When talk about the pneumonia caused by viruses first of all mean the damages to pulmonary fabric caused by H1N1 influenza virus. This pneumonia differs in rather heavy and long current, demands the accurate program of medical actions and often demands carrying out to the patient of respiratory support. It is connected with frequent development respiratory a distress syndrome, extensive defeat of pulmonary fabric, the increasing resistance of a virus to antiviral drugs. In more remote period also accession of a bacterial infection can play a role.
The disease begins with a typical viral infection and is first shown by flu symptomatology. Further resistant fervescence which badly answers standard febrifugal drugs is noted. There are signs of respiratory insufficiency, an asthma, cyanosis, hemodynamic disturbances. The symptomatology can accrue during a short period. After receipt in a hospital such patients are often hospitalized in intensive care units and resuscitation.
Monitoring shall include continuous clinical observation, a pulsoksimetriya, arterial blood pressure, heart rate, an ECG, control of gas composition of blood. According to indications also other types of monitoring, for example, invasive monitoring of a hemodynamics can be used.
In treatment of such patients the significant role is assigned to respiratory support which can vary from simple inhalation of the moistened oxygen before long mechanical ventilation of the lungs and even EKMO.
Inhalations of the moistened oxygen can provide substantial assistance to patients who on the clinical state do not need mechanical ventilation of the lungs. The oxygenotherapy is carried out under control of a pulsoksimetriya, respiration rate and gas composition of blood. It is desirable to use minimum sufficient streams of oxygen as he possesses negative action on a pulmonary parenchyma.
If the patient needs mechanical ventilation of the lungs, then follows special attention should be paid to prevention of an anoxemia in process of transformation in IVL as the specified group of patients belongs to the category of kislorodzavisimy. For this purpose pay attention to a qualitative preoksigenation and oxygenation during an intubation of a trachea. The patient is stacked in situation with the raised thorax. Preoksigenation will be seen to achievement of the indicators of oxygen on an exhalation demonstrating saturation of functional residual capacity of lungs oxygen. As for oxygenation of the patient during attempts of an intubation, it can be carried out by means of devices of high-line nasal oxygenation or by means of oxygen inhalation by a high stream through nasal cannulas.
In addition to oxygenation, when carrying out an intubation of a trachea at such patients it is necessary to pay attention to a system hemodynamics by the correct selection of the induction agent and his dose.
When choosing the modes of ventilation preference is given, as a rule, to the modes with control on pressure. It allows to control tightly pressure in respiratory tracts and to some extent to reduce barotrauma probability. The alternating compulsory ventilation with control on pressure and support of spontaneous breath of the patient pressure, the ventilation mode with two levels of pressure in respiratory tracts and other similar modes is used. Often for ensuring sufficient level of oxygenation it is necessary to use high values of positive pressure at the end of an exhalation. Oxygen concentration on a breath has to be minimum sufficient, considering the damaging action of its high concentrations on a pulmonary epithelium. It is necessary to seek to reach a certain balance between PDKV and oxygen concentration on a breath, seeking to provide adequate oxygenation and at the same time applying the ventilation mode which is most sparing for lungs.
Mechanical ventilation of the lungs with viral pneumonia can take rather long time therefore performance of early tracheotomy is important patients. Recently most often use puncture dilatatsionnuyu a tracheostomy, but in certain situations its performance can be complicated and it is necessary to use the traditional surgical equipment. Performance of a tracheostomy allows to improve considerably care of the patient and to reduce terms of finding of the patient by IVL.
In process of recovery of the patient and improvement of function of breath, carry out gradual transition to the IVL intellectual modes which allow to calculate respiratory support necessary for the patient and form the individual program of respiratory rehabilitation for each patient and excommunication from the fan.