Artificial ventilation is performed when the patient is unable to breathe on his own. It can be divided into manual and hardware, and if even a person who has nothing to do with medicine can cope with the first type, then for the second one you need to have knowledge of medical equipment.
What is this?
IVL is the blowing of air into the patient's lungs artificially. This ensures gas exchange between the environment and the alveoli. The procedure is used as part of resuscitation in case of a malfunction of the respiratory system, as well as to protect the body from oxygen starvation.
Oxygen deficiency in a patient occurs in the case of pathologies that are spontaneous in nature or operations when, during anesthesia, oxygen cannot enter the body properly.
IVL is divided into hardware and direct forms. In the first case, a special gas mixture is used, which is delivered to the lungs through a ventilator. Direct ventilation involves squeezing and unclenching the organ, during which passive inhalations and exhalations are provided.
Varieties
There are two types of procedure:
- Mechanical way. This method involves blowing air into the patient's mouth. For this, the patient must be placed on a flat surface and his head tilted back. It is necessary to stand next to the patient and, pinching his nose with your fingers, actively blow air through the mouth. In parallel with this, it is necessary to carry out an indirect heart massage, thus, a person begins to inhale air due to the elasticity of the tissues of the chest and lungs. The procedure is carried out at the moment of the critical condition of the patient, when there is no time to wait for the arrival of an ambulance.
- Hardware ventilation. This technique is carried out only in the intensive care unit of a he alth institution. The device, consisting of a special respirator and an endotracheal tube, is connected to a patient with impaired respiratory function, which is one of the main indications for mechanical ventilation. For adults and children, various artificial lung ventilation devices are used, which differ from each other in the parameters of the characteristics of the device. Hardware ventilation is always carried out in high-frequency mode, that is, 60 cycles can be carried out in one minute, which allows you to lower pressure in the respiratory organs, reduce lung volume and improve blood flow to them.
Possible indications
Indications for mechanical ventilation can be divided into absolute and relative:
- The absolute indications are those in which mechanical ventilation is the only option to save the patient's life. Absolute indications for mechanical ventilation are apnea for a long time, hypoventilation, critical respiratory rhythms. Apnea can be caused by the use of muscle relaxants used for anesthesia, as well as the treatment of tetanus and epilepsy, or any severe pathology: traumatic brain injury, tumor or swelling of the brain, anaphylactic shock, asphyxia, drowning, lack of blood and oxygen supply to the brain, electric shock. Excessively elevated or, conversely, low breathing rhythms can occur for the following reasons: edema, swelling and other injuries and diseases of the brain and lungs, agony, intoxication of the body, mechanical damage to the chest, pneumonia and bronchial pathology, occurring in severe form. The basis for absolute indications for mechanical ventilation is the clinical data of the general he alth of the patient.
- Relative indications include an increasing deterioration in the patient's condition, which does not require immediate connection to a ventilator. In this case, mechanical ventilation may be one of the methods of treatment used in intensive care. The grounds for relative indications, in which the use of artificial lung ventilation is necessary, are the data of analyzes obtained during clinical and laboratory examinations of the patient. Clinical guidelines for indications for mechanical ventilationare: acute respiratory failure resulting from disturbances in the functioning of the central nervous system, pronounced tachycardia or bradycardia, hypertension or hypotension, poisoning of the body with medicines or chemicals, rehabilitation after surgery. Relative indications for mechanical ventilation in respiratory failure in most cases become absolute. Therefore, you should not hesitate when they appear, and it is better to use one of the methods of artificial lung ventilation in relation to the patient.
Performance in the postoperative period
An endotracheal tube is inserted into the patient immediately after surgery while still in the operating room or in the intensive care unit. The main tasks and indications for transfer to mechanical ventilation are:
- Restoration of mental functions, normalization of the state during wakefulness and sleep.
- Feeding through a tube to restore normal bowel contraction and reduce gastrointestinal disturbances.
- Prevention of blood clots.
- Minimizing the risk of developing complications of an infectious nature by eliminating the expectoration of sputum and secretions from the lungs.
- Reducing the negative effects of anesthetics that affect the body over a long period of time.
VL after stroke
During and after a stroke, mechanical ventilation is used as a form of rehabilitation. Indications for mechanical ventilation during a stroke are:
- coma patient;
- internal bleeding;
- impaired respiratory function;
- affected by lung disease.
In ischemic and hemorrhagic stroke, the patient's breathing becomes difficult. With the help of a ventilator, cells are saturated with oxygen, gradually restoring brain function.
In case of a stroke, artificial ventilation of the lungs should be carried out no more than 14 days. It is believed that this period is enough to reduce cerebral edema and stop the acute period of the disease.
VL for pneumonia
In acute and severe inflammation of the lungs, the patient may develop oxygen deficiency, which requires him to be connected to artificial lung ventilation.
In case of pneumonia, the main indications for mechanical ventilation are:
- Irregular breathing - more than 35-40 times per minute.
- Hypertension and hypotension at the critical point.
- Faints and mental disorders.
In order to reduce the risk of death and increase the effectiveness of the procedure, mechanical ventilation is performed at an early stage of the disease and lasts for 10 days or two weeks. Sometimes a tracheostomy may be necessary a few hours after the tube is placed.
Methods of implementation
Artificial ventilation can be carried out in three ways. Indications for IVL and its methodsprocedures are individual for each patient:
- Volumetric. With this type of ventilation, the patient's respiratory rate is 80-100 cycles per minute.
- Oscillatory. With this technique, intermittent and continuous flows alternate, the respiratory rate is from 600 cycles per minute.
- Inkjet. The most common method of artificial ventilation of the lungs, pure oxygen or a special respiratory mixture is introduced at 300 cycles per minute.
Possible problems
After connecting the ventilator, some problems may occur, the main ones are:
- Desynchronization with a respirator. It occurs for the following reasons: cough, bronchospasm, breath holding, incorrectly installed apparatus.
- Struggle between man and machine. To correct the situation, it is necessary to eliminate hypoxia, reinstall the device and check the device parameters.
- Increased airway pressure. The causes may be pulmonary edema, bronchospasm, hypoxia, air ingress with a damaged apparatus tube.
Consequences and complications
The use of mechanical ventilation can lead to the following negative consequences and complications in the patient: pulmonary edema, mental disorders, bleeding, fistulas, bedsores of the bronchial mucosa, decreased pressure, cardiac arrest.
Despite the fact that mechanical ventilation may have negative consequences, its timely implementation helps to save the life of a patient in a criticalsituation, and provides adequate pain relief during surgery. Therefore, sometimes it simply does not make sense to talk about possible consequences.
