Breath plays very important role in ensuring activity of an organism. By means of the system of breath delivery of oxygen and removal of products of metabolism, first of all, of carbon dioxide is provided.
Respiratory insufficiency — inability of a system of breath to provide requirements of an organism on providing the last with oxygen and removal of carbon dioxide. In practice of an intensive care respiratory insufficiency most often meets for the following reasons: damage of lungs of various genesis, most often inflammatory, a thorax injury, a respiratory distress syndrome, a fluid lungs, exacerbation of chronic pulmonary diseases, secondary respiratory insufficiency owing to different lump, acute disorders of cerebral circulation and so on.
In diagnostics of respiratory insufficiency the significant role belongs to anamnestic data, a clinical picture and physical data. At the same time, more precisely the hypoxia and a hypercapnia is diagnosed by means of the gas analysis of an arterial and venous blood. For exact establishment of the reasons which caused respiratory insufficiency tool diagnostic methods can be used: X-ray analysis of bodies of a thorax, ultrasonic inspection (BLUE protocol), computer tomography and others.
Now in treatment of actually respiratory insufficiency distinguish invasive techniques — artificial ventilation of the lungs and noninvasive - an oxygenotherapy and noninvasive ventilation of the lungs.
The choice of the most preferable tactics of maintaining the patient is defined by the attending physician with a concrete clinical situation. In certain cases treatment can be begun with noninvasive techniques and be displaced to invasive if necessary.
Absolute indications by the beginning of artificial ventilation of the lungs is the apnoea, pathological types of breath, existence at the patient of deep disturbances of consciousness in combination with respiratory insufficiency, an aspiration syndrome or threat of its development in combination with consciousness disturbances, the expressed hypoxia and a hypercapnia. Now much attention is paid to the protective modes of artificial ventilation of the lungs which allow to achieve the greatest efficiency of ventilation at decrease in danger of injury of lungs.
For carrying out artificial ventilation of the lungs the modern respirators having a significant amount of the various modes of ventilation and also having functions of respiratory monitoring are used. When carrying out artificial ventilation of the lungs it is necessary to pay considerable attention to heating and moistening of respiratory mix that is usually reached by means of use of humidifiers or respiratory filters from functions warm and moisture exchange.
Access to respiratory tracts for the period of carrying out artificial ventilation of the lungs is provided by means of a trachea intubation at the first stages, and in the subsequent — by means of a tracheostomy. The tracheostomy allows to improve considerably quality of care after the patient therefore its performance has to be made without delays if long ventilation is planned (more than seven days, depending on pathology and other factors). The tracheostoma is much better transferred by the patient in comparison with a trachea intubation, allows it to eat food in the natural way and demands much less sedation. The recommended earlier nazotrakhealny intubation is used less often in view of considerable number of the complications connected with long stay of an endotracheal tube in a nasopharynx recently.
It is necessary to carry to noninvasive methods of respiratory support first of all a widespread oxygenotherapy most of which often is implemented by inhalation of the moistened oxygen through nasal cannulas. This rather simple technique allows to avoid increase of a hypoxia at the patient in those situations when respiratory insufficiency is not expressed and has short-term character (small oppression of respiratory function at patients in the postoperative period, residual effect of sedative drugs, a fluid lungs without indications to artificial ventilation and so on. For oxygen when performing inhalation it is necessary to establish minimum necessary stream and to use an oxygenotherapy only during that period when it it is really necessary.
More perspective direction is development recently of noninvasive techniques of ventilation of the lungs which in some cases allow to avoid transfer of the patient to artificial ventilation. For noninvasive ventilation of the lungs special algorithms of respirators and the corresponding expendables are used.