Mechanical ventilation is carried out in the case when the patient does not have the opportunity to breathe independently. It can be divided into manual and hardware, and if even the person who is not related to medicine can cope with the first type, then for the second it is necessary to have knowledge about medical equipment.
What it is?
Mechanical ventilation is the injection 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 the event of a malfunction of the respiratory system, as well as as a defense against oxygen starvation.
Oxygen deficiency in the patient occurs in the case of pathologies that are spontaneous or operations, when during anesthesia oxygen cannot enter the body properly.
Mechanical ventilation is divided into hardware and direct forms. In the first case, a special gas mixture is used, which is delivered to the lungs through an artificial ventilation device. Direct ventilation involves compressing and expanding the organ, which provides passive inhalations and exhalations.
Varieties
There are two types of procedure:
- The mechanical way. This method involves blowing air into the patient's mouth. For this patient, you need to put it on a flat surface and throw his head back. It is necessary to stand next to the patient and, holding his nose with his fingers, actively blow air through his mouth. In parallel with this, an indirect massage of the heart should be performed, so the person begins to inhale air due to the elasticity of the tissues of the chest and lungs. The procedure is performed at the time of 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 health institution. The device, consisting of a special respirator and an endotracheal tube, is connected to a patient with respiratory failure, 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 by 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 to lower the 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:
- Absolute indications include 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 breathing rhythms. Apnea can be caused by the use of muscle relaxants used in anesthesia, as well as in the treatment of tetanus and epilepsy or any serious pathology: traumatic brain injury, tumor or swelling of the brain, anaphylactic shock, asphyxiation, drowning, deficiency of blood and oxygen to the brain, electric shock. Excessively increased 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 pathologies that occur in severe form. The grounds for absolute indications for mechanical ventilation are the clinical data on the general state of health of the patient.
- Relative indications include the growing deterioration of the patient's condition, which does not require immediate connection to a mechanical ventilation device. In this case, mechanical ventilation can be one of the treatment methods used in intensive care. The grounds for the relative indications, which require the use of artificial ventilation, are the data of analyzes obtained during clinical and laboratory examinations of the patient. Clinical recommendations for indications for mechanical ventilation are: acute respiratory failure resulting from disturbances in the central nervous system, pronounced tachycardia or bradycardia, hypertension or hypotension, poisoning of the body with drugs or chemicals, rehabilitation after surgery. Relative indications for mechanical ventilation in respiratory failure in most cases turn into absolute. Therefore, do not hesitate in their appearance, and it is better to apply one of the methods of mechanical ventilation for the patient.
Postoperative
An endotracheal tube is inserted into the patient immediately after surgery even in the operating room or in the intensive care unit. The main tasks and indications for the transfer to mechanical ventilation are:
- Recovery of mental functions, normalization of state during wakefulness and sleep.
- Food through the tube in order to restore normal bowel contraction and reduce disorders in the functioning of the gastrointestinal tract.
- Prevention of thrombosis.
- 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, which over a long period of time affect the body.
Mechanical ventilation after stroke
During and after a stroke, mechanical ventilation is used as rehabilitation. Indications for mechanical ventilation during a stroke are:
- coma of the patient;
- internal bleeding;
- impaired respiratory function;
- lung disease.
With ischemic and hemorrhagic stroke, the patient's breathing is difficult. Using a ventilator, cells are saturated with oxygen, gradually restoring brain function.
In stroke, mechanical ventilation 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.
Mechanical ventilation for pneumonia
With pneumonia occurring in acute and severe form, the patient may develop oxygen deficiency, which requires connecting it to mechanical ventilation.
In pneumonia, the main indications for mechanical ventilation are:
- Uneven breathing - more than 35-40 times per minute.
- Hypertension and hypotension at a critical point.
- Fainting and mental disorders.
In order to reduce the risk of death and increase the effectiveness of the procedure, artificial lung ventilation is carried out at an early stage of the disease and lasts for 10 days or two weeks. Sometimes a few hours after placing the tube, it is necessary to make a patient a tracheostomy.
Methods
Artificial lung ventilation can be carried out in three ways. Indications for mechanical ventilation and its methods are individual for each patient:
- Volumetric. With this type of mechanical ventilation, the patient's respiratory rate is 80-100 cycles per minute.
- Oscillation. With this technique, intermittent and continuous flows alternate, respiratory rate of 600 cycles per minute.
- Inkjet. The most common method of artificial lung ventilation, at 300 cycles per minute, pure oxygen or a special breathing mixture is introduced.
Possible problems
After connecting the ventilator, some problems may occur, the main of which are:
- Desynchronization with a respirator. It occurs for the following reasons: cough, bronchospasm, breath holding, improperly installed device.
- The struggle of man with the apparatus. To correct the situation, it is necessary to eliminate hypoxia, reinstall the device and check the device parameters.
- Increased airway pressure. The causes can be pulmonary edema, bronchospasm, hypoxia, air ingress with a damaged tube of the device.
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, pressure sores of the bronchial mucosa, decreased pressure, cardiac arrest.
Regardless of the fact that negative consequences are possible with artificial ventilation of the lungs, its timely implementation helps save the patient's life in a critical situation, and provides adequate pain relief during surgery. Therefore, talking about the possible consequences sometimes just does not make sense.