IVL in the postoperative period. Respiratory restoration through artificial ventilation of the lungs Who shuts off the lung ventilation unit

In modern medicine, artificial ventilation devices for the forced air supply (sometimes with an additional addition of other gases, for example, oxygen) in lightweight and removal of carbon dioxide are widely used.

Usually such a device is connected to the respiratory (endotracheal) tube inserted into the trachea (respiratory throat) of the patient. After the tube is inserted into a special cylinder located on it, the air is pumped up, the balloon is swept and overlaps the trachea (the air can act in lungs or leave them only through the endotracheal tube). This tube is double, its inner part can be removed for cleaning, sterilization or replacement.

In the process of artificial ventilation of the lungs, the air is injected into them, then the pressure decreases, and the air leaves the lungs, energized by spontaneous reduction of their elastic tissues. This process is called periodic ventilation ventilation (the most frequently used artificial ventilation scheme).

The artificial respiration apparatus used in the past was injected into the lungs and removed it forced (ventilation with negative pressure), currently such a scheme is practiced much less.

Application of artificial ventilation devices

Most often, artificial ventilation devices are used in surgical operations when respiratory stop is possible. It is usually operations on organs chest Or the abdominal cavity, during which the breathing muscles can be relaxed by special medicines.

Artificial ventilation devices are also used to restore the normal respiration of patients into the postoperative period and to maintain the lives of people with impaired respiratory system, for example, as a result of an accident.

The solution to use mechanical ventilation is made on the basis of the assessment of the possibility of the patient to breathe independently. For this, the amount of air entering light and leaving them for a certain period (usually one minute), and the level of oxygen in the blood is measured.

Connecting and shutting down artificial ventilation devices

Patients with connected devices of artificial ventilation of the lungs are almost always in the separation of intensive therapy (or in the operating room). Hospital personnel of the department has a special training on the use of these devices.

In the past, intubation (Introduction of the endotracheal tube) often caused the kneading irritation and especially the larynx, so it could not be used for longer than a few days. Endo-tracheal tube made of modern materials, Delivers the patient significantly less inconvenience. However, if artificial ventilation is necessary for a long time, it is necessary to carry out the tracheostomy - the operation at which the endotracheal tube is entered through the hole in the trachea.

In disruption of the function of the lungs through the devices of artificial ventilation into light patients, additional oxygen is supplied. Ordinary atmospheric air contains 21% oxygen, but some patients with light ventilate air, which contains up to 50% of this gas.

From artificial respiration can be abandoned if with improved state of the patient, its strength is restored to such an extent that it can breathe independently. It is important to provide a gradual transition to independent breathing. When the patient's condition reduces the oxygen content in the air supplied to the atmospheric level, the intensity of the respiratory mixture is also reduced.

One of the most common techniques is that the device is adjusted to a small amount of breath, allowing the patient to breathe in the intervals. This usually happens a few days after connecting to an artificial respiratory device.

701) Does everyone have patients who carry out artificial ventilation of the lungs, have difficulties in the resumption of independent respiration?

Many patients who need short-term artificial ventilation of the lungs can restore independent respiration without much difficulties.

Before the extubation, the patient's ability to breathe independently through the T-shaped tube or a dyeing outline of the respirator. Although breathing through the respiratory contour of the IVL apparatus can increase the patient's breathing operation and therefore is not recommended.

702) What is "excommunication" from artificial ventilation of the lungs?

The process of termination of artificial ventilation of light workers of intensive care departments in everyday professional language is usually called radiation. In the strict sense of the word "excommunication" there is a gradual decrease in respiratory support, while the patient gradually takes on the whole of breathing. However, this term is usually applied more widely, to denote all methods for the cessation of artificial ventilation of the lungs. In accordance with general practice, such a concept is used in this book to describe the entire process of stopping respiratory support, and not a slow and gradual transition of the patient for self-breathing.

703) Explain what place is the "excommunication" from artificial ventilation of the lungs in the general process of treating respiratory failure. What determines the successful translation of the patient on self-breathing and what are the parameters to predict the success of "excommunication"?

Most patients can be easily "separating" from artificial ventilation of the lungs, but there are many such patients who have significant difficulties. This group of patients is the cause of too much costs in the health sector, and they create huge clinical, economic and ethical problems. The main determinants of the results of "excommunication" - the adequacy of the pulmonary gas exchange, the function of the respiratory muscles and psychological condition patient. The respiratory ratio to the respiratory volume is the most reliable parameter to predict the result.

704) Call the conditions under which one-time cessation of artificial ventilation of the lungs and fast extubation of the trachea are possible.

The one-time cessation of artificial ventilation of the lungs, followed by quickly extubating the trachea, can be safely fulfilled in most postoperative patients. It is very important to make sure that the patient is able to provide permeability respiratory tract Without an endotracheal tube and maintain self-breathing. Quantitative physiological parameters help to predict the likelihood of the success of "excommunication", and this is discussed in responses to relevant issues.

705) how difficult it is to stop respiratory support? How important it is to choose suitable timeto start "excommunication" from IVL?

The termination of respiratory support represents difficulties of about 20% of patients, and the main causes are the violation of the function of respiratory muscles as a result of the inconsistency between the respiratory load and the ability of the respiratory muscles to withstand it, deterioration of oxygenation and psychological factors. This procedure passes easily in patients who needed short-term support, but can be very problematic in patients correlated after severe acute respiratory failure. "Relief" of such patients from the respirator sometimes represents a serious clinical task and is most of the workload in the separation of intensive therapy. The beginning of the "Outstation" process requires a thorough selection of time: if it is unnecessarily delayed, the patient is at risk of complications associated with artificial ventilation of the lungs, and the premature beginning of "ottitude" entails the risk of severe cardiopulmonary decompensation, and the extubation will delay even more.

706) Are the paradoxical contraction of the abdominal wall muscles and frequent surface breathing with reliable indicators of the fatigue of the respiratory muscles? Is the muscular fatigue cause of unsuccessful "excommunication"?

In the past, the paradoxical reduction of abdominal muscles during the inhalation and frequent surface breathing were considered as signs of fatigue of respiratory muscles. Accordingly, it was believed that the latter is frequent cause unsuccessful "excommunication". Recent studies have shown that fatigue is neither mandatory nor a sufficient condition for the development of pathological movements of the chest and abdominal walls or frequent surface breathing. However, the presence of communication between the fattent and the pathological nature of respiration does not exclude fatigue from among the causes of unsuccessful "excommunication". Unfortunately, we simply do not know whether there is really fatigue muscles in patients with specified signs, and if so, how important it is to determine the clinical result.

707) What factor must be assessed before the trachea extbation?

In addition to the ability of the patient, to withstand self-breathing without excessive effort, before the tracheal extbationia, it is also necessary to estimate the patient's ability to protect their upper respiratory tract and rejection of the secret. In patients who can transfer independent ventilation without extreme voltage, after extubations, difficulties may occur due to the obstruction of the upper respiratory tract, the inability to protect them from aspiration or delete the secret. Unlike many parameters, which were proposed to predict the results of "excommunication", indicators for reliable prediction of the probability of complications after the extubation were not developed, therefore, they are based on such clinical factors, as the level of consciousness, the amount of the secret and the ability of the patient to flick.

708) What criteria are used to determine the optimal time to remove the endotracheal tube (extbation) after the "ottitude" is completed from respiratory support?

Patients with the obstruction of the upper respiratory tract, excessive secretion in the respiratory tract and weakened or missing pharyngeal reflex (with a high risk of massive aspiration of food or the contents of the stomach), it may be necessary to continue the intubation of the trachea and after interrupting the artificial ventilation of the lungs. If there are no such disorders, it is recommended to test self-breathing with a T-shaped tube before extbacy. Since after the tracheal extbation, the swallowing function for several hours or days can be impaired, it is recommended to be caution when feeding these patients through the mouth.

709) How can I predict the success of the extubation at an intubed patient, who has no respiratory disruption after stopping respiratory support?

If the patient is not given in response to the energetic pressed language back wall Rotoglotka, this is often considered as a contraindication to the extubation of the trachea. However, this reflex is missing from about 20% healthy people, and aspiration pneumonia may still develop and then when pipple reflex Saved. Important ability to flip, because the accompanying cough expulsive forces can normally clean the respiratory tract to the level of mid-caliber bronchi. The cough reflex can be checked, irritating the patient's respiratory paths aspiration catheter. Some time after the extubation for the sick, it is necessary to closely monitor to determine whether there is no need to re-intubate the trachea.

If a person has breakdown, due to some circumstances, breathing is carried out by artificial ventilation of the lungs. This technique is used when the patient cannot breathe himself, as well as during surgery. In this case, due to anesthesia, the flow of oxygen into the body is disturbed. IVL can be both simple manual and hardware. The first is available to almost every person, and for the second, knowledge of the device of medical devices is necessary.

Mechanism IVL

Artificial ventilation of the lungs implies the forced blowing of the gas mixture into light, to normalize the gas exchange of the external environment and alveoli. This technique can be applied at resuscitation eventsWhen the patient has a violated self-breathing, and to protect the organism from oxygen deficiency. Recent cases are often when conducting anesthesia or with spontaneous, acute pathologies.

IVL can be a hardware and direct. In the first case, a special gas mixture is used for inhalation, which is blown into the lungs forced through the intubation tube. With direct ventilation, the patient makes an indirect massage of lungs, due to which they are compressed and squeezed. In addition, the so-called "electric light" is used in this case, the breaths and exhalations are stimulated by an electrical impulse.

Varieties of IVL

There are two techniques for artificial ventilation. Simple is carried out in emergency situations, and the hardware can be carried out only in the hospital, in the resuscitation department. Simple techniques can master almost every person, for conducting such manipulation does not require special medical knowledge. TO simple ways IVL include:

• Blowing air into the mouth or nose. The patient is conveniently stacked and the head will sweep the head as much as possible. In this position, the larynx opens maximally and the base of the language does not prevent the passage of air. A person who assists help becomes next to the patient, covers his nose with his fingers and, tightly pressing his lips to the lips of the patient, begins to actively blow the air. Simultaneously with this, almost always make an indirect heart massage. Man exhales due to the elasticity of the fabrics of lungs and sternum;
• A special air duct can be used or a bag of Ruben. To begin with, the respiratory tract of the patient is well cleaned, then tightly apply a mask.

The separation of artificial ventilation of the lungs is designed for assisting patients who have impaired self-breathing. The separation uses special devices to which patients are connected. Such devices consist of a special respirator and intubation tube, in some cases the tracheostomy cannula is used.

For adults and children use various devices of artificial respiration. Here the parameters of the device characteristics and the respiratory frequency are distinguished. Hardware ventilation is always carried out in a special high-frequency mode, more than 60 cycles are released in one minute. This is necessary to reduce the volume of lungs, lowering pressure in the respiratory organs and improving blood flow to the lung.

Simple ventilation of the lungs do in the event that the patient's condition is severe and there is no time to wait for ambulance.

Indications

Methods of artificial ventilation of lungs are used in cases where the condition of people is heavy and independent respiration is difficult or absent at all. The main indications for the performance of the IVL are:

• Spontaneous cessation of blood circulation;
• Asphyxia;
• Severe injuries of the head and sternum;
• Severe poisoning;
• A significant decrease in blood pressure;
• Asthma attack;
• Cardiogenic shock;
• Long operation.

Most often, the ventilation is resorted to prior surgical operations. In this case, through the device in the human body, not only oxygen, but also special gases, which are needed to maintain anesthesia and ensure some function of organs. To IVL resorted in all cases when the work of the lungs is disturbed. It is often happening at pneumonia, heavy pathologies of the heart and head, as well as as a result of an accident.

If the patient is damaged by the brain department, which regulates breathing and blood circulation, then artificial ventilation can be sufficiently long.

Features after surgery

Artificial ventilation of the lungs after surgery can begin to be carried out in the operating department or in the separation of intensive therapy. The main goals of IVL after surgery are:

• Elimination of flipping of patients with mucus from lungs, which reduces the likelihood of complications;
• Reduces the need to maintain the cardiovascular system and reduces the likelihood of the development of lower venous thrombosis;
• Helps create optimal conditions for powering the patient through the tube. This reduces the likelihood of disorder digestive organs and improves peristality;
• Reduces the negative effect on the muscles of the skeleton, which is especially relevant after long anesthesia.

Artificial ventilation helps to normalize periods of sleep and wakefulness, and also normalizes some mental functions.

Artificial ventilation devices are used in operating, resuscitation and separation of intensive therapy. In addition, such devices are equipped with some ambulances.

Features of the inflammation of lungs

The consequence of severe pneumonia can be acute respiratory failure. The main indications for connecting the patient pneumonia to the IVL apparatus are such conditions:

• Notable disturbances of consciousness and sometimes psyche;
• Lowering blood pressure to dangerous marks;
• Breathing unstable, more than 40 cycles per minute.

Conduct artificial ventilation on initial stages Diseases. This reduces the likelihood. fatal outcome. Its duration can be from 10 to 14 days. 3 hours after entering the intubation tube into the lungs, the patient is carried out by tracheostomy. If pneumonia takes place very hard, then by the end of the inch make pressure positive. It helps to straighten the lightweight tissue and reduces venous shunting.

Simultaneously with the IVL, with inflammation of light, antibacterial therapy is always carried out.

Features of stroke

In stroke, the IVL can be carried out as a rehabilitation event. Such a procedure is assigned under the following testimony:

• With damage to light tissue;
• With suspected internal bleeding;
• With different pathologies of respiratory organs;
• If the patient is in a comatose state.

If the patient has an attack, then breathing is very difficult. In the event of the IVL apparatus helps to restore the brain cells and provides the body with a sufficient oxygen volume. In the stroke, artificial ventilation of the lungs can last up to 2 weeks. During this period, usually the acute phase of the disease passes, and the solidity of the brain decreases. Tightening the IVL is impossible, the patient is disconnected from the machine at the first opportunity.

Methods

High-frequency ventilation of lungs can be carried out in three ways. The doctor determines the feasibility of conducting a technique depending on the patient's condition:

1. Volumetric. In this case, the patient's respiration frequency is 80-100 cycles per minute.
2. Oscillation. More than 600 cycles per minute. In this case, interrupt and continuous stream alternates.
3. Jet. Not more than 300 per minute. This technique is the most common. In this case, pure oxygen or a special mixture of gases through a thin tube is blocked into the respiratory tract. An intubation tube or tracheostom can be used.

In addition, the methods of carrying out IVL according to the apparatus used.

• Auto. In this method, the patient's breathing is carried out by medicinal preparations. The patient breathes only at the expense of compression;
• Auxiliary. Here, breathing is preserved, and the oxygen supply or gas mixture is carried out on inhalation;
• Periodic forced. This technique is used when moving from IVL to natural respiration. Over time, the frequency of artificial breaths is reduced, so that a person begins to breathe independently;
• With PDKV (positive pressure to the end of the exhalation). In this case, the light pressure remains positive, in relation to external. Due to this oxygen in the lungs is better distributed, and the edema reduce;
• Electrostimulation. Here, with the help of small electrodes, nerves are irritated on the diaphragm, due to which it is actively shrinking.

What method to use in one way or another is determined by the doctor resuscitation or anesthesiologist. Sometimes one kind of IVL is replaced with the other time.

The gas mixture for inhalation picks up a specialist. The IVL apparatus is equipped with a signaling system that is notified of the violation of the respiratory process.

What problems arise

During the hardware IVL, a number of problems may arise.

• The struggle of the patient with the device. In this case, they eliminate hypoxia, they correct all the tubes and check the operation of the device;
• Non-chronic breathing with aspirator. This leads to a decrease in the respiratory volume and poor ventilation. The reason for this may be bronchospasm, breathing delay or incorrectly installed apparatus;
• Increased pressure in respiratory organs. It occurs due to the eighth tissue, hypoxia and violation of the structure of the tube.

For the patient connected to the IVL apparatus should be constant control. If the breathing is disrupted, the tube is corrected, and the device is adjusted to the desired frequency.

Negative consequences

After performing artificial ventilation, a number of negative consequences may occur.

• Bronchites, fistulas, as well as small breakdowns in the mucous membranes;
• Inflammation of the lungs, often with light bleeding;
• Lower pressure and spontaneous heart stop;
• Outlet of light tissue;
• Violation of urination;
• Mental disorders.

When conducting an IVL, the patient's condition deteriorates somewhat. Pneumothorax or squeezing the lungs may occur. In addition, the inserted tube can slip into the bronchi and damage them.

Artificial ventilation of lungs do according to life indications. This manipulation is shown in injuries of the head and chest, as well as in stroke. The main indication is the lasting operations in which the flow of oxygen into the body is violated.

Conductive paths

Nose - The first changes in the incoming air occur in the nose, where it is cleaned, heated and moistened. This contributes to the hair filter, the inversion and shells of the nose. Intensive blood supply to the mucous membrane and cavernous plexus shells provide rapid warming or cooling air to the body temperature. Water evaporating from the mucous membrane is moisturizing air to 75-80%. Long inhalation of air of low humidity leads to a drying of the mucous membrane, dry air enter into the lungs, the development of atelectasis, pneumonia and the increase in resistance in the aerial pathways.

Pharynx Separates food from the air, regulates the pressure in the middle ear.

Larynx provides a voice function, using a hash preventing aspiration, and the closure of voice ligaments is one of the main cough components.

Trachea - The main air duct, the air is warmed and moistened. The cells of the mucous membrane capture foreign substances, and the cilias promote mucus up the trachea.

Bronchi (equity and segmental) end with terminal bronchioles.

Lanes, trachea and bronchi are also involved in cleansing, warming and humidifying air.

The structure of the wall of conducting airways (VP) differs from the structure of the respiratory tract of the gas exchange zone. The wall of conductive aerial paths consists of a mucous membrane, a layer of smooth muscles, submucosal connective and cartilage shells. Epithelial cells The airways are equipped with cilia, which, rhythmically fluctuating, promote a protective layer of mucus in the direction of the nasopharynx. The mucous membrane VP and the pulmonary fabric contain macrophages, phagocying and digesting mineral and bacterial particles. Normally, mucus from the respiratory tract and Alveol is constantly removed. The mucous membrane is represented by the semiconductor-layer epithelium, as well as secretory cells separating mucus, immunoglobulins, complement, lysozyme, inhibitors, interferon and other substances. The cilia contains many mitochondria, providing energy to their high motor activity (about 1000 movements in 1 min.), Which allows you to transport a wet at a speed of up to 1 cm / min in bronchi and up to 3 cm / min in the trachea. During the day from the trachea and bronchi, about 100 ml of sputum is evacuated, and with pathological conditions up to 100 ml / hour.

Cilia functions in a double layer of mucus. Lower there are biologically active substances, enzymes, immunoglobulins, the concentration of which is 10 times more than in the blood. This causes the biological protective function of the mucus. The top layer is mechanically protecting the cilia from damage. Thickening or reduction of the top layer of mucus when inflammation or toxic effects Inevitably disrupts the drainage feature of the family epithelium, annoying the respiratory tract and reflectically causes cough. Sneezing and cough protect the lungs from the penetration of mineral and bacterial particles.

Alveola

In Alveoloch, gas exchange occurs between the blood of pulmonary capillaries and air. The total number of Alveol is approximately 300 million, and the total area of \u200b\u200btheir surface is approximately 80 m 2. The diameter of the alveoli is 0.2-0.3 mm. Gas exchange between alveolar air and blood is carried out by diffusion. The blood of pulmonary capillaries is separated from the alveolar space with only a thin layer of tissue - the so-called alveolar-capillary membrane formed by the alveolar epithelium, narrow interstitial space and the endothelium of the capillary. The total thickness of this membrane does not exceed 1 μm. The entire alveolar surface of the lungs is covered with a thin film called a surfactant.

Surfactant Reduces surface tension on the border between the liquid and air at the end of the exhalation, when the volume of lung is minimal, increases elasticity lungs and plays the role of the opposite factor(Does not miss a pair of water from alveolar air), as a result of which the alveoli remain dry. It reduces the surface tension with a decrease in the volume of the alveoli during the exhalation and prevents its appearance; Reduces shunting that improves oxygenation arterial blood At lower pressure and minimum content of 2 in the inhaled mixture.

The surfactant layer consists of:

1) actually surfactant (micropolots of phospholipid or polyprotem molecular complexes on the border with air Wednesday);

2) hypophase (deep-sex hydrophilic layer of proteins, electrolytes, related water, phospholipids and polysaccharides);

3) the cell component represented by alveoocytes and alveolar macrophages.

The main chemical components of the surfactant are lipids, proteins and carbohydrates. Phospholipids (lecithin, palmitic acid, heparin) make up 80-90% of its mass. Surfactant covers a continuous layer and bronchioles, lowers breathing resistance, supports content

With low stretch pressure, reduces the effect of forces causing the accumulation of fluid in the tissues. In addition, the surfactant purifies the inhaled gases, filters and captures the inhaled particles, regulates the exchange of water between blood and the alveoli air medium, speeds up the diffusion of CO 2, has a pronounced antioxidant effect. The surfactant is very sensitive to various endo and exogenous factors: circulatory disorders, ventilation and metabolism, changes in PO 2 in the inhaled air, contamination. With a shortage of a surfactant, atelectases and RDS newborns arise. Approximately 90-95% of the alveolar surfactant is recycled, cleared, accumulates and reacted. The half-life of the surfactant components from the lumen of the alveoli of healthy lungs is about 20 hours.

Pulmonary volumes

Lighting lungs depends on the depth of breathing and the frequency of respiratory movements. Both of these parameters can vary depending on the needs of the body. There are a number of volumetric indicators characterizing the state of the lungs. Normal average values \u200b\u200bfor an adult are the following:

1. Respiratory volume(DO- VT. - TIDAL VOLUME)- volume of inhaled and exhaled air with calm breathing. Normal values - 7-9ml / kg.

2. Reserve volume of inhalation (ROVD - IRV. - INSPIRATORY RESERVE VOLUME) - the volume that can additionally go after a calm breath, i.e. The difference between normal and maximum ventilation. Normal value: 2-2.5 l (about 2/3 jerse).

3. Reserve exhalation volume (Rhodd - ERV - EXPIRATORY RESERVE VOLUME) - the volume that can be additionally exhaled after a calm exhalation, i.e. The difference between normal and maximum exhalation. Normal value: 1.0-1.5 l (about 1/3 jersey).

4.Residual volume (OO - RV - Residal Volume) - the volume remaining in the lungs after the maximum exhalation. About 1.5-2.0 liters.

5. Light Life Capacity (Zan - VT - Vital Capacity) - the amount of air that can be most exhausted after the maximum inhale. Zappa is an indicator of mobility of the lungs and chest. It depends on age, gender, sizes and position of the body, degree of training. Normal values \u200b\u200bof jerks - 60-70 ml / kg - 3.5-5.5 liters.

6. Reserve inhale (RV) -Capacity inha (EVD - IC - INSPIRITORY CAPACITY) - the maximum amount of air that can go into the lungs after calm exhalation. Equal to the amount of before and the ROVD.

7. Total lung capacity (Hell - TLC - Total Lung Capacity) or the maximum lung capacity is the amount of air contained in the lungs at the height of the maximum inhale. It consists of jerks and oo and is calculated as the amount of the jam and oo. Normal value is about 6.0 liters.
The study of the ELO structure is decisive in finding out the ways to increase or decrease the jam, which can be of significant practical importance. Increasing the jerk can be regarded positively in the cases if the IEL does not change or increases, but less than the jerk, which is happening with increasing ZA due to the reduction of the OO. If simultaneously with an increase in the jack occurs even greater an increase in the IEL, then it cannot be considered a positive factor. Upin 70% function external breathing Deeply broken. Usually, with pathological states of IEEL and jerks, they change the same, with the exception of obstructive emphysema of the lungs, when the jerks, as a rule, decreases, the OO increases, and the IEL can remain normal or above the norm.

8. Functional Residual Capacity (F-FRC - Functional Residual Volume) - the amount of air that remains in the lungs after calm exhalation. Normal values \u200b\u200bin adults - from 3 to 3.5 liters. Foy \u003d oo + rowd. By definition, the fuel is the volume of gas that remains in the lungs with a calm exhale and may be a measure of the gas exchange area. It is formed as a result of the balance between the oppositely directed elastic forces of the lungs and the chest. The physiological value of the Few consists in a partial update of the alveolar air volume during the inhalation (ventilated volume) and indicates the volume of alveolar air constantly located in the lungs. With the decrease in the Few, the development of atelectasis is associated, the closure of small respiratory tract, a decrease in the lungs, an increase in the alveolar-arterial difference in O 2 as a result of perfusion in the atelectasted lung plots, a decrease in the ventilation and perfusion relationship. Obstructive ventilation disorders lead to an increase in fuel, restrictive disorders - to a decrease in the Few.

Anatomical and functional dead space

Anatomical dead space Call the volume of airways in which gas exchange does not occur. This space includes a nasal and oral cavity, a throat, larynx, trachea, bronchi and bronchioles. The volume of dead space depends on the growth and position of the body. Approximately it can be assumed that in a seated person, the volume of dead space (in milliliters) is equal to the double mass of the body (in kilograms). Thus, in adults, it is about 150-200 ml (2 ml / kg of body weight).

Under functional (physiological) dead spaceunderstand all those areas of the respiratory system, in which gas exchange does not occur due to reduced or missing blood flow. The functional dead space, in contrast to the anatomical, not only the air-axis paths, but also those alveoli, which are ventilated, but not perfect blood.

Alveolar ventilation and ventilation of a dead space

A portion of a minute result of breathing, reaching alveoli, is called alveolar ventilation, its remaining part is the ventilation of a dead space. Alveolar ventilation serves as an indicator of respiratory efficiency as a whole. It is from this magnitude that the gas composition is depends on the alveolar space. As for a minute volume, it only significantly reflects the effectiveness of the ventilation of the lungs. So, if the minute respiratory volume is normal (7l / min), but breathing frequent and surface (up to-0.2 l, CH-35 / min), then ventilated

It will be mainly dead space in which air comes earlier than in alveolar; In this case, the inhaled air will almost not reach the Alveol. Insofar as the volume of the dead space is constant, the alveolar ventilation is the greater, the deeper breathing and less frequency.

Extension (compliance) pulmonary fabric
The tensile lungs is a measure of elastic traction, as well as the elastic resistance of the pulmonary fabric, which is overcome during the inhalation. In other words, the stretchability is a measure of the elasticity of the pulmonary fabric, that is, her compliance. Mathematically, the tensile is expressed in the form of a private from the change in the volume of lungs and the corresponding change in intra-aless pressure.

Tensility can be measured separately for the lungs and for the chest. From a clinical point of view (especially during IVL), the most interest is the compliance of the lung tissue itself, reflecting the degree of restrictive pulmonary pathology. IN modern literature The extensibility of the lungs is made to denote the term "complines" (from the English word "compliance", abbreviated - c).

Feligious lungs decreases:

With age (patients over 50 years old);

In the lying position (due to the pressure of the abdominal cavity organs on the diaphragm);

During laparoscopic surgical interventions due to carboxyperitoneum;

With acute restrictive pathology (sharp polysegnatory pneumonia, RDS, pulmonary edema, actelectazing, aspiration, etc.);

In chronic restrictive pathology (chronic pneumonia, fibrosis of lungs, collagenoses, silicos, etc.);

In the pathology of the bodies that surround the lungs (pneumatic or hydrotorax, high standing of the dome of the diaphragm during the intestinal paresis, etc.).

The worse the fitness of the lungs, the greater the elastic resistance of the pulmonary fabric it is necessary to overcome in order to achieve that respiratory volume as with normal adhesiveness. Therefore, in the case of deteriorating extension of the lungs when the same respiratory volume is reached, the pressure in the respiratory tract increases significantly.

This provision is very important for understanding: with a volumetric IVL, when the forced respiratory volume is supplied to a patient with poor lung fuel (without high respiratory resistance), a significant increase in peak pressure in respiratory tract and intra-airectural pressure significantly increases the risk of barotrauma.

Resistance to respiratory tract

The flow of the respiratory mixture in the lungs should be overcome not only the elastic resistance of the tissue itself, but also resistance resistance of the respiratory tract Raw (abbreviation from the English word "Resistance"). Since the tracheobronchial tree is a system of tubes of various lengths and widths, then the resistance of the gas flow in the lungs can be determined by known physical laws. In general, the stream resistance depends on the pressure gradient at the beginning and at the end of the tube, as well as on the size of the stream itself.

The gas flow in the lungs may be laminar, turbulent and transition. For laminar flow, the layer-by-layer gas movement with

Different speed: the flow rate is highest in the center and gradually decreases to the walls. The laminar gas flow prevails at relatively low speeds and is described by the law of Poiseil, according to which the resistance of the gasot flow largely depends on the tube radius (bronchi). Reducing the radius 2 times leads to an increase in resistance 16 times. In this regard, the importance of choosing the most wide endotracheal (tracheostomic) tube and maintaining the tracheobronchial wood during IVL is clearly understood.
Resistance to the respiratory tract of the gasotoku significantly increases with bronchio-free, swelling of the mucous membrane of the bronchi, accumulation of mucus and inflammation due to the narrowing of the lumen of the bronchial tree. The flow rate and the length of the tube (bronchi) also affect resistance. FROM

Increasing the flow rate (forcing inhale or exhalation) Resistance of the respiratory tract increases.

The main reasons for increasing the resistance of the respiratory tract:

Bronchiolespass;

Swelling of the mucous membrane of the bronchi, (aggravation of bronchial asthma, bronchitis, refurbished laryngitis);

Foreign body, aspiration, neoplasms;

Cluster of sputum and inflammatory secret;

Emphysema (dynamic airway compression).

The turbulent flow is characterized by a chaotic movement of gas molecules along the tube (bronchi). It prevails at high voluminous flow rates. In the case of a turbulent flux, the resistance of the respiratory tract increases, since it is even more depends on the flow rate and the bronchi radius. Turbulent movement occurs at high threads, sharp changes in the flow rate, in the places of bends and branches of bronchi, with a sharp change in the diameter of the bronchi. That is why the turbulent stream is characteristic of COL patients, when even in the remission stage, there is an increased resistance of the respiratory tract. The same applies to the patients with bronchial asthma.

The resistance of the air pathways is distributed in the lungs unevenly. The greatest resistance creates bronet of the middle caliber (up to 5-7th generation), since the resistance of large bronchi is small due to their large diameter, and small bronchi - due to the considerable total cross-sectional area.

Resistance to respiratory tract depends on the volume of lungs. With a large amount of parenchyma, it has a greater "tensile" effect on the respiratory tract, and their resistance decreases. The use of PDKV (PEEP) contributes to an increase in the volume of lungs and, consequently, a decrease in respiratory resistance.

Resistance to the respiratory tract in the norm is:

In adults - 3-10 mm water. / L / s;

In children - 15-20 mm water. / L / s;

In babies up to 1 year - 20-30 mm water. / L / s;

In newborns - 30-50 mm water. / L / s.

On the exhalation resistance of the respiratory tract at 2-4 mm water. / L / c more than in the breath. This is due to the passive character of the exhalation, when the condition of the wall of the air paths is greater than affects the gas consisting than with an active breath. Therefore, for a full exemption is required 2-3 times longer than for inhalation. Normally, the ratio of time inhale / exhale (I: E) is for adults about 1: 1.5-2. The fullness of exhalation in the patient during IVL can be assessed using the monitoring of the expiratory temporary constant.

Work of breathing

The work of breathing is carried out mainly by inspiratory muscles during the inhalation; Exhalation almost always passive. At the same time, in the case of, for example, acute bronchospasm or edema of the mucous membrane of the respiratory tract, exhale also becomes active, which increases significantly overall work External ventilation.

During the inhalation, the work of breathing is mainly spent on overcoming the elastic resistance of the pulmonary tissue and resistivity resistance of the respiratory tract, while about 50% of the energy spent accumulates in elastic lung structures. During the exhalation, this accumulated potential energy is released, which allows you to overcome the expiratory resistance of the respiratory tract.

An increase in resistance to inhale or exhale is compensated by additional operation of respiratory muscles. The respiratory operation increases with a decrease in lung tensile (restrictive pathology), the growth of respiratory tract (obstructive pathology), tachipne (due to the ventilation of the dead space).

ONLY 2-3% of the total oxygen consumed is spent on the work of the respiratory muscles. This is the so-called "cost of breathing." In physical work, the cost of breathing can reach 10-15%. And with pathology (especially restrictive), more than 30-40% of the total oxygen absorbed by the organism can be spent on the work of the respiratory muscles. With severe diffusion respiratory failure, the cost of breathing increases to 90%. At some point, all the additional oxygen, obtained by increasing ventilation, goes to cover the appropriate increase in the operation of the respiratory muscles. That is why at a certain stage there is a significant increase in breathing work is a direct indication to the beginning of the IVL, in which the cost of breathing is reduced almost to 0.

The operation of respiration, which is required to overcome elastic resistance (lung adequacy), increases as the respiratory volume increases. The work required to overcome the resistance resistance of the respiratory tract increases with increasing respiratory frequency. The patient seeks to reduce the work of breathing, changing the respiratory frequency and respiratory volume depending on the prevailing pathology. For each situation, there are optimal respiratory frequency and respiratory volume, in which respiratory operation is minimal. So, for patients with reduced tensions, in terms of minimizing breathing, more frequent and surface breathing is suitable (low-fat lungs are difficult to refuse). On the other hand, with an increased respiratory resistance of the respiratory tract, optimally deep and slow breathing. This is understandable: an increase in the respiratory volume allows you to "stretch", expand bronchi, reduce their resistance to gasotock; With the same purpose, patients with obstructive pathology are squeezed by lips during the exhalation, creating their own "PDKV" (PEEP). Slow and rare breathing contributes to the elongation of exhalation, which is important for more complete removal of the exhaled gas mixture in conditions of increased expiratory resistance of the respiratory tract.

Respiratory regulation

The respiratory process is regulated by the central and peripheral nervous system. In the reticular formation of the brain there is a respiratory center consisting of inhalation centers, exhalation and pneumotaxis.

Central chemoreceptors are located in the oblong brain and are excited by increasing the concentration of H + and RSO 2 in the spinal fluid. In the norm of the pH of the latter, 7.32, RSO 2 - 50 mm.rt.st., and the content of the NSO 3 - 24.5 mmol / l. Even a slight decrease in pH and the growth of RSO 2 increases the ventilation of the lungs. These receptors react to hyperkapinia and acidosis slower than peripherals, since an additional time is required to measure the value of CO 2, H + and NSO 3 due to overcoming the hematorecephalic barrier. Reducing the respiratory muscles controls the central respiratory mechanism consisting of a group of cells oblong brain, Bridge, as well as pneumatic centers. They tone the respiratory center and on impulsation from the mechanoreceptors determine the threshold of the excitation, in which inhale ceases. Pneumotactic cells also switch inhale to exhale.

Peripheral chemoreceptors located on the inner shells of the sleepy sine, the arcs of the aorta, the left atrium, control the humoral parameters (PO 2, RSO 2 in arterial blood and the spinal fluid) and immediately react to changes in the inner environment, changing the mode of self-breathing and, thus, Corringing pH, PO 2 and RSO 2 in arterial blood and spinal fluid. Hemoreceptor pulses regulate ventilation volume necessary to maintain a certain level of metabolism. In optimizing the ventilation mode, i.e. Establishing the frequency and depth of breathing, the duration of inhalation and exhalation, the strength of the respiratory muscles at a given level of ventilation, and mechanoreceptors are involved. The lung ventilation is determined by the level of metabolism, the effects of metabolic products and O2 on chemoreceptors that transform them into afferent impulse. nervous structures central respiratory mechanism. The main function of arterial chemoreceptors is the immediate respiratory correction in response to changes in blood gas composition.

Peripheral mechanoreceptors, localized in the walls of the alveoli, intercostal muscles and aperture, react to the stretching of the structures in which they are on information about mechanical phenomena. The main role is played by mechanoreceptors of the lungs. Inhaled air enters VP to Alveola and participates in gas exchange at the level of the alveolar and capillary membrane. As the walls are stretching, the alveolis during the inhalation, the mechanoreceptors are excited and sent an afferent signal to the respiratory center, which inhibits breath (Reflex Gereing Breyer).

In conventional breathing, intercore-diaphragmal mechanoreceptors are not excited and have an auxiliary value.

The regulation system is completed with neurons that integrate pulses that come to them from chemoreceptors, and sending pulses of excitation to respiratory motor mechanons. The cells of the bulbar respiratory center are sent both exciting and braking impulses to respiratory muscles. The coordinated excitation of respiratory motorcycles leads to a synchronous reduction in respiratory muscles.

Respiratory movements air flow, occur due to the agreed work of all respiratory muscles. Nerve cells Motors

The neurons of the respiratory muscles are located in the front horns gray substance Spinal cord (cervical and chest segments).

A person in the regulation of breathing takes part big Brain within the limits allowed by chemoreceptor respiratory regulation. For example, the volitional retention of respiration is limited by time during which RAO 2 in the spinal fluid increases to levels exciting arterial and medullary receptors.

Biomechanics breathing

Ventilation of the lungs occurs due to periodic changes in the working pressure muscles, volume breast cavity and lungs. The main muscles inhale are the diaphragm and outdoor intercostal muscles. During their reduction, the formation of the diaphragm dome and the elevation of the edges will take up, as a result, the chest volume increases, negative intrapharmal pressure (PPL) is growing. Before the beginning of the inhalation (at the end of the exhalation), PPL is about minus 3-5 cm water. Alveolar pressure (PALV) is accepted in 0 (i.e. equal to atmospheric), it also reflects the pressure in the respiratory tract and correlates with intragenuous pressure.

The gradient between alveolar and intrapleural pressure is called transpulmonary pressure (PTP). At the end of the exhalation it is 3-5 cm water. During the spontaneous breath, the growth of negative PPL (up to minus 6-10 cm water) causes a decrease in pressure in alveoli and respiratory tract below atmospheric. In Alveoli, pressure decreases to minus 3-5 cm water. Due to the difference in pressures, air flows (sucking) from the external environment into the lungs. The chest and a diaphragm act as a piston pump that retracts the air into the lungs. Such a "pricing" effect of the chest is important not only for ventilation, but also for blood circulation. During the spontaneous breath, an additional "sinking" of blood to the heart (maintenance of preloads) and the activation of pulmonary blood flow from the right ventricle on the system pulmonary artery. At the end of the inhalation, when the gas movement stops, the alveolar pressure returns to zero, but intra-light pressure remains reduced to minus 6-10 cm water.

Exhalation is normal is a passive process. After relaxing the respiratory muscles of the strength of the elastic thrust of the chest and the lungs cause removal (extrusion) of gas from the lungs and the restoration of the initial volume of the lungs. In the event of a violation of the tracheobronchial trees (inflammatory secret, swelling of the mucous membrane, bronchospasm) the exhalation process is difficult, and the muscles of the exhalation are also beginning to participate in the act of breathing (internal intercostal muscles, breast muscles, abdominal muscles, etc.). When exposing the expiratory muscles, the exhalation process is even more difficult, the exhaled mixture is delayed and the dynamic recycling of the lungs.

Little abdication functions

Functions of the lungs are not limited to the diffusion of gases. They contain 50% of all endothelial cells of the body, which linse the capillary surface of the membrane and participate in the metabolism and inactivation of biologically active substances passing through the lungs.

1. The lungs control overall hemodynamics by various filling of its own vascular channel and influence on biologically active substances regulating vascular tone (serotonin, histamine, bradykin, catecholamines), converting angiotensin I in angiotensin II, participation in prostaglandin metabolism.

2. The lungs regulate blood coagulation, securing the prostacycline - platelet aggregation inhibitor, and removing thromboplastin blood flow, fibrin and its degradation products. As a result, the blood flowing from the lungs has a higher fibrinolytic activity.

3. Lights are involved in protein, carbohydrate and fat metabolism, synthesizing phospholipids (phosphatidylcholine and phosphatidylglycerol - the main components of the surfactant).

4. Lungs produce and eliminate heat, maintaining the body's energy balance.

5. Lights clean the blood from mechanical impurities. Cell aggregates, microtrombids, bacteria, air bubbles, fat drops are linger to lungs and are destruction and metabolism.

Ventilation Types and types of ventilation disorders

A physiologically clear classification of ventilation types has been developed, which is based on partial gases in alveoli. In accordance with this classification, the following types of ventilation are allocated:

1. Norming the normal ventilation at which the CO2 partial pressure in alveoli is maintained at about 40 mm.rt..

2.Fypertigilation - reinforced ventilation, exceeding the basic needs of the body (RAS2<40 мм.рт.ст.).

3.Gipvention - reduced ventilation compared with the metabolic needs of the body (Raso2\u003e 40 mm.rt.).

4. Increased ventilation - any increase in alveolar ventilation compared with the level of rest, regardless of the partial pressure of gases in alveoli (for example, with muscle work).

5.People - Normal ventilation alone, accompanied by a subjective feeling of comfort.

6.Gypepnoe - an increase in respiratory depth, regardless of whether the frequency of respiratory movements is increased or not.

7.Tahipne is an increase in respiratory frequency.

8.Bradipne - Reduced breathing rate.

9. APNEE - Stop breathing due to mainly lack of physiological stimulation of the respiratory center (decrease in CO2 voltage, in arterial blood).

10. Dyspna (shortness of breath) - an unpleasant subjective feeling of respiratory failure or difficulty breathing.

11.TopNee - pronounced shortness of breath, associated with blood stagnation in pulmonary capillaries as a result of the lack of left heart. In a horizontal position, this state is aggravated, and therefore it is difficult to lie in such patients.

12.Sfiksia - stop or inhibition of respiration, mainly related, with paralysis of the respiratory centers or the closure of the respiratory tract. The gas exchange at the same time is sharply violated (hypoxia and hypercapnia are observed).

For the purpose of diagnosis, it is advisable to distinguish between two types of ventilation disorders - restrictive and obstructive.

The restrictive type of ventilation disorders includes all pathological conditions under which the respiratory excursion is reduced and the ability of the lungs to parse, i.e. Their extensibility decreases. Such violations are observed, for example, with lesions of pulmonary parenchyma (pneumonia, emitting, fibrosis of lungs) or with pleural spikes.

The obstructive type of ventilation disorders is due to the narrowing of the air pathways, i.e. Increase their aerodynamic resistance. Such states are found, for example, when accumulated in the respiratory tract of mucus, swelling of their mucous membrane or spasme of bronchial muscles (allergic bronchio-acid, bronchial asthma, astmoid bronchitis, etc.). In such patients, resistance to breathe and exhale increased, and therefore, over time, airiness of the lungs and the foys increase. Pathological statecharacterized by an excessive decrease in the number of elastic fibers (the disappearance of alveolar partitions, the association of the capillary network), is called emphysemic lungs.

Tracostomy is divided into noncommunicable and infectious. Among noncommunicable complications, there is a different severity of bleeding and (or) hemoscript, mediastinal emphy of the mediastinum and subcutaneous fiber, breakdown with ulcerations of the tracheal mucosa from the cannul and cuffs of the intubation tube.

Infectious complications of tracheostomy - laryngitis, tracheoobronchites, pneumonia, pomephone's phlegloheal phlegmon, purulent thyroiditis.

Complications of artificial ventilation of the lungs

The pulmonary resuscitation is carried out with the help of artificial ventilation of the lungs. In the process of conducting IVL, a number of complications can develop, especially, and some of them themselves are tanatogenetically significant. According to various authors, the frequency of these complications ranges from 21.3% to 100% (Cassil V. L., 1987).

On the localization and nature of the complication of IVL V. L. Kassil (1981) divides into four groups:

1. complications on the side of the respiratory tract (tracheoobronchites, breakdowns of the mucous membrane of the trachea, tracheopic fistula, stenosis of the trachea);
2. complications from lungs (pneumonia, atelectases, pneumothorax);
3. complications from the cardiovascular system (blood bleeding, sudden heart stop, reduction of blood pressure);
4. complications due to technical errors of the IVL.

General complications of IVL.Before considering the private complications of IVL, we will separately focus on adverse physiological changes and complications that artificial ventilation of the lungs bears in itself.

In this regard, it is appropriate to recall the philosophical remark F. Engels (1975):

"We will not, however, too dedicated to our victories over nature. For each such victory, she takes us. Each of these victories is true, first of all, the consequences for which we expected, but in the second and third item are completely different, unforeseen consequences that very often destroy the meaning of the first. "

First of all, when using hardware artificial respiration, biomechanics varies with respiratory regulation, primarily due to the fact that there is a pronounced difference in intangularlyolar and intrapharmal pressures at the end of the breath compared to spontaneous breathing. If, with spontaneous breath, these indicators respectively make up minus 1 - 0 mm Hg. Art. and minus 10 cm waters. Art., then at the IVL - respectively +15 - +20 mm Hg. Art. and +3 cm waters. Art. In this regard, when the IVL increases the tensile wall of the respiratory tract N changes the ratio of anatomically dead space to transpulmonal pressure. With a long IVL, the lungs are gradually decreasing. This is due to the obstructive atelectasis of the lungs due to violation drainage function respiratory tract, ventilation-nefsyne, filtering by absorption ratio, as well as with destruction of superficial active substance - Surfactant. Long-term IVL leads to the formation of atelectasis caused by violations of the drainage function of the bronchi and the exchange of a surfactant.

When IVL, the principle of blowing is disturbed by the pristent effect of the chest, providing a significant part of the venous return with natural breath. Since the pressure in pulmonary capillaries is normal equal to 10-12 mm Hg. Art., Ivl with a higher. Pressure inhale inevitably breaks pulmonary blood flow. Cutting blood from the lungs in left atrium During an artificial breath and countering the emission of the right ventricle of the heart, an essential imbalance in the functioning of the right and left half of the heart contributes to the functioning of the right and left half of the heart. Therefore, as one of general complications IVL in the circulatory system discusses violations of venous return and reduction of cardiac output.

In addition to the effect on the circulatory system, the IVL can lead to the development of a pronounced respiratory alkalosis or acidosis (due to inadequately selected mode: accordingly, with hyper-or hypoventilation). Complications of IVL include extended Annel when switching to spontaneous ventilation. Usually it is the result of the abnormal irritation of the lung receptors, overwhelming physiological reflexes.

When manipulating (sucking, changing the intubation tube, tracheotomic cannula. Sanations of the tracheobronchial tree) can develop acute hypoxemia with hypotension and the subsequent stop of the heart and breathing. In the genesis of such a stop of the heart in patients, the respiratory stop and heart can occur with a rapid pressure reduction. For example, in response to hyperventilation after the shanction of the tracheobronchial tree.

The consequences of long-term intubation of trachea and tracheostomy.The IVL complications group are pathological processes associated with a long stay in the respiratory tract of intubation or tracheotomic tubes. At the same time, fibrinously hemorrhagic and necrotic laryngotrachera-bronchites can develop (Fig. 59; see illustration. Mat.). Prolesidery, bleeding from the respiratory tract. Tracheobronchites arise in 35 40% of patients who are conducted by IVL. The high frequency of their occurrence is marked in patients. located and comatose state. More than half of the patients tracheobronchitis are revealed for 2 3 and a day of the ventilator. At the site of the fitting of the cuff or the end of the intubation tube can develop areas of the oar of the mucous membrane. They are found during fibrosconhonony when changing tubes in 12-13% of patients with long-term IVL. Deep breakdown of the tracheal walls can in itself lead to other complications (trachecopic fog, stenosis of tracheas, bleeding from arrocated vessels) (Kassil V. L., 1987).

Lung Barryrav. With an excessive volume of ventilation and desynchronization with the IVL apparatus, a borotraham of the lungs with an extracting and breaking of the alveoli can develop, with the occurrence of hemorrhages in the tissue of the lungs. The manifestation of the barotrauma can be a bullous or interstitial emphysema, tense pneumothorax, especially in patients with inflammatory-destructive lung diseases.

Under the conditions of IVL, Pneumothorax is a very dangerous complication, as it always has the nature of the intense and fast increasing. Clinically, this is manifested by the asymmetry of respiratory movements, a sharp impact of breathing on the side of the pneumothorax, as well as sharp cyanosis. The latter is due not only to the violation of oxygenation due to collaboration of the lung, but also the central venous hypertension in response to the inflection of hollow veins when the mediastinal shift in the opposite direction. At the same time, the resistance of the device ZVL pa inhale is significantly increased. On the radiograph of air in the pleural cavity, the collaboration of the lung and displacement of the mediastinum.

In some patients, Pneumothorax is accompanied by the development of mediastinum emphysema. V. L. Kassil (1987) describes a rare situation when, on the contrary, due to insufficient sealing between the tracheostomy cannula and the wall of the trachea, the air during an artificial inspire can penetrate the mediastinum, and further break through the mediastinal pleura in one or both pleural cavities. In the latter case, bilateral pneumothorax develops.

Excessive ventilation can lead to mechanical desquamation of tracheobronchial epithelium. At the same time, histologically in the Alveoli in the patients who were conducted by IVL in excessive hyperventilation mode, fragments of the tracheobronchial tree epithelium can be detected.

The consequences of the hyperoxic and drying effect of oxygen. It should be borne in mind that breathing with 100% oxygen, especially long conducted, leads to hyperoxic damage to the epithelium of the tracheobronchial tree and the alveolokapillary membrane, followed by diffuse lung sclerosis (Matsubara O. et al., 1986). It is known that oxygen, especially in high concentrations, dries the respiratory surface of the lungs, which is advisable when cardio easy swelling. This is due to the fact that after drying, the protein masses "bore" the respiratory surface, catastrophically increase the diffusion path and even stop diffusion. In this regard, the concentration of oxygen in the inhaled air without an extreme need should not exceed 40-50%

Infectious complications of IVL. Among the infectious processes associated with IVL are often larying and tracheobronchites. But data of V. L. Kassil (1987), in 36-40% of patients who are on IVL developing pneumonia. In hepesa inflammatory lesions of the lungs very important It has infection, including cross. In a bacteriological study of sputum, the staphylococcal and hemolytic flora, the blue chopstick and microbes of the intestinal group in the Razmpch of the associations are most often driving. When taking samples at the same time in patients. located in different chambers, flora in the respiratory tract, as a rule, the same. Unfortunately, its contribution to the occurrence of pneumonia is making functions of the lungs through the IVL devices (for example, the RO family). This is due to the impossibility of complete disinfection of the inner parts of these devices.

Most often, pneumonia begins on the 2nd day of the IVL. Usually it is manifested by hyperthermia to 38 "C, the appearance of light crepitations and wet fine-grained wheezes, shortness of breath, other symptoms of hypoxemia. A reinforcement of vascular patterns are detected on the radiograph, focal blacks in the lungs.

One of the serious complications and lines through the mask is inflating the air of the stomach. Most often this complication occurs when used increased pressure With IVL under an hour for a trap or complete obstruction of the respiratory tract. As a result, the air with power enters the esophagus of the stomach. A significant accumulation of air in the stomach not only creates prerequisites for regurgitation and limits the functional reserves of the lung, but can contribute to the development of the break of the stomach wall during the period of peamentation.