropoiesis and other adaptive mechanisms. However at the animals which were in the atmosphere with impurity of 1,5-3% of carbon dioxide within 20-100 days growth retardation and gistol, changes in bodies are noted. According to a number of authors, human performance can be maintained, changing, but not lost, when the content of carbon dioxide in the inhaled air is 1% for a month or more, at 2-3% - for several days, at 4-5% - for several days. several hours; 6% of carbon dioxide is the limit when a person's condition deteriorates sharply and performance is impaired. At a carbon dioxide concentration of up to 10%, a person's condition is disturbed after 5-10 minutes, and at 15%, clouding of consciousness occurs after 2 minutes. The life of man and higher animals at a concentration of carbon dioxide of 15-20% can be preserved for many hours and even a number of days. Lethal concentration - 30-35%; death does not occur immediately, but after a few hours.

Carbogen inhalation is used in medicine for carbon monoxide or narcotic poisoning, in the postoperative period and in other situations when there are no serious disorders of the respiratory center, but it is necessary to increase the volume of ventilation by deepening breathing (the presence of 5-7% carbon dioxide in the inhaled mixture stimulates the respiratory center). Questions are being investigated about the positive effect of hypothermia on the processes of saturation and desaturation of nitrogen during diving and caisson work, about the possibility of using hypothermia to obtain deep hypothermia under conditions of cardiopulmonary bypass (see Artificial hypothermia), etc.

There is no clear relationship between the level of pCO 2 and the wedge, G.'s manifestations; G. does not cause a specific pathoanatomical picture.

Clinical manifestations are inconsistent and lack specific diagnostic features. At chronic G. with moderate increase in pCO 2 a wedge, signs are observed seldom in connection with gradual adaptation of systems of an organism. Wedge, manifestations are characteristic of hl. arr. acutely developing G. At the same time, the shifts caused by G. (respiratory acidosis) do not depend on which way - endogenous or exogenous - there was an increase in the content of carbon dioxide in the body.

At acute poisoning carbon dioxide causes shortness of breath at rest, nausea and vomiting, headache, dizziness, cyanosis of the mucous membranes and skin of the face, severe sweating, impaired vision. The most important sign of G. is depression, which increases as the carbon dioxide tension in the body increases. With an increase in pCO 2 to about 80 mm Hg. Art. the ability to concentrate attention is impaired, drowsiness, confusion of consciousness appear; with an increase in pCO 2 to 90-120 mm Hg. Art. the victim loses consciousness, he has patol, reflexes; pupils are usually uniformly constricted.

At hron. G. - changes in psychomotor activity (excitation, followed by depression), headache and nausea are less pronounced; mainly severe fatigue and persistent hypotension are observed.

Breathing deepens at first with a tendency to increase respiratory excursions, which leads to an increase in minute ventilation; however at hron, respiratory insufficiency reaction of an organism to carbon dioxide as on a ventilation stimulator is significantly weakened (the same is noted at use of anesthetics, drugs, relaxants). With G.'s increase, the respiratory cycles gradually slow down, patol, respiration appears, and a complete cessation of breathing may occur.

As a result of vasodilation, a bright pink color of the skin appears. The pulse is usually well-filled, rare, but can be quickened, blood pressure rises significantly (increase in cardiac output). But with an increase in carbon dioxide tension, cardiac output decreases, and blood pressure decreases. However, changes in heart rate and blood pressure are not constant and cannot be reliable signs. G. is often accompanied by arrhythmias, more often by individual or group extrasystoles, which usually does not pose a danger, but under conditions of anesthesia with halothane or cyclopropane, arrhythmias can become threatening (ventricular fibrillation).

A small degree of G. has little effect or slightly increases renal blood flow and glomerular filtration (urine excretion increases slightly); at high pCO 2 due to the reduction of leading arterioles in the glomeruli, the amount of urine excreted by the kidneys decreases (see Oliguria).

One of the formidable complications of G. can be a coma, the development of which is observed during the transition from breathing with hypercapnic mixtures to breathing with oxygen; when transferring breath to air, deep hypoxia can develop, which can be the cause of death.

Diagnosis

G.'s condition can be established according to the readings of the instruments, as well as suggested by subjective signs and objective indicators. However, the only reliable criterion is both acute and hron. G. is the definition of pCO 2 in arterial blood. The study of indicators of acid-base balance (see) detects decompensated respiratory acidosis (see), which is subsequently compensated by the occurrence of metabolic alkalosis (see).

Instrumental diagnosis of G. is based on direct or indirect measurement of carbon dioxide tension in arterial blood.

Direct measurement is carried out in a sample of arterial or arterialized blood taken from a finger by the electrochemical method by changing the EMF of the electrode system when the latter comes into contact with the analyzed medium. The electrode system consists of a glass electrode for measuring pH and an auxiliary silver chloride electrode immersed in a buffer solution containing Na or K bicarbonate. Both electrodes are connected by an electrical circuit with a high-resistance amplifier. The electrolyte and pH electrode are separated from the blood sample by a membrane that is permeable to carbon dioxide but impermeable to liquid. Upon contact with a gas-permeable membrane, carbon dioxide dissolved in the blood diffuses through the membrane into the bicarbonate solution of the electrode, changing its pH, which in turn leads to a change in the EMF value in the electrical circuit. Such an electrode system for direct measurement of blood pCO 2 is the main unit of a number of foreign models of gas analyzers. The gas analyzer AZIV-2, manufactured by the domestic industry, provides an indirect determination of pCO 2 according to the O’Segor-Andersen nomogram based on the determination of blood pH. In some cases, G. can be indirectly established by measuring and recording the concentration of carbon dioxide in the alveolar air - capnography using an optical-acoustic gas analyzer, the action of which is based on measuring the degree of selective absorption of infrared radiation by carbon dioxide. The domestic industry produces a low-inertia carbon dioxide gas analyzer GUM-3, which allows express diagnostics (see Gas analyzers, Gas analysis).

Treatment

With signs of acute G. of exogenous origin, first of all, it is necessary to remove the victim from the atmosphere with a high content of carbon dioxide (eliminate malfunctions of the anesthesia machine, replace the inactivated carbon dioxide absorbent, if the regeneration system is disturbed, urgently restore the normal gas composition of the inhaled air). The only one reliable way removing the victim from coma- emergency use of artificial ventilation of the lungs (see artificial respiration, artificial ventilation of the lungs). Oxygen therapy (see) is unconditionally shown only at G. of an exogenous origin and in combination with artificial ventilation of the lungs. With G., inhalation of an oxygen-nitrogen gas mixture (up to 40% oxygen) has a good therapeutic effect; this effect was noted in experiments at a barometric pressure of 760 mm Hg. Art.

Endogenous G. is eliminated in the treatment of acute respiratory failure. It must be borne in mind that in case of violation of the central regulation of respiration (in most patients with exacerbation of hron, respiratory failure, in case of poisoning with drugs, barbiturates, etc.), uncontrolled use of oxygen can lead to even greater inhibition of ventilation and an increase in G., t. to. the effect of hypoxia on the respiratory center is eliminated.

Forecast

Light G. (up to 50 mm Hg. Art.) does not have a significant effect on the vital activity of the body even with prolonged exposure: from 1-2 months - for people working in hermetically sealed rooms, up to many years - for patients suffering from hron, respiratory failure. G.'s tolerance and outcome at higher pCO 2 is determined by training, the composition of the inhaled gas mixture (air or oxygen), or the presence of a disease of the cardiovascular system.

When breathing air, an increase in pCO 2 to 70-90 mm Hg. Art. causes the expressed hypoxia, edges at further progressing of G. can cause death. Against the background of oxygen breathing, the achievement of pCO 2 90-120 mm Hg. Art. causes the coma demanding emergency to lay down. measures.

The exact period after which it is still possible to bring a person out of a coma is unknown; this period is shorter, the more severe the general condition of the patient. However, timely emergency treatment can prevent a fatal outcome, even if a person is in a coma for several hours or even days.

There are known cases of a successful outcome of G., which arose during anesthesia, with an increase in pCO 2 to 160-200 mm Hg. Art.

Prevention

Prevention involves ensuring the absorption of carbon dioxide when working in hermetically sealed rooms, compliance with the rules for working with anesthesia and mechanical ventilation devices and the principles of general anesthesia, timely treatment the diseases which are followed by acute or hron, respiratory insufficiency. Specific Methods Increasing the body's resistance to the action of elevated concentrations of carbon dioxide has not yet been developed.

Features of hypercapnia in conditions of aviation and space flight

In a pilot, G. is unlikely, because a small amount of harmful space in oxygen masks, moderate physical. the activity of the crew in flight, the relative short duration of the flight exclude the accumulation of carbon dioxide in the inhaled air. If the ventilation systems malfunction, the pilot can use the emergency oxygen supply system and stop the flight.

Big potential danger G.'s occurrence exists in space flight due to the possibility of accumulation of carbon dioxide in the atmosphere of the cabin or in the pressure helmet of the spacesuit in the event of a malfunction of the oxygen-respiratory equipment (see). However, a certain excess of carbon dioxide in the cockpit can be allowed by the flight program for reasons of saving weight, dimensions and power supply to the life support system, as well as to enhance oxygen regeneration and prevent hypocapnia (see), etc. But modern flight programs do not increase the concentration of carbon dioxide in excess of those used fiziol, limits are not allowed (1% - for flight days and 2-3% - for flight hours).

If the increase in the concentration of carbon dioxide to a toxic level occurs within a few minutes (or hours), a person develops a state of acute G. A long stay in an atmosphere with a moderately high content of gas leads to hron. D. Calculations show that if the knapsack system for absorbing carbon dioxide in a space suit fails while an astronaut is working on the lunar surface, the toxic level of carbon dioxide in the helmet will be reached in 1 - 2 minutes.

In the cockpit of an Apollo spacecraft with three astronauts doing their usual work, this can happen in more than 7 hours. after a complete failure of the regeneration system. In both cases, acute G. may occur. With minor malfunctions in the operation of the carbon dioxide absorption system in long flights preconditions for development hron are created. G.

G. in space flight is fraught with serious complications and in connection with the "reverse" effect of carbon dioxide (a wedge, its symptoms are opposite to the direct effect), because after the transfer of breathing to a normal gas mixture, disturbances in the body often not only do not weaken, but even intensify .

The content of carbon dioxide in the range of 0.8-1% (6-7.5 mm Hg) can be considered an acceptable level for short-term and long-term stay both in the cockpit and in the helmet. If an astronaut has to work for several hours in a space suit, then the carbon dioxide content in the helmet should not exceed 2% (15 mm Hg); although the cosmonaut's working capacity is somewhat reduced (shortness of breath and fatigue appear), the work can be done in full.

When the content of carbon dioxide in the inhaled air is up to 3% (22.5 mmHg), an astronaut can perform light work for several hours, but severe shortness of breath, headache, and other symptoms are observed; therefore, an increase in the carbon dioxide content in the pressure helmet of a space suit or in the cabin to 3% or more must be considered as a situation that must be immediately eliminated.

Bibliography: Breslav I. S. Perception of the respiratory environment and gas preference in animals and humans, L., 1970, bibliogr.; Golodov II Influence of high concentrations of carbonic acid on an organism, L., 1946, bibliogr.; Shar o in S. G., et al. Artificial atmosphere of spacecraft cabins, in the book: Kosmich * biol, and medical, ed. V. I. Yazdoshsky, p. 285, M., 1966; Ivanov D.I. and X r o-mushkin A.I. Human life support systems during high-altitude and space flights, M., 1968; Kovalenko E. A. and Chernyakov I. N. Oxygen of tissues under extreme flight factors, M., 1972; Marshak M. E. Physiological significance of carbon dioxide, M., 1969 # bibliogr.; Fundamentals of space biology and medicine, ed. O. G. Gazenko and M. Calvin, vol. 2, book. 1, M., 1975, Campbell E. D. M. Respiratory failure, trans. from English, M., 1974, bibliography; Sulimo-Samuillo 3. K. Hypercapnia, L., 1971 * Physiology in space, trans. from English, KHt i-2, M., 1972; In u s b at D. E. Space clinical medicine, Dordrecht, 1968.

H. I. Losev; V. A. Gologorsky (gen. ter.), I. N. Chernyakov (av. med.), V. M. Yurevich (instr. diag.).

Hypercapnia (syn. hypercarbia) - an increase in the content of carbon dioxide in the blood, which is caused by a violation of respiratory processes. The partial voltage exceeds 45 millimeters of mercury. The disease can develop in both adults and children.

The causes of the pathological condition are often pathological character and consist in a disorder of ventilation against the background of the course of diseases of the organs of the respiratory system. Sources include polluted air, addiction to bad habits and other unfavorable factors.

Clinical picture quite specific, expressed in a feeling of lack of air, rapid breathing, increased sweating, behavioral disorders and changes from skin.

The process of establishing the correct diagnosis is based on the results of laboratory parameters. In the process of diagnosing, instrumental procedures and manipulations carried out by the attending physician are necessary.

The tactics of therapy completely depends on the root cause, more often it has a conservative character. In some cases, they turn to a procedure such as artificial ventilation of the lungs.

Etiology

In hypercapnia, the causes of origin are very diverse, divided into external and internal. The first category is elevated content carbon dioxide in the air - if a person is in such an environment for a long time, develops pathological condition. This group includes:

some professional features are at risk for bakers, divers and steelworkers;
air pollution;
prolonged stay of a person in an unventilated room;
long-term addiction to cigarettes;
passive smoking;
inhalation of carbon dioxide during a fire;
diving to great depths while diving;
excess nutrition;
wrong job special respiratory equipment, which is used during surgical operations - when the patient is under anesthesia.

Stuffy room and hypercapnia

Internal provocateurs are represented by the following list:

convulsive or epileptic seizures;
violation of the integrity of the brain stem, which can occur against the background of injury, leakage oncological process, inflammatory lesion or stroke;
the course of bronchial asthma;
pathology spinal cord eg poliomyelitis;
irrational use medicines;
sleep apnea syndrome - there is a sudden cessation of respiratory movements;
dystrophy muscle tissue;
deformation changes chest, in particular kyphosis;
sepsis;
severe form of obesity;
myasthenia gravis;
chronic bronchopulmonary diseases accompanied by obstructive syndrome;
damage to the central nervous system;
fever;
disruption of gas exchange lung tissue- the disorder may occur due to Mendelssohn's syndrome, Hamman-Rich disease, pneumothorax, respiratory distress syndrome, edema or pneumonia;
the period of bearing a child - often the disease develops in the 3rd trimester, when any breathing problems can cause hypercapnia;
respiratory acidosis;
malignant hyperthermia;
atherosclerosis.

The condition is closely related to hypoxia - insufficient oxygen in the blood or oxygen starvation organism.

Classification

Based on the nature of the course, hypercapnia happens:

acute - characterized by a sharp appearance of clinical signs and a significant deterioration in the condition, most often occurs in children;
chronic - the clinic is expressed in a slow increase in symptoms for a long time.

There are several degrees of severity of the course of the disease:

moderate;
deep - symptoms from the central nervous system appear and manifestations of acute respiratory failure increase;
acidotic coma.

Depending on the causes of development, the disease happens:

endogenous - internal sources act as provocateurs;
exogenous - develops against the background external factors.

Separately, chronic compensated hypercapnia is distinguished - it occurs when a person is in conditions of a slow increase in the level of carbon dioxide in the air for a long period of time. In the body, the processes of adaptation to a new environment are activated - this is a compensation for the state with increased respiratory movements.

None of the classifications includes permissive hypercapnia - a purposeful restriction of the volume of ventilation of the lungs, which is necessary to avoid excessive stretching of the alveoli, despite an increase in CO2 beyond the normal range, up to 50-100 millimeters of mercury. Art.

Symptoms

Usually the disease develops slowly, with a gradual increase in intensity. clinical manifestations. Very rarely happens lightning-fast development symptoms.

The symptoms of hypercapnia will vary slightly depending on the severity of the problem. For example, the moderate form is characterized by:

sleep problems;
euphoria;
increased sweating;
skin hyperemia;
increased respiratory movements;
increase in blood tone;
increase in heart rate.

The deep stage is expressed by the following symptoms:

increased aggressiveness and agitation;
severe headache;
nausea and weakness;
the appearance of bruises under the eyes;
puffiness;
decreased visual acuity;
rare and shallow breathing;
cyanosis of the skin;
strong allocation of cold sweat;
increased heart rate up to 150 beats per minute;
increase in blood pressure values;
dizziness;
difficulty urinating.

Acidotic coma is expressed by such signs:

decreased reflexes;
hyperhidrosis;
sharp decline blood tone;
loss of consciousness;
cyanotic skin tone;
convulsive seizures.

In the case of a chronic course of the disease, symptoms include:

constant fatigue;
decrease in working capacity;
lowering blood pressure;
excitation, replaced by oppression of consciousness;
dyspnea;
breathing problems;
sleep disturbance;
headaches and dizziness.

In children, the symptoms are practically the same. It should be remembered that in this category of patients, hypercapnia develops much faster and is much more severe than in adults.

In those situations where the disease develops against the background of other diseases, the likelihood of the appearance of external signs underlying pathology.

If symptoms occur, it is very important to provide emergency assistance to the victim. You should call a team of doctors at home, and then perform the following actions:

remove or remove a person from a room with a high content of carbon dioxide;
perform tracheal intubation (only if serious condition patient) - an experienced clinician can do this;
administer emergency oxygen therapy.

The only measure of assistance to a person who has fallen into an acidotic coma is artificial ventilation of the lungs.

The main symptoms of hypercapnia

Diagnostics

Put correct diagnosis an experienced clinician will be able, based on symptoms and findings laboratory research.

The doctor needs:

study the medical history - to look for a possible underlying disease;
collect and analyze a life history - to identify external causes, which will determine whether there was a need for a procedure such as permissive hypercapnia;
assess the condition of the skin;
measure pulse, heart rate and blood tone;
interrogate the patient in detail (if the person is conscious) or the one who delivered the victim to a medical facility - to compile a complete symptomatic picture and determining the severity of the condition.

Laboratory research:

general clinical blood test;
blood biochemistry;
assessment of the gas composition of the biological fluid;
analysis for KOS.

As for instrumental procedures, the following tests are performed:

chest x-ray;
ultrasonography;

How is an MRI done?

The tactics of therapy depends on the sources against which hypercapnia arose. If the pathology is exogenous, it is necessary:

ventilate the room;
go out into the fresh air;
take a break from work
drink plenty of fluids.

If the malaise has become a secondary phenomenon, in order to eliminate the pathology, it is necessary to eliminate the underlying disease. You may need to take these medications:

bronchodilators;
antibiotics;
anti-inflammatory drugs;
hormonal drugs;
immunostimulants;
diuretics;
bronchodilators;
medications to relieve symptoms.

You can eliminate the negative effect of carbon dioxide on the body in the following ways:

infusion therapy;
artificial ventilation of the lungs;
oxygen therapy;
chest massage;

Possible Complications

Violation normal composition blood can cause the formation of a large number of complications:

delayed child in mental and psychomotor development;
epilepsy;
hypoxia without hypercapnia in newborns;
miscarriage;
pulmonary hypertension;
malignant hypertension;
acute respiratory failure.

Prevention and prognosis

There are simple things you can do to help prevent high levels of carbon dioxide in your blood. preventive advice:

regular airing and ventilation of premises;
implementation of breathing exercises;
frequent exposure to fresh air;
observance of an adequate regime of work and rest;
rational use of medicines strictly according to the prescription of the attending physician;
checking and troubleshooting anesthesia machines;
prevention of the development of conditions when permissive hypercapnia may be needed;
ensuring adequate functioning of breathing apparatus, which are necessary for miners, firefighters and divers to work;
timely detection and treatment of any diseases of the respiratory system, which can lead not only to hypercapnia, but also to such a condition as hypoxia without hypercapnia;
annual full preventive examination in the clinic.

Hypercapnia has an ambiguous prognosis, since it all depends on the severity of the pathology. Death often results in respiratory and cardiac arrest.

A person who has been in closed rooms for a long time often complains about the occurrence unpleasant symptoms. After contacting a medical institution, doctors diagnose "hypercapnia".

Hypercapnia (sometimes hypercarbia) is the name of a pathological process that occurs as a result of an excess of carbon dioxide in the circulatory system and soft tissues of the human body, or, more simply, carbon dioxide (CO2) poisoning.

There are two types of hypercapnia:

exogenous - characterized by an increase in the amount of carbon dioxide in the body, developing as a result of the victim's stay in a room with an increased level of it;
endogenous - appears as a result of deviations of the human respiratory system.

If the disease develops, you need to contact a qualified doctor who will explain how the pathology appeared and how to eliminate the symptoms.

Causes

Hypercapnia can develop due to different reasons, but there is a list of factors that increase the likelihood of its occurrence:

periodic epileptic urges;
traumatic effect on the brain stem;
damage to the brain stem as a result of cancer, stroke or other inflammatory processes;
the presence of bronchial asthma;
pathological changes in the spinal cord that occur with poliomyelitis;
use pharmacological preparations that can disrupt the respiratory system;
the presence in the body of myasthenia gravis;
muscular dystrophy;
all kinds of pathological changes in the structure of the sternum;
serious stage of obesity;
chronic diseases of the bronchi, in which the patency of the respiratory system is impaired.

Exogenous hypercapnia occurs due to:

inhaling excessive amounts of carbon monoxide;
diving and strong diving under water (improper breathing, hyperventilation and intense exercise - factors can provoke the development of such an ailment);
prolonged stay in miniature enclosed spaces (well, mine, submarine and spacesuit);
technical failures in the device, is responsible for maintaining the respiratory rhythm at the time of the surgical intervention.

Symptoms

Symptoms of hypercapnia are acute and chronic. Common signs of an acute form of the disease:

the skin acquires a reddish tint;
sudden headache and dizziness;
even with minor physical exertion, shortness of breath is present;
blood pressure rises significantly;
the person feels drowsy and becomes lethargic;
the rhythm of the heart muscle accelerates;
pain in the chest area;
there are periodic urges of a gag reflex and nausea;
the patient is disturbed by frequent convulsions;
the consciousness of the victim is confused, speech is slurred;
possibly fainting.

The severity of the above symptoms depends entirely on the stage and nature of the disease. The higher the level of carbon dioxide in the circulatory system and soft tissues, the more pronounced the signs of the disease.

If not detected and eliminated sharp shape hypercapnia, it is possible to provoke the appearance of many negative complications and a complete disruption of the respiratory and cardiovascular systems, and the consequence of such a process is the most dangerous consequence – fatal outcome the victim.

Symptoms of a chronic course:

feeling sluggish and tired (after normal sleep);
psychological disorders (depression, stress, hypersensitivity, agitation and irritability);
reduced blood pressure;
the occurrence of deviations in the respiratory and cardiac rhythm;
the presence of shortness of breath with minor exertion;
deterioration of vital functions and brain activity.

Existing signs of carbon dioxide poisoning, it is possible to prevent the occurrence of complications in a timely manner. If you have several of the described symptoms, you must visit a medical facility or call an ambulance.

However, there are cases when the pathology is called chronic compensated hypercapnia, but it does not threaten human health and does not require prompt medical intervention.

This is explained by the fact that when the level of carbon dioxide in the room rises gradually, and the negative effect on the body of the victim occurs slowly, due to his prolonged stay in such an environment, the body begins to adapt to the changes.

The respiratory system begins to work faster, the acid-base balance in the circulatory system begins to recover, and the work of the cardiovascular system begins to function much faster. Due to adaptive processes in the human body, the disease does not require therapy and the attention of doctors.

First aid

When external influence carbon dioxide on the victim is first aid:

an ambulance is called;
a person with suspected hypercapnia is removed from a closed room that contains an increased level of an unfavorable gas;
in the event of a malfunction of a device that supports respiratory process the patient, stop the violation that has arisen and stabilize the patient's condition;
when the resulting poisoning threatens human life, then tracheal intubation is performed;
in case of exogenous type pathology, oxygen therapy and artificial lung ventilation.

When the victim is taken to a medical facility for confirmation of the diagnosis and the appointment of therapeutic measures.

Diagnosis technique

During the diagnosis, a qualified doctor examines the patient, interviews about the symptoms present and types precise research. You can confirm or refute the presence of carbon dioxide poisoning using diagnostic methods:

study of the level of carbon dioxide in the arterial blood of the victim. The established norm of РСО2 is 4.6-6.0 kPa or 35-45 mm Hg. Art. In case of poisoning, the PCO2 indicators rise to 55-80 mm Hg. Art., and the level of oxygen decreases (CO2 indicator);
examination of alveolar ventilation to determine the state of lack of pulmonary ventilation, which provokes a decrease in oxygen levels and an increase in carbon dioxide;
in order to detect gas acidosis, a specialized apparatus is used - a capnograph. With its help, an experienced doctor is able to determine the presence and amount of carbon dioxide by the partial pressure contained in the exhaled air;
diagnostics can be carried out using aerotonometry. Her calculation technique is able to determine the amount of gases present in the circulatory system.

After the diagnostic examination and careful study of the results obtained, qualified medical worker, taking into account the possible and individual characteristics of the victim's body, prescribes the most effective method of therapy.

What is hypercapnia

Hypercapnia is a pathological condition that occurs when there is an excess of carbon dioxide (CO 2) in the blood and tissues, with signs of poisoning, hypoventilation (breathing disorders due to insufficient ventilation of the lungs) and hypoxia (low oxygen content). In essence, is integral part oxygen starvation of the body against the background of oxygen deficiency in the blood and respiratory acidosis.

Gas (respiratory) acidosis is a synonymous name for hypercapnia. It is used when the accumulation of carbon dioxide (partial pressure) in arterial blood exceeds the norm of 40-45 mm Hg. Art. (in the venous - 51), and its acidity increases, which is expressed in a decrease in the pH parameter, which ideally should be in the range from 7.35 to 7.45.

Signs of carbon dioxide poisoning are formed as a result of damage to oxygen carriers - red blood cells. Carbon dioxide binds erythrocyte hemoglobin, forming carbohemoglobin, unable to carry oxygen to organs, causing, along with hypercapnia, acute oxygen starvation - hypoxia.

The nature of hypercapnia is:

endogenous;
exogenous.

The exogenous form means that the abnormal increase in gaseous carbon dioxide in the tissues and blood is due to external causes. For example, inhalation of air saturated with carbon dioxide (more than 5%). In this case, a person has signs of obvious intoxication.

The endogenous nature is associated with internal factors - pathological changes in certain diseases, accompanied by signs of respiratory failure.

Carbon dioxide poisoning - video

Causes and risk factors

The following conditions lead to the development of hypercapnia:

pulmonary hypoventilation, accompanied by a violation of gas exchange in the alveoli (the end bubble structures of the lungs) and developing due to respiratory diseases (obstruction, inflammation, trauma, foreign objects, operations);
impaired respiratory function due to depression of the respiratory center due to brain injury, neoplasms, cerebral edema, poisoning with certain medicines - morphine derivatives, barbiturates, anesthetics and others;
inability of the chest to carry out full respiratory movements.

Hyperventilation as a "provocateur" of hypercapnia

Separately, hyperventilation of the lungs should be singled out, which is the opposite of hypoventilation and develops with intensive breathing, during which the body is oversaturated with oxygen. Often this condition leads to an increase in the amount of carbon dioxide in the tissues and blood. This happens, for example, when diving (deep diving), when a person in front of him is actively and quickly breathing, trying to saturate his lungs with oxygen, but does it wrong.

During neurological hyperventilation (for example, during panic attacks), which provokes frequent, but shallow breathing in the patient, poisoning can also occur - first with an excess of oxygen, then with carbon dioxide. The fact is that during superficial inhalations and exhalations, carbon dioxide is not completely removed from the lungs, accumulating in them. For this reason, experienced runners, hunters, special forces maintain a breathing rhythm in which exhalation is 2 or 3 times longer than inhalation. In this case, a person completely frees the lungs from carbon dioxide, but does not provoke hyperventilation either.

Endogenous factors

For the causal factors causing the occurrence endogenous hypercapnia, include the following diseases and pathological conditions:

respiratory diseases: pneumonia, asthma, emphysema, pneumosclerosis, obstruction respiratory tract;
chest injuries, including rib fractures, arthritis of the costal joints;
spinal deformity (scoliosis, kyphosis);
tuberculous spondylitis, rickets;
extreme obesity (Pickwick syndrome);
congenital defects of the bone and cartilage apparatus;
restriction of mobility of the chest with muscular dystrophy and pain against the background of intercostal neuralgia;
defeat and damage to the structures of the brain and spinal cord - strokes, encephalitis, trauma, tumor, poliomyelitis;
myasthenia gravis (a neuromuscular genetic disease);
acidosis, metabolic alkalosis;
atherosclerosis;
epileptic seizures;
apnea (sudden uncontrolled cessation of breathing).

Exogenous factors

External (exogenous) causes of hypercapnia are:

occupational activities associated with frequent inhalation carbon monoxide or prolonged breath holding (divers, firefighters, bakers, miners, foundry workers);
heavy exercise stress under conditions of carbon dioxide accumulation;
prolonged stay in stuffy rooms, smoking, including passive;
long stay in closed and sealed spaces (wells, mines, submarines, space suits, closed car garages), where carbon dioxide accumulates;
improper operation of furnaces, boilers;
defeat by phosgene, ammonia, hydrochloric, sulfuric acid;
poisoning with anticholinesterase drugs;
technical problems in the respiratory equipment during surgical interventions, when the patient was given anesthesia.

Symptoms

According to the time of manifestation, early and late clinical symptoms are distinguished, the severity of which is directly related to the level of carbon dioxide in the body and the degree of hypercapnia.

Early and late symptoms of gas acidosis - table

Signs of hypercapnia also differ depending on whether the condition of abnormally high carbon dioxide is acute (short-term) or chronic.

The normal concentration of CO 2 outdoors is about 0.04% or 380-400 ppm in terms of "number of particles of carbon dioxide per million particles atmospheric air" or "parts per million". Thus, 0.1% carbon dioxide corresponds to 1 thousand ppm.

Manifestations with short-term and long-term exposure to carbon dioxide - table

Body adaptation to respiratory acidosis

If a person stays for a long time in an environment with a constant moderately high level of carbon dioxide in the air or with a slow increase in the concentration of CO 2, a gradual adaptation to changes in the environment occurs.

Thanks to the mechanisms of compensation, the body to some extent has internal forces to eliminate the resulting respiratory disorders. Thus, an increase in carbon dioxide in the blood causes a reflex increase and deepening of respiratory movements to optimize lung ventilation, remove excess carbon dioxide and normalize acid-base balance blood. For example, with an increase in the partial pressure of carbon dioxide in the blood by 1 mm Hg. Art. breathing volume per minute (MOD) increases by 2-4 liters.

The heart and blood vessels also adapt to new conditions by increasing cardiac output and increasing blood pressure. This phenomenon in medicine is called "chronic compensated hypercapnia" and does not require hospital treatment.

Features of the state of hypercapnia in children

In children, respiratory failure due to carbon dioxide poisoning develops faster and is more severe than in adults.

The specificity of the course and consequences of hypercapnia in childhood are associated with the anatomy and functionality of the respiratory system:

narrow airways (cause a violation of their patency even with a slight edema or accumulation of mucus);
rapid reaction of the tissues of the respiratory tract to irritants (edema, spasm, increased secretion);
weakness of the respiratory muscles in children;
anatomical features - the abduction of the ribs from the sternum at almost a right angle reduces the depth of inspiration.

In the body of a child, a strong excess of carbon dioxide causes a slowdown metabolic processes, degenerative and irreversible changes against the background of oxygen starvation of the tissues of the heart, liver, brain, kidneys.

The increased content of carbon dioxide in the blood of a pregnant woman is a dangerous condition for both the mother and the child. Features that aggravate or provoke the development of hypercapnia:

during the bearing of the baby, the need for oxygen in a woman increases by about 18–22%;
as a result of the growth of the uterus, the abdominal type of breathing is replaced by the chest, in which the abdominal muscles, as auxiliary, are excluded from participation in breathing, which leads to incomplete expiration and accumulation of carbon dioxide in the lungs;
the growing uterus puts pressure on the liver, stomach, raises the diaphragm, reducing the respiratory volume of the lungs and making it impossible to deepen the breath with the help of its movement.

All these changes contribute to the rapid development of respiratory acidosis even with minor disorders in the respiratory system.

Effects:

respiratory failure, increased blood pressure, increased viscosity or, conversely, its dilution with the risk of bleeding;
high risk of developing eclampsia, early placental abruption;
miscarriage, premature birth;
hypoxia, respiratory failure in the fetus, newborn;
violation of placental gas exchange;
the negative impact of carbon dioxide on the central nervous system and cerebral cortex of an infant, leading to the development of the following pathologies:
- violations of the formation of organs in the embryo;
- delayed mental and physical development in a newborn;
- cerebral palsy;
- epilepsy.

If the baby survives the birth safely, then later he may develop severe chronic disorders. As a result, all newborns with respiratory acidosis require intensive treatment.

Diagnostics

Diagnosis of hypercapnia is based on:

subjective sensations of the patient;
objective signs of hypercapnia corresponding to the early or late development of poisoning and its severity;
laboratory test results.

The most reliable method is the determination of the concentration of carbon dioxide in arterial blood. The normal content of carbon dioxide is noted at a partial pressure ranging from 4.7 to 6 kPa, which corresponds to 35–45 mm Hg. Art.

With the development of hypercapnia, an increase in the partial pressure of carbon dioxide to 55 - 100 mm Hg is detected. Art., a decrease in oxygen content, an increase in blood acidity (acidosis) against the background of a downward shift in the acid-base balance (pH less than 7.35) or, conversely, alkalization (pH more than 7.45), which occurs, for example, during hyperventilation before diving.

A study of alveolar ventilation is also being carried out (updating the gas composition in lung alveoli when breathing) to identify the state of hypoventilation, that is, insufficient ventilation of the lungs, in which oxygen deficiency and an excess of carbon dioxide are formed in the blood.

To track the development of gaseous acidosis, a medical analyzer is used - a capnograph, which determines the content of carbon dioxide in the blood by its partial pressure in the air during exhalation.

In recent years, the pulse oximeter has become very popular. It is used to determine the pulse and estimate the oxygen saturation of hemoglobin. The latter indicator allows you to indirectly judge whether a person has oxygen starvation, and therefore an excess of carbon dioxide in the blood. Such diagnostics can be carried out at home by the patient himself, if he has this device.

Treatment

Treatment for hypercapnia is primarily aimed at improving pulmonary ventilation.

First aid

If the state of gaseous acidosis develops under the influence of external factors (exogenous hypercapnia), it is necessary:

ventilate the room or go outside;
drink plenty of fluids to prevent blood clotting and reduce intoxication.

In acute respiratory acidosis, you should:

immediately remove the patient from the place where the concentration of carbon dioxide in the air is increased;
during surgical interventions set up anesthesia equipment;
with the development of a coma and respiratory arrest, immediately begin forced ventilation of the lungs so that the inhalation of air into the patient's mouth or nose lasts twice as long as exhalation;
in case of particular severity and impossibility of independent breathing of the patient, for example, when the airways are blocked, intubate the trachea.

Medical and instrumental therapy

Therapy for hypercapnia and respiratory failure that develops against its background is aimed at:

to eliminate the causes that provoked the pathology;
for the treatment of internal diseases that caused respiratory acidosis;
for recovery normal exchange gases in the pulmonary alveoli.

Often carry out hardware ventilation of the lungs. Her help is resorted to in cases where:

a person is not breathing, or he has severe shortness of breath with a frequency of more than 40 breaths per minute;
oxygen therapy does not give a positive result (the partial pressure of oxygen falls below 45 mm Hg);
arterial blood pH less than 7.3.

They also resort to oxygen therapy, which is used only for acute exogenous hypercapnia (caused by external conditions) in combination with artificial lung ventilation. In this case, the patient breathes a balanced oxygen-nitrogen mixture with an oxygen content of up to 40%.

Illiterate oxygen therapy (especially with pure oxygen under pressure) leads to an increase in the content of carbon dioxide in the blood and even more pronounced respiratory disorders. Particular attention should be paid to the state of depression of the respiratory center, which occurs with drug overdose, poisoning with anesthetics and other pathological conditions.

In addition, with oxygen therapy, it is easy to miss the development of the “reverse” critical state - hypocapnia (lack of carbon dioxide in the blood) and alkalosis (alkalinization of the blood). Therefore, oxygen treatment requires constant monitoring of blood gases and pH (acid-base balance).

If necessary, the following activities are carried out:

the airways are regularly cleared of viscous sputum using a catheter or endotracheal tube;
introduced saline through droppers to thin and remove bronchial secretions, activate blood flow;
0.5–1 ml of a solution of Atropine sulfate 0.1% is injected subcutaneously with profuse salivation and sputum production;
in acute respiratory failure, an asthma attack, Prednisolone is administered intravenously, which quickly relieves mucosal edema;
with a severe degree of respiratory acidosis, alkaline solutions (Carbicarb, Tromethamine), sodium bicarbonate are dripped in to compensate for respiratory acidosis;
diuretics are used to relieve edema, improve lung compliance;
Doxopram, bronchodilators (Theophylline, Salbutamol, Fenoterol, Ipratropium bromide, Aminophylline) are used to stimulate breathing, expand the bronchi, enhance pulmonary ventilation.

Further therapy depends on the disease provocateur of hypercapnia and may include:

antibacterial, anti-inflammatory, hormonal, immunostimulating drugs;
bronchodilators in patients with pulmonary obstruction (adrenaline, isoproteronol) in conjunction with careful therapy with small doses of oxygen;
aerosol therapy to improve airway patency, including inhalation with a solution of sodium bicarbonate 3%, the composition of aerosols includes bronchodilators (Salbutamol, Novodrin 1%, Solutan, Euspiran, Isadrin 1%);
injections of sodium hydroxybutyrate 20%, Sibazon 0.5% (relieves spasms), Cocarboxylase (maintains blood pH in normal conditions in acidosis) and Essentiale to eliminate oxygen starvation accompanying hypercapnia and acute respiratory failure.

Folk remedies

Home therapy using folk remedies does not have an “arsenal” for a full-fledged fight against hypercapnia and acute respiratory failure. However, a certain positive result in the chronic course of pathology, decoctions of medicinal plants are able to give. As a rule, the effect is expected if bronchopulmonary diseases become the cause of respiratory acidosis.

Many of them help to partially relax the bronchi, relieve swelling, reduce the viscosity of sputum and improve the excretion of purulent mucus from the lungs.

With the independent use of folk recipes without a specified diagnosis, it is impossible to predict the patient's reaction to a specific remedy, and the condition can only worsen: certain herbs, products, medicinal substances cause allergies with laryngeal edema, when inhaled with them, there is a danger of bronchospasm, sudden swelling, burns of the respiratory tract, and even activation of the reproduction of pathogenic microbes. For example, oregano, anise or licorice root, useful for breathing problems, can provoke uterine bleeding in pregnant women, allergies.

The "chest" fees, which facilitate breathing in diseases provocateurs of gaseous acidosis, include plantain, coltsfoot, licorice, marshmallow, sage, pine buds, anise, mint, wild rosemary (poisonous), chamomile, violet, calendula.

Usually, 2 tablespoons of herbs are poured into 250-300 ml of boiling water, boiled slowly for 15 minutes, insisted for about 30-40 minutes, filtered. The resulting broth is brought to a volume of 200 ml by adding boiled water, and take half a glass warm up to 4 times a day for 2 weeks.

Milk-based products are also considered effective:

Carrot juice with milk. Warm boiled milk is poured into fresh carrot juice in a ratio of 1:1. The medicinal drink is drunk 100-150 ml three times a day (warm). Removes moisture well.
Leek root decoction in milk. They take raw materials from 2-3 plants, removing the lower white part. Crush, pour 250-300 ml of milk and simmer for 10 minutes over low heat. Insist up to 6-7 hours. Filter and drink "onion milk" 5 times a day for a tablespoon. It relaxes the bronchi, makes breathing easier.

Medicinal herbs for the treatment of hypercapnia - photo

Treatment prognosis and possible complications

Hypercapnia can go unnoticed with a low content of carbon dioxide in the air. But it can also lead to the development of severe complications, depending on the concentration of CO 2 , physiology, human age, and internal diseases.

With a mild degree of respiratory acidosis (up to 50 mm Hg), the condition does not have a too negative effect on the body even with prolonged exposure due to the adaptive capabilities of a person and the adaptability of a person to such conditions. Tolerance of a higher content of carbon dioxide in the blood is associated with the general condition of a person, the presence of chronic pulmonary and heart diseases. Partial pressure of 70–90 mm Hg. Art. causes a severe lack of oxygen, which in the absence of medical care and further development hypercapnia leads the patient to death.

The most serious complication of acute respiratory acidosis is hypercapnic coma, which, without intensive emergency treatment, ends in respiratory and cardiac arrest.

Prevention

To prevent hypercapnia, you need:

timely and proper treatment diseases of the bronchi and lungs, especially those accompanied by acute or chronic insufficiency respiratory functions;
regular and prolonged exposure to the open air;
compliance with the rules for working with professional breathing apparatus used by miners, firefighters, divers, pilots, astronauts;
active and regular ventilation of household and office space(especially with installed plastic windows that do not have valves);
providing supply ventilation and exhaust in working, workshop premises (exchange with the external atmosphere is calculated at a rate of 30 m 3 per hour per person), providing a comfortable concentration of carbon dioxide in the air for people (no more than 450–500 ppm);
provision of airtight rooms with CO 2 absorbers;
checking, troubleshooting equipment for anesthesia, artificial pulmonary ventilation;
proper administration of general anesthesia.

Both short-term carbon dioxide intoxication and its long-term effect on the body can have an extremely negative effect on a person. Early detection symptoms in acute carbon dioxide poisoning and monitoring for symptoms of hypercapnia caused by internal diseases can prevent many serious conditions. Immediate treatment can prevent the death of the patient even in the case of prolonged acidotic coma (hours, days), which develops with carbon dioxide poisoning. Medical statistics confirm cases of a successful outcome with severe respiratory acidosis, when the carbon dioxide tension in the blood reached 160–200 mm Hg. Art., which occurred during anesthesia of the patient.

Etiology

In hypercapnia, the causes of origin are very diverse, divided into external and internal. The first category is the increased content of carbon dioxide in the air - if a person is in such an environment for a long time, a pathological condition develops. This group includes:

some professional features are at risk for bakers, divers and steelworkers;
air pollution;
prolonged stay of a person in an unventilated room;
long-term addiction to cigarettes;
passive smoking;
inhalation of carbon dioxide during a fire;
diving to great depths while diving;
excess nutrition;
improper operation of special respiratory equipment, which is used during surgical operations - when the patient is under anesthesia.

Internal provocateurs are represented by the following list:

convulsive or epileptic seizures;
violation of the integrity of the brain stem, which can occur against the background of trauma, the course of an oncological process, an inflammatory lesion, or a stroke;
the course of bronchial asthma;
spinal cord pathologies, for example, poliomyelitis;
irrational use of drugs;
sleep apnea syndrome - there is a sudden cessation of respiratory movements;
dystrophy of muscle tissue;
deformation changes in the chest, in particular kyphosis;
sepsis;
severe form of obesity;
myasthenia gravis;
chronic bronchopulmonary diseases accompanied by obstructive syndrome;
damage to the central nervous system;
fever;
violation of gas exchange in the lung tissue - the disorder may occur due to Mendelsohn's syndrome, Hamman-Rich disease, pneumothorax, respiratory distress syndrome, edema or pneumonia;
the period of bearing a child - often the disease develops in the 3rd trimester, when any breathing problems can cause hypercapnia;
respiratory acidosis;
malignant hyperthermia;
atherosclerosis.

The condition is closely related to hypoxia - insufficient oxygen in the blood or oxygen starvation of the body.

Classification

Based on the nature of the course, hypercapnia happens:

acute - characterized by a sharp appearance of clinical signs and a significant deterioration in the condition, most often occurs in children;
chronic - the clinic is expressed in a slow increase in symptoms for a long time.

There are several degrees of severity of the course of the disease:

moderate;
deep - symptoms from the central nervous system appear and manifestations of acute respiratory failure increase;
acidotic coma.

Depending on the causes of development, the disease happens:

endogenous - internal sources act as provocateurs;
exogenous - develops against the background of external factors.

Symptoms

Usually the disease develops slowly, with a gradual increase in the intensity of clinical manifestations. Extremely rarely there is a lightning-fast development of symptoms.

The symptoms of hypercapnia will vary slightly depending on the severity of the problem. For example, the moderate form is characterized by:

sleep problems;
euphoria;
increased sweating;
skin hyperemia;
increased respiratory movements;
increase in blood tone;
increase in heart rate.

The deep stage is expressed by the following symptoms:

increased aggressiveness and agitation;
severe headache;
nausea and weakness;
the appearance of bruises under the eyes;
puffiness;
decreased visual acuity;
rare and shallow breathing;
cyanosis of the skin;
strong allocation of cold sweat;
increased heart rate up to 150 beats per minute;
increase in blood pressure values;
dizziness;
difficulty urinating.

Acidotic coma is expressed by such signs:

decreased reflexes;
hyperhidrosis;
a sharp decrease in blood tone;
loss of consciousness;
cyanotic skin tone;
convulsive seizures.

In the case of a chronic course of the disease, symptoms include:

constant fatigue;
decrease in working capacity;
lowering blood pressure;
excitation, replaced by oppression of consciousness;
dyspnea;
breathing problems;
sleep disturbance;
headaches and dizziness.

In children, the symptoms are practically the same. It should be remembered that in this category of patients, hypercapnia develops much faster and is much more severe than in adults.

In those situations when the disease develops against the background of other diseases, the possibility of the appearance of external signs of the underlying pathology is not excluded.

If symptoms occur, it is very important to provide emergency assistance to the victim. You should call a team of doctors at home, and then perform the following actions:

remove or remove a person from a room with a high content of carbon dioxide;
carry out tracheal intubation (only in a serious condition of the patient) - an experienced clinician can do this;
administer emergency oxygen therapy.

The only measure of assistance to a person who has fallen into an acidotic coma is artificial ventilation of the lungs.

Diagnostics

An experienced clinician will be able to make the correct diagnosis based on symptoms and laboratory results.

The doctor needs:

study the medical history - to look for a possible underlying disease;
collect and analyze a life history - to identify external causes, which will determine whether there was a need for a procedure such as permissive hypercapnia;
assess the condition of the skin;
measure pulse, heart rate and blood tone;
interview the patient in detail (if the person is conscious) or the one who delivered the victim to a medical facility - to compile a complete symptomatic picture and determine the severity of the condition.

Laboratory research:

general clinical blood test;
blood biochemistry;
assessment of the gas composition of the biological fluid;
analysis for KOS.

As for instrumental procedures, the following tests are performed:

chest x-ray;
ultrasonography;

Treatment

The tactics of therapy depends on the sources against which hypercapnia arose. If the pathology is exogenous, it is necessary:

ventilate the room;
go out into the fresh air;
take a break from work
drink plenty of fluids.

If the malaise has become a secondary phenomenon, in order to eliminate the pathology, it is necessary to eliminate the underlying disease. You may need to take these medications:

bronchodilators;
antibiotics;
anti-inflammatory drugs;
hormonal drugs;
immunostimulants;
diuretics;
bronchodilators;
medications to relieve symptoms.

You can eliminate the negative effect of carbon dioxide on the body in the following ways:

infusion therapy;
artificial ventilation of the lungs;
oxygen therapy;
chest massage;

Possible Complications

Violation of the normal composition of the blood can cause the formation of a large number of complications:

delayed child in mental and psychomotor development;
epilepsy;
hypoxia without hypercapnia in newborns;
miscarriage;
pulmonary hypertension;
malignant hypertension;
acute respiratory failure.

When you stay for a long time in a closed room with large quantity people have nausea, drowsiness and headaches. This suggests that hypercapnia may occur.

To understand how dangerous such a condition can be, you need to understand what it is and what it can be connected with.

Description of pathology

Hypercapnia is characterized by elevated levels of carbon dioxide in the blood. Initially, this condition is associated with respiratory failure.

In order to more fully understand the nuances of this disease, it is important not to forget about such a concept as the acid-base state (ACS), which is characterized by the production and release of acid in the human body, aimed at maintaining blood pH at normal level. The permissible value of this indicator is 7.35-7.45.

According to its origin, hypercapnia is divided into:

Exogenous, its development is facilitated by an increased level of gaseous carbon dioxide. When a person is in such an environment, CO 2 in the composition of his blood pathologically increases.
Endogenous. The provocateurs of its development are various pathologies occurring directly inside the body and accompanied by respiratory failure.

There is a close relationship between hypercapnia and hypoxia and respiratory acidosis.

What provokes the development of the disease

There are a number of causes of hypercapnia, which can be conditionally divided into three groups.

AT normal condition the release of carbon dioxide occurs through the lungs through penetration from the vessels into the alveoli. Due to a violation of breathing or blood circulation in the body, it is delayed.

In addition, some of the processes occurring in it can contribute to the increased content of CO 2 in the body:

fever;
excess nutrition;
sepsis;
polytrauma;
malignant hyperthermia.

Also, no less influence on the body and the development of hypercapnia have such reasons as:

equipment failure during the operation, when the patient is under anesthesia;
inhalation of carbon monoxide, for example, in a fire;
staying in poorly ventilated rooms for a long time.

Diving to a sufficiently large depth also leads to an increase in the level of carbon dioxide in the human blood.

Main manifestations, signs

Pathology can be acute or chronic.

The first is characterized by such symptoms of hypercapnia as:

dyspnea;
pain in the chest;
redness of the skin;
nausea;
rapid pulse;
headaches and dizziness;
drowsiness;
confusion.

The level of carbon dioxide in the blood will directly affect the severity of symptoms.

With short-term exposure (over several hours), the following will be observed:

apathy;
poor concentration;
lack of fresh air;
feeling of heat;
fatigue;
eye irritation.

As a result of regular exposure to CO 2 for several days or years, many functions are impaired. Let's see how this manifests itself.

From the nasopharynx and respiratory system:
- rhinitis;
- bouts of dry cough;
- asthma;
- allergic reactions;
- dry mucous membranes.
Effect on sleep:
- increased snoring;
- insomnia;
- lack of energy after waking up.

Clinical manifestations may be:

Early. The condition is characterized by vasodilation, reddening of the skin and profuse sweating. In the future, a high content of carbon dioxide induces the body to activate mechanisms from the vessels and the heart in order to compensate. As a result, tachycardia begins to develop, an increase in heart rate is noted, and the tone of the veins increases. Such symptoms inform about the body's attempt to restore blood circulation, which is necessary to saturate the central nervous system with oxygen. Blood begins to flow to the brain and heart.
Late. They show decompensation due to the nervous, respiratory and cardiovascular systems. This is expressed by blue skin, overexcitation or inhibition.

Signs of hypercapnia, depending on the severity of the pathology:

The chronic form of hypercapnia is characterized by the manifestation of the following symptoms:

dyspnea;
constant feeling of fatigue;
respiratory rhythm disturbances;
lack of performance;
unstable mood;
pressure drop.

It should be noted that with this form of the disease, changes are rarely observed. This is due to the gradual development of pathology, which allows the body to get used to this condition.

How the disease is diagnosed

The following methods are used to diagnose hypercapnia:

clinical data. First of all, the symptoms accompanying similar condition: cyanosis, shortness of breath, forced position and other characteristic signs.
Laboratory research:

aerotonometry - determination of the gas content in the blood;
analysis of the acid-base state.

Only after receiving the results, the doctor will be able to make a final diagnosis and prescribe the correct treatment for hypercapnia.

Therapeutic measures

When a pathology is detected, the first step is to eliminate the cause that provoked respiratory disorders, which led to a large accumulation of carbon dioxide in the body. With an exogenous form of the disease, it is recommended:

to ventilate the room;
drink large amounts of liquid;
be sure to rest after a working day;
go out into the fresh air.

At the initial stage of development of respiratory failure, the use of folk remedies in the form of herbal decoctions is not excluded.

With a noticeable deterioration in the condition, it is important to immediately seek help from specialists who, after examination and confirmation of the diagnosis, will prescribe if necessary medical therapy including:

taking bronchodilator drugs;
oxygen therapy;
the introduction of fluid through a vein;
connection of a ventilator (the method is used in extreme cases).

In addition, depending on the form of the course of the disease, drugs of the following groups can be prescribed:

hormonal;
antibiotics;
anti-inflammatory;
immunostimulating.

A capnograph is used to control seizures. It determines the concentration of carbon dioxide in the air exhaled by people.

Possible complications and consequences

A disease such as hypercapnia can both go unnoticed by a person and cause a number of serious complications. Everything will depend on the severity of the pathology and how well the treatment therapy was chosen.

Respiratory failure can provoke many consequences in the fetus or newborn, if during pregnancy the expectant mother had respiratory acidosis. The increased content of carbon dioxide in the body negatively affects the incompletely formed nervous system of the fetus.

As a result, this can turn into:

developmental delay not only mental, but also psychomotor;
cerebral palsy;
epilepsy and other rather serious diseases.

The most severe complication is considered to be hypercapnic coma, which can lead to respiratory and cardiac arrest, resulting in death.

Preventive actions

To prevent the development of an endogenous pathology, it is important to take timely measures to eliminate respiratory diseases, especially those that can lead to respiratory failure.

Measures to prevent the pathology of a chronic exogenous species are:

frequent exposure to fresh air;
regular breathing exercises;
ventilation of closed premises;
timely check of the devices used for anesthesia.

Most people, perhaps, have experienced early symptoms more than once. advanced level carbon dioxide in the blood. It should be remembered that mild form disease does not pose any danger to the human body.

More serious consequences may be deep form pathology. Therefore, it is so important to observe elementary preventive measures, and at the first signs of deterioration, seek medical help in a timely manner.

Doctor-therapist, candidate of medical sciences, practicing doctor.

Hypercapnia is an increased amount of carbon dioxide in the arterial blood and tissues of the body. This term is not familiar to many, but almost everyone felt the state characterized by this word.

Remember what you experienced large cluster people– in queues, in stuffy offices. or state during respiratory diseases when the nose is stuffed up and the bronchi are clogged with phlegm. The head begins to spin or hurt, there is severe weakness, nausea, the heart beats faster, sweat comes out.

In an article about benefits of carbon dioxide We have already touched upon the concept of hypercapnia. Let's take a closer look at what this term means?

What is hypercapnia?

Carbon dioxide in our body can be both beneficial and harmful. It all depends on the amount of content. There is a concept of balance, the norm for this indicator is 4.7-6%.

The normal mechanism for removing carbon dioxide from the human body– through the lungs, by penetration from blood vessels into the alveoli. If for some reason this process is disrupted,hypercapnia– increase in carbon dioxide.

Then the CO pressure 2 in the gas mixture rises to 55– 80 mm Hg, and the level of oxygen decreases. Simply put, carbon dioxide poisoning occurs.

Types of hypercapnia

Hypercapnia is inherentlyexogenous and endogenous.

Exogenous develops with an increased content of carbon dioxide in the air. It arises, one might say, for external reasons beyond your control: queues, a stuffy room.

And endogenous hypercapnia is caused by internal causes:

Violation of the respiratory mechanism due to weakness of the skeletal muscles, chest injuries (compression, fractures), morbid obesity, scoliosis.
Respiratory center depression (more than rare breath) associated with damage to the central nervous system, the use of pharmaceuticals (anesthetics, narcotic analgesics), circulatory arrest, etc.
Gas exchange disorders: pulmonary edema, COPD (chronic obstructive pulmonary disease), pleurisy (inflammation of the lining of the lungs), pneumothorax (accumulation of air in pleural cavity) and etc.

Increase in CO 2 may also be a consequence of its increased formation in the body itself. The cause may be fever, sepsis, polytrauma, malignant hyperthermia.

Why is hypercapnia dangerous and who is affected by it?

The form of hypercapnia can be mild, such a person will not particularly feel. Leaving the stuffy room, he will quickly forget about the sensations that he experienced,– slight dizziness, redness of the skin, rapid heartbeat and breathing.

With hypercapnia of the initial form, especially if it "forms" gradually (within several days, even a month), the human body copes more easily. The mechanisms of adaptation and compensation are included.

With deep hypercapnia, the symptoms are more aggressive. There may be deviations from several body systems at once.

From the nervous system: there is agitation, symptoms of increased intracranial pressure (nausea, headache, bruising under the eyes, swelling, etc.).
From the side of the cardiovascular system: blood pressure continues to rise, the pulse reaches 150 beats per minute, there is a risk of bleeding.
From the respiratory system. The symptoms of acute respiratory failure increase: the rhythm of breathing is disturbed, it becomes superficial and rare, bronchosecretion increases, the skin tone is bluish, sweating is strong.

The most severe degree of hypercapnia (it is also the most dangerous)– hypercapnic coma. A person in a state of coma has no reflexes and consciousness, blood pressure drops sharply, the skin tone is cyanotic (bluish). The result can be respiratory and cardiac arrest, i.e. death.

Hypercapnia is very dangerous for women during pregnancy. Speech can go
about miscarriage due to the development of respiratory failure, increased blood pressure
and disorders of placental gas exchange.

The second scenario– a child may be born with a pathology (mental retardation, psychomotor development, child cerebral paralysis, epilepsy, etc.). High level SO 2 negatively affects the still not fully developed nervous system of the baby.

How to stabilize the condition of a person affected by hypercapnia?

Help with hypercapnia

The amount of assistance to the victim depends, of course, on the degree of carbon dioxide poisoning. In order to stabilize a person's condition and reduce the risks of complications, it is necessary, firstly, to ensure a sufficient supply of oxygen. This is the simplest and at the same time the most important step.

If a person himself is not able to leave a stuffy room, you need to take him out into the air. Most of the time this is enough for elimination of mild exogenous hypercapnia.

With endogenous (internal) origin, it is about eliminating the underlying disease or alleviating the severity of its symptoms. Some patients are prescribed systematic airway clearance, thinning and removal of viscous bronchial secretions.

A good effect is given by the patient's stay in a cool room with a humidity level of more than 50%. To improve lung ventilation, bronchodilators are used - a group of drugs that can relax the muscular wall of the bronchi and thereby increase their lumen, as well as respiratory stimulants. Thanks to these measures, the patient's condition is normalized.

In case of severe carbon dioxide poisoning, you will not manage on your own, here you will need the help of doctors, sometimes emergency. Otherwise, the person may die.

In especially severe cases, doctors perform tracheal intubation (the introduction of a special tube for intensive care), oxygen therapy (the patient breathes a balanced oxygen-nitrogen mixture), resort to artificial lung ventilation.

Hypercapnia and breathing exercises

With endogenous hypercapnia, which appears due to internal disturbances in the functioning of the body, it is contraindicated to engage in respiratory gymnastics or conduct classes on respiratory simulators.

But despite this, it was important for us to blog about this phenomenon and its consequences. After all, we often talk about the benefits of carbon dioxide, so it would be simply dishonest to remain silent about its harm.

If you have been diagnosed with hypercapnia or acidosis by your doctor, do not under any circumstances start exercising on breathing machines. This may make the situation worse.

If you do not have such a diagnosis, and the carbon dioxide content is below normal, then you can purchase breathing simulator. In this case, you do not need to be afraid that you will have a serious endogenous hypercapnia.

Firstly, the simulator cannot lead to such a result, it is aimed only athealing of the body . Secondly, you can always measure the level of carbon dioxide using a special camera that comes with the simulator.

Carefully monitor your health, listen to all the "signals" of your body
and subscribe to our blog to recognize them in time.