The technique of artificial lung ventilation is considered in this review as a combination of physiology, medicine and engineering principles. Their combination contributed to the development of mechanical ventilation, revealed the most pressing needs for improving this technology and the most promising ideas for the future development of this area.
What is resuscitation?
Resuscitation refers to a set of actions, which includes measures to restore the suddenly lost vital functions of the body. Their main goal is the application of methods of artificial ventilation of the lungs 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 system and metabolic system.
Methods of artificial ventilation of the lungs 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 achieve effective reduction of the victim's feelings.
Artificial ventilation, also called artificial respiration, is any means of assisting or stimulating breathing, a metabolic process associated with the general exchange of gases in the body through ventilation of the lungs, external and internal respiration. It can take the form of a manual air supply to a person who does not breathe, or does not exert sufficient effort to breathe. Or it can be mechanical ventilation using a device to move air from the lungs when a person cannot breathe on his own, for example, during surgery with general anesthesia or when the person is in a coma.
The task of resuscitation is to achieve the following results:
- the airways should be clean and free;
- need to conduct a mechanical ventilation in a timely manner;
- it is necessary to restore blood circulation.
Features of the technique of holding mechanical ventilation
Pulmonary ventilation is achieved by means of a manual device for blowing air into the lungs either with the help of a lifeguard feeding it to the patient’s organ by resuscitation from mouth to mouth, or using a mechanical device designed for this procedure. The latter method turned out to be more effective than those that include manual manipulations with the patient’s chest or arms, such as the Sylvester method.
Mouth-to-mouth resuscitation is also part of cardiopulmonary resuscitation, which makes 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, in case of opiate overdoses. Method performance is currently limited in most protocols for healthcare professionals. Junior medical workers are advised to perform mechanical mechanical ventilation in each case when the patient is not breathing properly.
Sequence of actions
The technique of artificial ventilation consists in the following measures:
- The victim is laid on his back, his clothes are unfastened.
- The victim's head is thrown back. To do this, one hand is brought under the neck, the other carefully lifts the chin. It is important that you tilt your head back and open the victim’s mouth.
- If this is a situation where you cannot open your mouth, you should try to put pressure on the chin area and make sure that the mouth opens automatically.
- 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 carefully tilt your head back and check if the airways are blocked.
Varieties of ventilation techniques
To bring a person into feelings, 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.
The technique of artificial ventilation requires knowledge of some features.
It is important when performing such operations to monitor whether the heart has stopped.
Signs of this condition may include:
- The appearance of sharp blueness or pallor on the skin.
- Lack of pulse in parts of the carotid artery.
- Lack of consciousness.
If your heart stopped
In case of cardiac arrest, it is necessary to perform a closed heart massage:
- A person quickly lays on his back, it is important to choose a hard surface for this.
- The resuscitator kneels on his side.
- It is necessary to put the palm of the base on the sternum of the victim. However, 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 using vigorous jerky movements, the depth of which should be four to five centimeters.
- Each pressure should alternate with straightening.
Performing a triple intake of Safar involves the following procedures during artificial ventilation of the lungs :
- Maximum head tipping to straighten the airways.
- Advancing the lower jaw so that the tongue does not sink.
- Easy mouth opening.
Features of the mouth-to-nose method
The technique of artificial ventilation of the lungs by the “mouth-to-nose” method implies the need to close the victim’s mouth and push the lower jaw forward. It is also necessary to cover the area of ​​the nose with the help of lips and to blow air in there.
To be blown simultaneously into the oral and nasal cavities, it is necessary with caution to protect lung tissue from possible rupture. This applies, first of all, the features of mechanical ventilation (mechanical ventilation) for children.
Rules for performing indirect heart massage
Heart starting procedures should be performed along with artificial ventilation of the lungs. It is important to ensure the position of the patient on a hard floor or boards.
It will take jerky movements using the gravity of the lifeguard’s own body. The frequency of shocks should be 60 pressures in 60 seconds. After this, ten to twelve pressures on the chest area should be performed.
The technique of artificial ventilation of the lungs will show greater efficiency if it is carried out by two lifeguards. Resuscitation should continue until breathing and palpitations are restored. It will be necessary to terminate the actions in the event that a biological death of the patient has occurred, which can be determined by characteristic signs.
Important notes for rescue breathing
Rules for mechanical ventilation of the lungs by mechanical means:
- ventilation can be accomplished by using an apparatus called a fan;
- insert the device into the patient’s mouth and bring it into action by hand, observing the necessary interval when introducing air into the lungs;
- breathing can be helped by a nurse, doctor, doctor's assistant, respiratory therapist, paramedic, or other suitable person holding a bag valve mask or set of bellows.
Mechanical ventilation is called invasive if it includes any instrument that penetrates through the mouth (e.g., endotracheal tube) or skin (e.g., tracheostomy tube).
There are two main modes of mechanical ventilation in two departments:
- forced pressure ventilation where air (or another gas mixture) enters the trachea;
- negative pressure ventilation, where air is essentially absorbed into the lungs.
Tracheal intubation is often used for short-term mechanical ventilation. The tube is inserted through the nose (nasotracheal intubation) or the mouth (orthotracheal intubation) and moves into the trachea. In most cases, products with inflatable cuffs are used to protect against leakage and aspiration. Cuff tube intubation is believed to provide better protection against aspiration. Tracheal tubes inevitably cause pain and cough. Therefore, if the patient is not unconscious or anesthetized for other reasons, sedatives are usually prescribed to ensure tolerance to the tube. Other disadvantages of tracheal intubation are damage to the mucous membrane of the nasopharynx.
Method History
The general method of external mechanical manipulation introduced in 1858 was the Sylvester Method, invented by Dr. Henry Robert Sylvester. The patient lies on his back, and his arms are raised above his head to help inhalation and then are pressed to his chest.
The shortcomings of mechanical manipulation led to the fact that in the 1880s, doctors developed advanced methods of mechanical ventilation, including the method of Dr. George Edward Fell and the second, consisting of a bellows and a breathing valve for air to pass through the tracheotomy. Collaboration with Dr. Joseph O'Dwyer made it possible to invent the Fell-O'Dwyer apparatus: bellows and tools for inserting and removing a tube that moved down the patient’s trachea.
To summarize
A feature of artificial lung ventilation in an emergency is that it can be used not only by health professionals (mouth-to-mouth method). Although for greater efficiency, the tube must be inserted into the respiratory tract through an opening made surgically, which only medical personnel or rescuers can do. This is similar to a tracheostomy, but cricothyrotomy is reserved for emergency access to the lungs. Usually it is used only when the throat is completely blocked or if there is a massive maxillofacial trauma that prevents the use of other aids.
Features of artificial lung ventilation for children are to accurately carry out procedures simultaneously in the oral and nasal cavities. Using a respirator and an oxygen bag will help facilitate the procedure.
When conducting mechanical ventilation, it is necessary to control the work of the heart. Resuscitation procedures stop when the patient begins to breathe on his own, or he has signs of biological death.