The rebreathing system serves for connection of a respirator with an endotracheal or trakheostomchesky tube. In structure the unidirectional (unilinear) and bidirectional (two-linear) rebreathing systems differ. In the first case the exhalation of the patient is made via various types of valves in the atmosphere at once. In the second case the exhalation of the patient gets at first to the line of an exhalation, then goes to a respirator and is removed in the atmosphere via the exhalation valve.
According to the destination distinguish anesthesiology rebreathing systems which are intended for narcotic devices and contours for ventilators. Also contours can be warmed, that is have the built-in heating element and a temperature sensor and not warmed. In the latter case, if heating of such contour is planned, the heating element and a temperature sensor are mounted in it by preparation of a respirator for work. Also rebreathing systems differ depending on material of which they are made.
During an era of a pandemic of a koronavirusny infection two main strategy of respiratory support for this pathology which flow on increase of invasiveness from one in another at inefficiency of less invasive were created. Very first, initial, strategy means use of an oxygen mask or nasal cannulas with supply of the moistened oxygen.
Following level of respiratory support: use of high-line nasal oxygenation or noninvasive ventilation through a mask. These stages already mean use of special rebreathing systems. In a case with high-line nasal oxygenation the unidirectional contour for supply of the heated and moistened respiratory mix with a certain oxygen concentration and a certain stream is used. When carrying out noninvasive ventilation of the lungs through a front mask (CPAP and other similar techniques) both unilinear, and two-linear options of a rebreathing system can be used. When using an unilinear rebreathing system with leak placement of the virus and bacterial respiratory filter on the line of a breath and also between the patient and the valve of an exhalation for decrease in both planting of the room, and virus load of personnel is obligatory. If it is going to use a two-linear rebreathing system, then virus and bacterial filters are placed on branch pipes of a breath and an exhalation. If the virus and bacterial filter with heatmoisture exchange function is used, then it can be placed between a rebreathing system and the patient's mask.
It should be noted that when using noninvasive methods of respiratory support of patients with a koronavirusny infection (high-line nasal oxygenation, noninvasive ventilation of the lungs) massive planting of the environment and high virus load of personnel is noted. It is connected with techniques of such respiratory support which mean the high level of leak of respiratory mix in the atmosphere and dictates special attention of personnel which are engaged in treatment of such patients, to individual protection equipment. In the organizational plan it is expedient to allocate for the patients getting neinazivny respiratory support, separate chambers and to separate them from the patients who are on artificial ventilation of the lungs.
At inefficiency of noninvasive respiratory support resort to standard (invasive) artificial ventilation of the lungs through an endotracheal or tracheostomy tube. At the same time the two-linear rebreathing system with two virus and bacterial filters (on branch pipes of a breath and an exhalation) or one virus and bacterial filter with function of heatmoisture exchange on the distal end of a rebreathing system is used (usually after the Y-shaped connector). In the latter case the humidifier is not used. Also unacceptably combined use of the respiratory filters located on the distal end of a rebreathing system (after the Y-shaped connector), with humidifiers of respiratory mix as it leads to accumulation of damp and warm respiratory mix in space between a humidifier and the filter.
Special attention should be paid to the organization of sanitation of a tracheobronchial tree at patients with a koronavirusny infection. Because this procedure is one of the most dangerous in respect of virus load of personnel, it is expedient to use the special closed systems of sanitation which are placed between a contour and an endotracheal (tracheostomy) tube and allow to avoid depressurization of a contour. Essential plus of such systems is the fact that at their use carrying out artificial ventilation of the lungs in the course of sanitation of a tracheobronchial tree does not stop that reduces risk of a hypoxia at the patient during the procedure. In the absence of such systems for sanitation it is necessary to use special corrugated adapters with port for sanitation which are placed between a rebreathing system and an endotracheal (tracheostomy) tube.