At implementation of respiratory support for a koronavirusny infection the choice of the IVL mode is made proceeding from a condition of the patient, safety of function of spontaneous breath at it and also by degrees of sedation and the neuromuscular block which are necessary for ensuring normal ventilation and oxygenation. Thus, if the patient has no spontaneous breath completely, respiratory support usually begins with the compulsory modes of ventilation. It allows the doctor to control completely oxygenation and ventilation of the patient and to be sure that respiratory support will be adequate. However in process of restoration at patients of spontaneous breath, their transfer to the compulsory and auxiliary modes, and further — on the intellectual modes of artificial ventilation of the lungs further is required.
Mean group of the modes which on the basis of the built-in artificial intelligence are capable to calculate and realize extent of necessary respiratory support for the specific patient, proceeding from his age, sex, anthropometrical data and other factors by the intellectual modes of artificial ventilation of the lungs. At the same time qualitatively realized intellectual modes allows to work to a respirator as it is exclusive in compulsory, and in completely auxiliary mode. For this reason many intensivist use only these modes for ventilation of patients, only in certain cases resorting to others.
One of examples of the intellectual modes of artificial ventilation of the lungs is the Smart Care mode in Evita fans of Drager. The essence of this mode consists that the doctor sets rather detailed initial parameters of the patient, such as growth, weight, existence of certain chronic diseases, the size of an endotracheal tube and so on, and a respirator automatically builds the program of ventilating support so that gradually to transfer the patient to spontaneous ventilation. The mode automatically analyzes a respiration rate, respiratory volume and also concentration of carbon dioxide in expired air and on the basis of it builds the individual program of excommunication of the patient from a respirator. If the patient, at the set level of inspiratory pressure adequately breathes, then the fan gradually reduces support pressure. If the fan understands that the patient at the set level of inspiratory pressure breathes inadequately, then it automatically raises support level till demanded. It should be noted that such assessment is carried out each two minutes. When the program is completely implemented, there is an inscription that the patient can be disconnected from the fan. It occurs when the patient begins to breathe steadily at the minimum level of support.
The following conditions are necessary for work of this program: invasive ventilation, a stable hemodynamics, existence of a certain level of consciousness at the patient, stable and steady respiratory activity.
The second example of use of the intellectual modes in respirators is the ASV mode in respirators of Hamilton. The purpose of this mode consists in providing the sufficient level of respiratory support of the patient and at the same time not to allow development in the last tachypnea. Are for this purpose used the special program which is adjusted by the doctor. Depending on respiratory activity of the patient and settings, the mode automatically establishes frequency of both compulsory, and spontaneous breaths of the patient. At the same time correction of parameters of both a compulsory, and spontaneous breath is carried out automatically, depending on the tasks set in settings. If to speak in other words, the device itself changes extent of respiratory support to reach target respiratory volume. Also the device automatically selects a respiration rate of the patient so that during an exhalation full release of lungs from the last portion of respiratory mix was carried out.
In settings of this mode the doctor establishes target indicators of minute volume and also border admissible during ventilation, at the same time settings can be set in such a way that the fan can work in this mode as with patients who need full ventilating support, and with patients who need only assisted ventilation and excommunication from IVL.
As we see, possibilities of intellectual artificial ventilation of the lungs are rather wide now and this method can be used for respiratory support of patients with a koronavirusny infection at different degree of need for ventilation.