The Artificial Ventilation of the Lungs (AVL) is among enough traumatic ways of an intensive care when which carrying out development of various complications is possible.
All complications connected with carrying out IVL can be divided into two groups conditionally: early and late. The complications entering into the first group arise the first minutes and hours after the beginning of IVL, and development of complications of the second group requires usually several days or even weeks.
Disturbances of a hemodynamics usually develop right after an intubation of the patient and the beginning of hardware breath. Patients with a hypovolemia differ in special predisposition to them. As the reason of frustration of a hemodynamics after the beginning of IVL serves decrease in venous return to heart owing to positive pressure in respiratory tracts during an artificial breath, disturbance of diastolic filling of ventricles and also residual effect of the drugs used for the patient's intubation. Not expressed frustration of a hemodynamics usually do not demand serious correction; in other cases performing infusional therapy and purpose of inotropic support can be required by the patient.
The barotrauma can be shown both at the very beginning of IVL, and in later period. Serve as prerequisites to its development: initial existence at the patient of pulmonary pathology in the form of bullous emphysema, a pneumosclerosis, destructive pneumonia, the wrong control of the IVL parameters, use of the aggressive modes at patients with the kept respiratory activity, autocycling of a respirator and so on. This complication is usually shown by development of pheumothorax, or is (much more rare) than a pneumomediastinum or even a pneumopericardium. Treatment of consequences of a barotrauma consists in correction of the mode and parameters of ventilation and also to elimination of pheumothorax (pneumomediastinum). Softer option of a barotrauma is development of intersticial emphysema of lungs.
The atelectasis when carrying out IVL can have the reason as the wrong standing of an endotracheal (tracheostomy) tube — its arrangement in one of primary bronchi (is more often in right), and obstruction of the main thing or lobar bronchi phlegm clots. All this leads to hypoventilation or total absence of ventilation of the blocked departments of a bronchopulmonary tree. The atelectasis is shown by weakening of breath over an affected area and also a characteristic X-ray pattern. Treatment of an atelectasis consists in elimination of its reason and further continuation of IVL.
Obstruction of an endotracheal (tracheostomy) tube is rather frequent late complication of IVL which is very dangerous to the patient at his untimely recognition. Obstruction usually happens due to drying of a phlegm on an internal surface of a tube, at the same time the obstruction option on a valve mechanism when air mixture arrives to the patient during a breath is most dangerous, and the exhalation is impossible. The patient behaves extremely uneasily, complains of the shortage of air. It is possible to suspect obstruction of a tube when performing its sanitation or in attempt to ventilate the patient by means of AMBU bag. Treatment consists in an immediate reintubation of the patient, or replacement of a tracheostomy tube.
Trachea stenoses also belong to late complications of IVL. They are shown after extubation of the patient. The clinical picture depends on level and degree of a stenosis, but usually includes difficulty of breath and a stridor of various degree of manifestation. All this can demand a reintubation of the patient or imposing of a tracheostoma. Treatment of stenoses usually surgical.
The fan-associated pneumonia is a late complication of mechanical ventilation of the lungs. It usually develops since the third day of stay of the patient on IVL. As a rule, the fan - the associated pneumonia is caused by intrahospital flora of the intensive care unit, and from here badly gives in to standard antibacterial therapy. The most frequent activators: kliyebsiyella, acinetobacter, golden staphylococcus. Diagnostics the fan - the associated pneumonia is carried out on the basis of clinic (persistent fever, an auskultativny picture), datas of laboratory, a X-ray pattern. Crops of a phlegm and determination of sensitivity of the marked-out culture to antibiotics are obligatory. Treatment consists in purpose of the empirical, and then and aim antibacterial therapy which is usually consisting of reserve antibiotics. Effectively also prescription of antibiotics and antiseptic agents is inhalation.
Sinusitis develops usually owing to a long intubation of a trachea, especially nazotrakhealny. Treat late complications of IVL. Are shown by all-inflammatory reaction, the obvious clinical symptomatology can be absent. Are diagnosed usually by means of a rengtgenografiya of a skull and a computer tomography. Treatment consists in purpose of antibacterial drugs. If necessary surgical sanitation of the center is carried out.
Infection of a tracheostoma also belongs to late complications. It is shown by visible infection of an opening in which there is a tracheostomy tube. Diagnostics usually does not cause difficulties. Treatment consists in purpose of antibacterial and antiseptic agents to the place of an infection. System antibacterial therapy is required seldom.