Process of excommunication of the patient from artificial ventilation of the lungs is one of the most important stages of treatment of a koronavirusny infection at a favorable current. It is connected as with the speed of the process of excommunication from IVL, and with the fact that at a koronavirusny infection artificial ventilation of the lungs is carried out for a long time. Therefore process of excommunication from IVL can be rather long and difficult both for the doctor, and for the patient. Besides, it must be kept in mind the fact that a considerable part of patients with a koronavirusny infection are people of advanced and senile age that also introduces the amendments in translation process them on spontaneous ventilation.
When planning excommunication of the patient from artificial ventilation of the lungs first of all it is necessary to estimate his compensatory reserves and ability to independent breath. To start the procedure of excommunication the patient has to be completely stable in respect of breath, a hemodynamics, a condition of internal environment of an organism, elimination of the main centers of an infection. In particular, such criteria as sufficient level of consciousness, positive clinicoradiological dynamics of pathology of lungs, normalization of pliability of pulmonary fabric, decrease in resistance of respiratory tracts, adequate neuromuscular conductivity, a normovolemia are very important. It is important that the patient had a compensated condition of acid-base equilibrium and water and electrolytic balance. Oxygenation parameters also have to be good.
If the condition of the patient allows to begin excommunication from the fan, then the intensivist makes the decision on the beginning of the transfer of the patient to spontaneous breath. If to speak simply, then excommunication from the fan represents process of gradual transfer of functioning of a system of breath from the device to the patient. At this stage return to some previous stages of an algorithm of excommunication and a delay on some of them is possible if the condition of the patient does not allow to pass to the following yet. Here it is very important not to hurry and understand that the artificial ventilation of the lungs was longer on time, the process of excommunication from the fan will be longer.
General scheme of excommunication of the patient from long IVL following. The patient is transferred from the compulsory mode on the compulsory and auxiliary mode. In the course of ventilation of the patient on the compulsory and auxiliary mode gradual reduction of frequency of compulsory breaths is carried out to stimulate growth of number of independent breaths at the patient. At the same time independent breaths of the patient get support by pressure or volume that allows the patient to feel more comfortably at the initial stage of excommunication from the fan. Further gradually the patient is transferred to the mode of support of independent breath by pressure or volume (is more often pressure). In this mode to the patient gradually reduce support by pressure, watching closely that necessary minute ventilation was reached and there was no tachypnea. It is very responsible stage of excommunication from the fan as compulsory ventilation from the fan is absent, and minute ventilation depends generally on the patient therefore when using this mode on the fan the ventilation mode on an apnoea has to be adjusted. Further transfer of the patient to the mode of spontaneous ventilation through a respirator with this or that level of support by pressure is possible, or if the patient shows good work of external respiration, the translation of the patient on spontaneous ventilation after test for independent breath is possible at once. As a rule, after excommunication from the fan the patient for some time needs an oxygenotherapy.
In case of use for excommunication from the fan of the intellectual modes, excommunication process considerably becomes simpler as the algorithm of the intellectual mode itself selects the necessary level of support and reduces it in process of restoration of spontaneous breath at the patient. If the patient shows good restoration of respiratory function, extent of support gradually decrease and if on the contrary, the aggravation of symptoms of the patient is observed, then extent of respiratory support increases up to necessary level. In process of restoration of spontaneous breath of the patient it is enough to transfer to spontaneous ventilation through a respirator or if it allows respiratory function, completely to pass to spontaneous breath with an oxygenotherapy.
Thus, we considered the main algorithm of excommunication of the patient from artificial ventilation of the lungs at a koronavirusny infection.