I didn’t know what was wrong with my lungs until I was put on a ventilator. Uncover the truth about “lung damage”!

This is your first exposure to the concept of "severe respiratory disease"

Is it because of the "new coronavirus"?

"Severe respiratory illness" occurs every day in the respiratory and critical care medicine ward.

The coronavirus has only magnified the panic about "severe respiratory illness"

We are used to panicking about the results and selectively ignoring the causes, especially for something as common as breathing. We rarely wonder why the person next to us fell down first even though we were breathing the same air.

Dr. Xiao Jun from the Department of Respiratory and Critical Care Medicine at West China Hospital of Sichuan University was interviewed by West China doctors. We decided to start with breathing and find out how those severe respiratory illnesses that were sent to the ICU occurred.

Shortness of breath

So short that we always ignore it unconsciously

Experience the breathing process👇👇👇

The respiratory system completes one breath in 3 to 5 seconds.

"Begin to breathe"

Air is inhaled through the mouth and nose, and passes through the trachea until it reaches the alveoli.

The alveoli are lined with capillaries

The hemoglobin in it acts like a porter.

On the one hand, it moves oxygen molecules in the alveoli into the blood one by one, allowing the blood to transport oxygen to the entire body;

On the other hand, it unloads carbon dioxide from the blood and puts it into the alveoli.

The chest cavity contracts, creating pressure that pushes carbon dioxide out of the body.

The breathing time is very short.

So we rarely pay attention to it.

They don't even care what they inhale after taking a deep breath...

**Same environment,** Why did I get sick first?

It’s the same breathing process, there’s no big difference.

Why do some people become so sick that they fall down unexpectedly?

We don't pay attention to what we inhale.

But the truth is - the pathogens mixed in the air are precisely the culprits that cause us pneumonia.

Yes, the air can carry a variety of pathogens. Bacteria, viruses, mycoplasma, chlamydia, etc. can all be transmitted through the air.

When talking or sneezing, droplets carrying pathogens come out of the sick person's mouth and nose and rush into the respiratory tract of the next person.

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Once pathogens land in the lungs, they may set up camp, multiply in large numbers and attack lung tissue, causing an inflammatory response, leading to lung damage and destroying lung function.

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As a respiratory organ, once the function of the lungs is damaged, the corresponding gas exchange capacity will be affected. In mild cases, people will feel chest tightness and shortness of breath, while in severe cases, people will have difficulty breathing and a feeling of suffocation.

What about our immune system?

With an immune system, how is it possible for pathogens to take up residence in the lungs so easily?

Catching a cold, being tired, drinking too much or having an upper respiratory tract infection can cause the respiratory tract defense function to be impaired. In these cases, the immune system is not as powerful as the pathogen, so whoever wins will be the boss - this is also the reason why some people with low immunity are prone to pneumonia.

Overactivation of the immune system

Stimulate inflammatory mediator response

The inability of the immune system to fight pathogens is irritating.

But an overly strong immune system can also be fatal .

After pathogens enter the body, the immune system will resist too strongly. Although it can kill these invaders, it will also attack "its own people" - such as lung tissue when it goes crazy. This indiscriminate attack can also cause serious lung damage, which may even be more serious than direct attacks on lung tissue by viruses, causing ARDS - acute respiratory distress syndrome.

In addition to attacking the lungs, the "crazy" immune system may continue to attack the brain, heart, kidneys, liver, gastrointestinal tract, etc., causing multiple organ dysfunction throughout the body, which can be life-threatening in severe cases.

We call this situation "inflammatory storm".

This is the main reason why some young people who are in good physical condition are pushed into the ICU after being infected .

At this time, doctors need to protect not only your lungs, but also other organs to avoid the "tragedy" of a cold knocking out half of your organs.

**Entering the ICU means being intubated?

uncertain!

The most important task of the ICU at this time is to stabilize the patient (save his life), carry out targeted treatment, and buy time to identify the cause of the disease.

Common treatments include:

**Oxygen therapy and respiratory support: **When respiratory function is impaired, the patient's normal oxygen supply is affected, and oxygen therapy, ventilator, artificial lung (ECMO), etc. are needed to maintain respiratory function.

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**Find the cause of the disease: **After finding the pathogen that causes the disease, the doctor will try every means to provide a treatment plan to solve or control the cause.

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For example, for patients with severe pneumonia, doctors will find pathogens by sending the patient's tracheal secretions, bronchoalveolar lavage specimens or lung tissue biopsy specimens for testing, and then give precise antibacterial treatment to eliminate the pathogens from the body .

**Protect other organs: **For example, use vasoactive drugs to maintain adequate blood perfusion to various organs; provide bedside dialysis treatment when kidney function is impaired to allow the kidneys to get the necessary rest; use glucocorticoids when necessary to inhibit excessive inflammatory responses, reduce damage to other organs, and reduce the risk of sequelae.

These "respiratory emergencies"

You may be sent to the ICU.

High altitude pulmonary edema

People from the plains who suddenly enter a plateau over 3,000 meters above sea level may suddenly experience symptoms such as difficulty breathing, chest tightness, chest tightness, coughing, and coughing up white or pink foamy sputum.

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Acute asthma attack

It often occurs in patients with underlying asthma and is triggered by factors such as pollen, irritating odors, mood swings, exercise, etc., causing acute breathing difficulties, which may quickly endanger life in severe cases.

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Tension pneumothorax

There is actually a potential space between the lung tissue and the chest wall - the pleural cavity.

Pneumothorax occurs when the lung surface ruptures for any reason, causing the respiratory tract to communicate with the pleural cavity. If the rupture forms a one-way valve, gas can enter the pleural cavity but cannot be discharged. The gas in the pleural cavity increases, and the pressure increases, which will compress the lung tissue and heart shadow, affect respiratory function, and cause severe breathing difficulties.

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Acute laryngitis

Laryngitis caused by various reasons may progress to laryngeal mucosal edema. Severe mucosal edema may block the airway and cause breathing difficulties.

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Pulmonary embolism

Patients who have been bedridden for a long time after surgery, cancer patients, and people who do not move during long-distance travel (such as international flights, long-distance trains, and cars) may develop blood clots in the veins of the lower limbs. Activity, exertion, etc. can cause the blood clots to suddenly fall off.

The detached blood clot enters the lungs through the blood circulation, blocks the pulmonary artery, and causes pulmonary embolism, leading to sudden dyspnea, which may be accompanied by hemoptysis and chest pain.

Therefore, people who travel long distances should stop and walk more often.

Image source: Photo Network

Disclaimer: This article is for disease education purposes only, not medical treatment, and does not replace hospital visits.

About " Critical Respiratory Disease "

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References

[1] Yi Hui, Xie Canmao. Analysis of clinical and prognostic factors of severe pneumonia[C]//The 7th National Respiratory Disease Academic Conference and Training Course of the Chinese Medical Association. 0[2023-06-14].

[2] Liu Minsheng, Li Yanhua. Analysis of pre-hospital emergency treatment for traumatic tension pneumothorax[J]. Practical General Medicine, 2007. DOI:CNKI:SUN:SYQY.0.2007-08-057.

[3] Zhai Zhenguo, Wang Chen. Current status and prospects of research on pulmonary embolism-deep vein thrombosis[J]. Chinese Journal of Practical Internal Medicine, 2006. DOI:CNKI:SUN:SYNK.0.2006-14-006.

Content Production

Editor: Leslie

Map: Eastern Zhou Dynasty