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MCE for mechanically ventilated adults (stationary)

From 01.08.2011 we have a contract with the National Health Fund to provide the establishment for mechanically ventilated adults.

 1. What’s the mechanical ventilation?

It is a method of treatment in which the breathing of the patient is replaced by ventilator. The purpose of the device and mechanical ventilation is to enforce and maintain the breath gas exchange in the lungs of the patient in the most optimal and natural way. This method is required in many diseases and injuries treatment where the patient is unable to breathe independently (e. g. brain damage, injuries and neurological diseases, pharmacological coma etc.).

2. Mechanical ventilation methods

Depending on the condition of the patient ventilator can:

 a) completely replaced by the patient's breathing –it is a full control mode. It takes place in cases when patient’s breathing muscles are not working due to the damage or are pharmacologically flabby (f. e. during surgical procedures). Ventilator gives defined with patient’s air capability number of breaths into the patient’s airways. In this mode, the screen will display a shortcut – CMV (Controlled Mechanical Ventilation).

b) control the amount and quality of the patient's own breathing and, if necessary, to assist him. It works this way – doctor sets a specific amount of breaths which patient must breathe per minute and the amount of air which patient will inhale. Device "watches" the breath of the patient and controls it in real time, and if the patient can no longer breathe by himself it gives a set earlier amount of air into his airway. SiMV (Synchronized intermittent Mandatory Ventilation) is the most common mode of ventilation for patients who have their own respiratory drives.

c) to maintain positive end-expiratory pressure in the lungs of the patient – which prevents atelectasis outbreaks, It causes the patient's lungs to expand after exhalation reducing the risk of pneumonia and improves the overall oxygenation of the patient. It is not a method but rather a basic technique of ventilation which supports patient’s own breathing.

All of the above modes of ventilation concern the group of variable volume.

There is another mode used for ventilation - variable pressure mode:

PCV (pressure controlled ventilation)is a mode similar to the CMV one (described earlier) in which doctor rather than setting the amount of air inhaled determines the pressure which must be achieved by patient’s lungs. The ventilator will be giving air to the moment when patient’s lungs will reach the set amount of pressure and end a single “breath”. This is a mode which saves the patient's lungs from the viewpoint of modern ventilation therapy. It is not suitable, however, for use in all cases.

3. Chronic mechanical ventilation:

Depending on the patient’s condition and medical indications, it may be carried out in two ways:

- invasive method

- noninvasive method

Noninvasive mechanical ventilation

The purpose of this type of ventilation is to help the patient breathe without the use of endotracheal tube or tracheostomy tube. The air is fed into the patient's airway through a tightly fitting face masks of various kinds. This type of ventilation is often used in home for patients with chronic respiratory failure as an early phase of treatment.

What are the contraindications for non-invasive ventilation?

- inability to sustain life for a short separation from the apparatus

- airway obstruction

- sinusitis

- bleeding from the nose

- lack of cooperation from the patient

- the need for ventilation 24 hours a day

- swallowing disorders

Good and bad sides of noninvasive ventilation:

A decisive advantage is the fact that the patient in the mask can freely speak and swallow. Lack of tracheal tube reduces the risk of introducing infection to the respiratory tract. There is also no need to perform a number of care actions, which in the case of invasive ventilation becomes a necessity.

The disadvantages include pain in areas of continuous oppression of the mask and the risk of changes (pressure sores) on the patient's face. Besides, there can occur dry nasal and eye irritation. Part of the air supplied by the mask can penetrate the stomach causing distension and thus the patient’s pain and discomfort.

Invasive ventilation method:

It is used in advanced respiratory failure in patients in whom mechanical ventilation is necessary around the clock with additional disorders like impaired swallowing and cough reflex. Patient is ventilated through the previously established tracheostomy tube. This is due to the need for additional care activities that are not in the case of non-invasive ventilation and the use of well-defined rules that concern avoiding complications.

 

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