Osnove mehaničke ventilacijske potpore

master's thesis

• Title (english): Basic principles of mechanical vantilatory support
• Author: Ela Ćurčić
• Mentor: Mladen Perić (mentor)
• Committee member: Ante Sekulić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Mladen Perić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Mehanička ventilacija postupak je koji omogućuje pružanje umjetne potpore izmjeni plinova u slučajevima kada se spontanim disanjem ne može osigurati zadovoljavajuća minutna ventilacija, a izvodi se pomoću posebnih uređaja – ventilatora. Danas se uglavnom koriste mikroprocesorski kontrolirani ventilatori pozitivnog tlaka. Glavni ciljevi mehaničke ventilacijske potpore usmjereni su na očuvanje alveolarne ventilacije i arterijske oksigenacije, održavanje odgovarajućih plućnih volumena i smanjenje dišnog rada, pritom nastojeći maksimalno reducirati mogućnost nastanka ijatrogene plućne ozljede. Standardne indikacije za uspostavu mehaničke ventilacijske potpore obuhvaćaju apneju, respiracijsku insuficijenciju, GCS ≤ 8 te teške opekline lica i vrata s predvidivom oteklinom dišnog puta. Postoji nekoliko podjela mehaničke ventilacijske potpore – prema načinu stvaranja
inspiracijske sile (ventilacija negativnim i pozitivnim tlakom), prema postojanju umjetnog dišnog puta (invazivna naspram neinvazivne) te prema radu disanja (potpuna respiracijska potpora u odnosu prema djelomičnoj). Pojedini dišni ciklus koji obavi ventilator dijeli se na četiri faze i kontroliran je tzv. faznim i kontrolnim varijablama. S obzirom na odabir kontrolne varijable, ventilatore danas najčešće dijelimo na one kontrolirane volumenom ili tlakom. Kombinacija vrste udisaja (koji može biti
mandatorni ili spontani) te zadanih varijabli određuje modalitet mehaničke ventilacijske potpore. Odabir određenog modaliteta ovisi ponajviše o indikaciji i stavu kliničara. Budući da je duljina primjene mehaničke ventilacije u korelaciji s nastankom komplikacija, vremenom provedenim u bolnici i cjelokupnim ishodom liječenja, izrazito je važno slijediti smjernice za odvikavanje od mehaničke ventilacijske potpore te pritom pravodobno odrediti trenutak započinjanja odvajanja od aparata.

Abstract (english)

Mechanical ventilation is a procedure that enables artificial support to gas exchange in cases when spontaneous breathing cannot provide adequate minute ventilation. It is performed using a special device – the ventilator. Ventilators mainly used today are microprocessor-controlled positive pressure ventilators. The main objectives of mechanical ventilatory support are preservation of alveolar ventilation and arterial oxygenation, maintenance of adequate lung volumes and reduction in the work of breathing, while trying to maximally decrease the possibility of iatrogenic lung injury. Standard criteria for instituting mechanical ventilatory support include apnea, respiratory failure, GCS ≤ 8 and severe burns of the face and neck with predictable airway edema. There are several classifications of mechanical ventilatory support – according to the way the
inspiratory force is created (negative or positive pressure ventilation); according to the presence of an artificial airway (invasive versus non-invasive) and according to the work of breathing (full or partial ventilatory support). Each respiratory cycle accomplished by the ventilator is divided into four phases and controlled by the phase and control variables. Depending on the choice of the main control variable, ventilators are commonly described as volume controlled or pressure controlled. The combination of the breath type (which can be mandatory or spontaneous) and the set of variables during mechanical ventilation determines the mode of ventilation. Selection of a particular mode depends mainly on indication and clinician preference. Because the duration of mechanical ventilation is in correlation with a higher risk of complications, the length of time spent in hospital and the overall patient outcome, it is important to follow the evidence-based guidelines for ventilator weaning and precisely establish the moment when the patient meets the criteria for ventilator discontinuation.

• Keywords: mehanička ventilacijska potpora; respiracijska insuficijencija; modaliteti ventilacije; smjernice za odvajanje od aparata
• Keywords (english): mechanical ventilatory support; respiratory failure; modes of ventilation; weaning criteria
• Language: croatian
• URN:NBN: urn:nbn:hr:105:228205
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-10-13 12:10:18