The technique of mechanical ventilation is considered in this review as a combination of physiology, medicine and engineering principles. Their association contributed to the development of mechanical ventilation, revealed the most urgent needs for improving this technology and the most promising ideas for the future development of this direction.
What is resuscitation
Resuscitation is a set of actions, which includes measures to restore suddenly lost vital body functions. Their main goal is to use methods of artificial lung ventilation in order to restore cardiac activity, respiration and vital functions of the body.
The terminal state of the body implies the presence of pathological changes. They affect areas of all organs and systems:
- brain and heart;
- respiratory andmetabolic systems.
Methods of artificial lung ventilation require taking into account the peculiarity of the body that the life of organs and tissues continues a little even after the heart and breathing have completely stopped. Timely resuscitation allows you to effectively bring the victim to his senses.
Artificial ventilation, also called artificial respiration, is any means of assisting or stimulating respiration, a metabolic process associated with the general exchange of gases in the body through ventilation of the lungs, external and internal respiration. It may take the form of manually delivering air to a person who is not breathing or is not making sufficient effort to breathe. Or it could be mechanical ventilation using a device to move air from the lungs when the person is unable to breathe on their own, such as during surgery with general anesthesia or when the person is in a coma.
The objective of resuscitation is to achieve the following results:
- airways must be clear and clear;
- need timely ventilation;
- circulation needs to be restored.
Features of ventilator technique
Pulmonary ventilation is achieved by a manual device for blowing air into the lungs, either with the help of a rescuer who delivers it to the patient's organ by mouth-to-mouth resuscitation, or by using a mechanical device designed for this procedure. The latter method turned out to be moremore effective than those involving manual manipulation of the patient's chest or arms, such as the Sylvester method.
Mouth-to-mouth resuscitation is also part of cardiopulmonary resuscitation, making it an important first aid skill. In some situations, this method is used as the most effective, if there is no special equipment at hand, for example, with opiate overdoses. The performance of the method is currently limited in most protocols for he althcare professionals. Medical assistants are advised to administer mechanical ventilation whenever the patient is unable to breathe.
Sequence of actions
Technique for artificial lung ventilation is to carry out the following measures:
- The victim is laid on his back, his clothes are unbuttoned.
- The head of the victim is thrown back. To do this, one hand is brought under the neck, the other gently raises the chin. It is important to throw back the head as much as possible and open the mouth of the victim.
- If there is a situation where you cannot open your mouth, you should try to put pressure on the chin area and make the mouth automatically open.
- If the person is unconscious, push the lower jaw forward by inserting a finger into the mouth.
- If you suspect that there is an injury in the cervical spine, it is important to gently tilt your head back and check for airway obstruction.
Varieties of techniquesIVL
To bring a person to life, the following methods of performing artificial ventilation have been developed:
- "mouth to mouth";
- mouth to nose;
- "mouth-device-mouth" - with the introduction of an S-shaped tube.
Techniques for mechanical ventilation require knowledge of certain features.
It is important when performing such operations to monitor if the heart has stopped.
Signs of such a condition may be:
- The appearance of a sharp cyanosis or pallor on the skin.
- No pulse in the carotid artery.
- Unconscious.
If the heart stopped
In case of cardiac arrest, closed heart massage should be performed:
- The person is quickly laid on their back, it is important to choose a hard surface for this.
- Resuscitator kneels on the side.
- It is necessary to put the palm of the base on the sternum of the victim. At the same time, do not forget that you can not touch the xiphoid process. On top of one hand lies the other hand with the palm of your hand.
- Massage is performed with vigorous jerky movements, the depth of which should be four to five centimeters.
- Each pressure should alternate with a straightening.
Performing the Safar triple dose implies the following procedures during mechanical ventilation:
- Maximum tilt of the head to straighten the airways.
- Push forwardlower jaw so that the tongue does not sink.
- Easy mouth opening.
Features of the mouth-to-nose method
The technique of carrying out artificial ventilation of the lungs using the "mouth-to-nose" method implies the need to close the victim's mouth and push the lower jaw forward. You also need to cover the area of \u200b\u200bthe nose with your lips and blow air in there.
Blow simultaneously into the mouth and into the nasal cavity with care to protect the lung tissue from possible rupture. This applies, first of all, to the peculiarities of carrying out mechanical ventilation (artificial ventilation of the lungs) for children.
Rules for chest compressions
The procedures for starting the heart must be performed along with mechanical ventilation. It is important to ensure the position of the patient on a hard floor or boards.
You will need to perform jerky movements using the weight of the rescuer's own body. The frequency of pushes should be 60 pressures in 60 seconds. After that, ten to twelve chest compressions should be performed.
The technique of artificial lung ventilation will be more effective if carried out by two rescuers. Resuscitation should continue until breathing and heartbeat are restored. It will also be necessary to stop actions if the biological death of the patient has occurred, which can be determined by characteristic signs.
Important notes whenperforming artificial respiration
Rules for mechanical ventilation:
- ventilation can be done by using a device called a ventilator;
- insert the device into the patient's mouth and activate it by hand, observing the required interval when introducing air into the lungs;
- breathing can be assisted by a nurse, doctor, physician assistant, respiratory therapist, paramedic, or other suitable person squeezing a bag valve mask or bellows set.
Mechanical ventilation is called invasive if it involves any instrument that penetrates the mouth (such as an endotracheal tube) or the skin (such as a tracheostomy tube).
There are two main modes of mechanical ventilation in two departments:
- forced-pressure ventilation where air (or other gas mixture) enters the trachea;
- negative pressure ventilation, where air is essentially sucked into the lungs.
Tracheal intubation is often used for short-term mechanical ventilation. The tube is inserted through the nose (nasotracheal intubation) or mouth (orthotracheal intubation) and advanced into the trachea. In most cases, products with inflatable cuffs are used for leakage and aspiration protection. Cuffed intubation is considered to provide the best protection against aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, unless the patient is unconscious or otherwise anesthetized,sedatives are usually prescribed to ensure tube tolerance. Other disadvantages of tracheal intubation are damage to the nasopharyngeal mucosa.
History of the method
A common external mechanical manipulation method introduced in 1858 was the "Sylvester Method", invented by Dr. Henry Robert Sylvester. The patient lies on his back with his arms raised above his head to aid inhalation and then pressed against his chest.
The shortcomings of mechanical manipulation led physicians to develop improved methods of mechanical ventilation in the 1880s, including Dr. George Edward Fell's method and a second, consisting of a bellows and breathing valve to pass air through the tracheotomy. Collaboration with Dr. Joseph O'Dwyer led to the invention of the Fell-O'Dwyer apparatus: bellows and instruments for inserting and withdrawing a tube that was advanced down the trachea of patients.
Summarize
A feature of artificial lung ventilation in an emergency is that it can be used not only by he althcare professionals (mouth-to-mouth method). Although for greater effectiveness, a tube must be inserted into the airways through a hole made surgically, which only paramedics or rescuers can do. This is similar to a tracheostomy, but the cricothyrotomy is reserved for emergency lung access. It is usually used only when the pharynx is completely blocked or if there is a massive maxillofacial injury,preventing the use of other aids.
Features of artificial ventilation of the lungs for children are the careful conduct of procedures simultaneously in the oral and nasal cavities. Using a respirator and oxygen bag will help make the procedure easier.
When carrying out artificial ventilation of the lungs, it is necessary to control the work of the heart. Resuscitation procedures are terminated when the patient begins to breathe on his own, or he has signs of biological death.
