Respiratory therapy in the context of treatment of a koronavirusny infection plays a special role. It is connected with the fact that the coronavirus affects first of all the system of external respiration. Respectively, many patients need respiratory support of this or that degree of manifestation. Degree of manifestation of this support can vary from oxygenation by small streams before full artificial ventilation of the lungs.
Depending on stay terms on IVL, at patients consequences of this or that degree of manifestation can be observed. in general, the person is longer is on artificial ventilation of the lungs, the more difficult there is a process of its excommunication from a respirator. The complexity is caused both by process of long IVL, and damage of lungs owing to a koronavirusny infection and also its consequences, for example, of fibrosis here.
Respiratory rehabilitation of patients has to begin already in the course of carrying out mechanical ventilation, after stabilization of a condition of the main systems of an organism. Further major importance in respiratory rehabilitation of the patient is on sale to his excommunication from a respirator and transfer to spontaneous breath.
The term "excommunication" no other than the translation of the English word "weaning" which means process of gradual disconnection of the patient from the fan and transition to completely spontaneous breath. This process is one of the most responsible and dangerous stages of respiratory support and rehabilitation. Especially it should be meant at long IVL. Premature disconnection from the fan can worsen a condition of the patient and level the efforts directed to restoration of gas exchange and oxygenation and also to lead to serious complications (a hypoxia, heart failure, exhaustion of the respiratory drive, post-hypoxemic encephalopathy) up to irreversible consequences. On the other hand, the delay with excommunication from the fan causes lengthening of terms of IVL, longer finding of the patient in ORIT, increase in risk of development of intrahospital pneumonia.
The efficiency and safety of the transfer of the patient to spontaneous breath is defined first of all by its readiness for this stage of respiratory rehabilitation. For assessment of readiness of the patient for excommunication from IVL with the most important parameters the following is:
Sufficient level of consciousness (it is not lower than nine points on a scale a lump of Glasgow), the low need for sedative drugs, existence of a tussive reflex, adequate contact with the patient.
Positive dynamics of a koronavirusny infection, decrease in extent of damage of lungs, in particular, normalization of a komplayns of pulmonary fabric, decrease in resistance of respiratory tracts.
Adequate neuromuscular conductivity, removal of residual curarization at a neobodimost.
Stable hemodynamics and normovolemia, lack of a left ventricular failure.
Acceptable laboratory indicators.
The compensated condition of acid-base and electrolytic balance: BE = ±3, Ras02 = 35–45 mm Hg., HC03 ~ 18–25 mmol/l, To more than 3.5 mmol/l, Na more than 130 mmol/l.
Good parameters concerning oxygenation: Ra02 not less than 70 mm Hg. and Sa02 more than 92% at Fi02 less than 50%, PEEP no more than 6-7 cm w.g.
Translation process of the patient on spontaneous breath can be labor-consuming and long. It is considered that at long IVL time from the beginning of excommunication from a respirator before complete cessation of IVL occupies on average 30–40% of duration of the entire period of IVL, but at a koronavirusny infection this period can be longer.
Several various protocols of gradual cancellation of IVL are at the moment developed and is offered. They come down to excommunication from IVL through one of the compulsory and auxiliary modes which transition to completely assisted ventilation (PSV together with CPAP) with the subsequent disconnection from a respirator follows. But so far we have very few data on features of the transfer of the patient to spontaneous breath at a koronavirusny infection. For example, one of stages of excommunication of the patient from a respirator in this case can include oxygen support by carrying out a usual or high-line oxygenotherapy. At the same time it is very important to pay attention to the general state and health of the patient. With sufficient auxiliary respiratory support the patient is quiet, available to contact, does not note feeling of the expressed shortage of air, auxiliary muscles do not participate in the act of a breath or exhalation, there is no paradoxic movement of a stomach during a breath. At auscultation rather distinct respiratory noise on all pulmonary fields, including lower parts are noted. The tussive reflex is kept.
After transfer of the patient to spontaneous ventilation at it the need for an oxygenotherapy during certain time can remain.