Respiratory support is one of the most popular methods of treatment in an intensive care. The considerable number of various pathology became kurabelny thanks to this way of treatment. The number of patients who need respiratory support strongly depends on a profile of intensive care unit. For example, in offices where there are mainly patients after planned operations, the percent of the patients needing long respiratory support will be most often low while in intensive care units of hospitals of emergency medical service the number of patients on IVL are much higher.
Long artificial ventilation of the lungs contributes to the development in an organism of the patient of various changes which result in dependence of the patient on a respirator. This dependence is expressed in partial or full inability of the patient to maintain values of gas exchange at the normal level after disconnection from a respirator. With long respiratory support the atrophy of respiratory muscles and a diaphragm and also psychological dependence of the patient on the ventilator develops.
It is necessary to take into account and considerable number of specific respiratory pathology, first of all, the fan - the associated pneumonia which can increase terms of respiratory support and excommunication of the patient from a respirator is considerable complicate.
Excommunication of patients to various neuromuscular pathology, for example, with a myasthenia and also elderly patients, patients with the expressed disturbances of a lipometabolism, a syndrome of a sleepy apnoea and so on can happen especially difficult. Other things being equal conditions such rule usually works: the terms of respiratory support are lower, the excommunication of the patient from the fan is simpler.
It is also necessary to understand that excommunication of the patient from a respirator is not fast process and the dependence is here too traced: the more terms of respiratory support, the are longer there is an excommunication from a respirator with other things being equal.
Process of excommunication begins even during artificial ventilation of the lungs. In the course of implementation of respiratory support it is already necessary to imagine the plan of excommunication of the patient. Originally it is necessary to achieve resistant positive dynamics in treatment of that pathology which served as the cause of respiratory insufficiency and need of the patient for artificial ventilation of the lungs. Also significant role is played by quality of implementation of the general care of the patient and harmonious work of all medical personnel of office.
The significant role belongs to degree of sedation of the patient. It is recommended to support minimum necessary level of sedation as sedative drugs have ability to oppress not only consciousness, but also respiratory function of the patient.
Performance of a tracheostomy in early terms (if there are bases to believe that respiratory support will be long) allows to improve considerably quality of care after the patient, to achieve decrease in level of sedation, to eat to the patient food in the natural way. All this also promotes faster excommunication of the patient from the fan.
For excommunication of the patient the step scheme of decrease in level of respiratory support is used. The great value belongs to high-quality setup of the fan in the course of carrying out respiratory support. It allows not to oppress completely respiratory function (if it is kept) and, respectively, to reduce dependence of the patient on a respirator.
The general scheme of excommunication from a respirator looks as follows: the compulsory modes of ventilation → the compulsory and auxiliary modes of ventilation → the auxiliary or intellectual modes of ventilation → spontaneous breath with support by pressure or volume → detachment from the fan.
This scheme is conditional and reflects only the general principle of excommunication from a respirator - decrease in level of respiratory support. For example, ventilation often begins at once with the compulsory and auxiliary modes (SIMV or PSIMV), or can begin with support of spontaneous breath pressure or volume at once.
The significant role in the course of excommunication of the patient from respiratory support belongs to the IVL so-called intellectual modes (for example, the ASV mode in respirators Galileo or the Smart Care mode in Evita respirators). These program algorithms are capable to define extent of respiratory support, necessary individually for it, on the basis of basic data of the patient, gradually reducing its level up to that moment when respiratory function of the patient is restored so that it can be disconnected from a respirator.