Insuffisance respiratoire aiguë : diagnostic et traitement aux urgences

Respiratory failure is a vast subject due to the diversity of its sufferers, the range of organs it affects, as well as its many causes. The difficult in the emergency department is to combine an immediate symptomatic treatment, an urgent diagnostic step and a specific treatment whom the effects are often delayed. Concerning the symptomatic treatments, the use of the non-invasive ventilation represents the most striking evolution of these last years. In recent years there have been few changes in specific treatments - the treatment of cardiogenic pulmonary oedema being the exception. The diagnostic step evolves so as long on the clinical setting (pulmonary embolism) that paraclinical setting with a real added value of the dosage of the brain natriuretic peptid (BNP) to distinguishing between pulmonary and cardiac causes of respiratory failure. Preliminary results on pro-calcitonin seem to show a reduced need for antibiotics in cases of community-acquired pneumonia. Severity rating of patients upon their arrival and during the course of their stay on the emergency ward are becoming better defined in several areas such as asthma, community-acquired pneumonia and pulmonary embolism and allow for a more accurate dispatch of patients to the relevant services.