The patients who are on IVL treat the most dependent and heavy contingent among all being in intensive care units and resuscitation. Their life is completely dependent on work of a respirator and care of them of medical personnel that dictates need of the most careful attention to such patients.
The first problem of the patients who are on IVL is that they are completely not mobile or are substantially inactive. This circumstance can be as a consequence of weight of a basic disease, and to have the reason sedation and, in certain cases, muscle relaxation of the patient. Respectively, prevention of the hypostatic phenomena and decubituses is one of the main elements of care of patients on IVL. The acting parts of a body of the patient (joints, a sacrum, a calcaneus and so on) have to be protected from squeezing by means of special gel pillows or other soft material. Perestilaniye patients is made in due time (not less than 2 times a day), at the same time attentively exclude plication of sheets.
Turns of the patient in a bed are an important component of leaving. As a rule, standardly they are carried out each 2 hours, at the same time IVL in so-called "pron-position", that is on a stomach is of particular importance. In situation on a stomach there comes redistribution of a pulmonary blood-groove and ventilation of certain sites of lungs that promotes their more uniform raspravleniye, prevention of developments of stagnation and, respectively, the fan - the associated pneumonia.
The second problem of leaving is a constant observation of the patient. Does not raise doubts that the patient should not even remain for a minute in private with the ventilator and monitors, even during an era of snowballing of the equipment. The personnel have to be present constantly at chamber and observe the patient. It is crucial in separate situations, for example, at accidental extubation, depressurization of a contour, sudden failure of the ventilator and so on. Regular and careful survey of the patient who is on respiratory support can reveal and skorrigirovat such disturbances as the wrong provision of an endotracheal (tracheostomy) tube, development of atelectases, barotraumas, a bronchospasm, a fluid lungs in time, to establish need of sanitation and so on.
Providing a comfortable position of a rebreathing system concerning the head of the patient at whom the tension of hoses and also flowing of condensate in respiratory tracts is excluded is important. It is necessary to trace a condition of moisture collections and hoses, in due time to empty them from condensate and also to fill with the distilled water a humidifier of respiratory mix if necessary.
The third problem of leaving — need of the correct performance of sanitation of a tracheobronchial tree — the procedure, requirement for which at such patients arises rather often. Sanitation is carried out at a phlegm congestion in an endotracheal (tracheostomy) tube and is capable to remove a secret only from the tube or a trachea. The sanatsionny bronkhoskopiya is applied to removal of a secret from bronchial tubes. Sanitation of a tracheobronchial tree is carried out by a disposable sterile sanatsionny catheter which diameter has to be four times less than the internal diameter of a tube. It is extremely desirable to use catheters with an opening for vacuum control. Monitoring of the patient during sanitation has to include a pulsoksimetriya surely. The patient for sanitation is trained, carrying out a preoksigenation and increasing respiratory volume a little. Sanitation is made with obligatory observance of rules of an asepsis. The aspiration catheter is connected to the system of a vacuum (having adjusted at the same time its necessary level), without concerning a sterile tracheal part of a catheter. The connector of an endotracheal (tracheostomy) tube is disconnected, or open a cover of the rectangular adapter and enter a catheter on necessary depth. At feeling of an obstacle the catheter is not advanced further, and on the contrary, a little tightened. The opening of vacuum control is closed a finger and the catheter is slowly taken from a tube, at the same time rotating it around an axis a little. After extraction the catheter is washed out sterile normal saline solution and repeat the procedure if necessary.
Sanitation of an oral cavity at the patients who are on IVL needs to be carried out also regularly, using for this purpose sanatsionny catheters of large diameter. Importance of this procedure is proved by the fact that in nadmanzhetochny space a significant amount of contents of an oral cavity accumulates that can lead to development of pneumonia when flowing it in the lower respiratory tracts. From this point of view use of endotracheal tubes with the channel for nadmanzhetochny aspiration is preferable.
Important point of care of the patient who is on IVL is the choice of optimum access to respiratory tracts. Lasting IVL less than seven day there is enough trachea intubation, and with longer respiratory support the tracheostomy is carried out. The tracheostomy can is executed earlier if it is known that IVL will demand a long time.