Specifičnosti zdravstvene njege djeteta na izvantjelesnoj membranoznoj oksigenaciji

master's thesis

• Title (english): Nursing management of children on extracorporeal membrane oxygenation (ecmo)
• Author: Antonija Marić
• Mentor: Daniel Dilber (mentor)
• Committee member: Jurica Vuković (predsjednik povjerenstva)
• Committee member: Ruža Grizelj (član povjerenstva)
• Committee member: Daniel Dilber (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2019-06-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract

Ekstrakorporalna membranska oksigenacija (ECMO) modificirana je vrsta kardiopulmonalne premosnice. Koristi se kao privremena potpora bolesnicima s oštećenom respiracijskom i/ili srčanom funkcijom. Da bi njena upotreba bila indicirana, zatajivanje respiracijske i srčane funkcije mora biti akutno, potencijalno reverzibilno te otporno na konvencionalne mjere liječenja, a bolesnikov mortalitetni rizik veći od 50%. Osnovni dijelovi ECMO uređaja jesu membranski oksigenator, pomoću kojeg se krv difuzijom preko polupropusne membrane oksigenira, a ugljikov dioksid uklanja, i pumpa za krv, pomoću koje se održava adekvatan protok krvi kroz ECMO sustav. ECMO potpora uspostavlja se kanilacijom bolesnikovoga cirkulacijskog sustava, koja može biti središnja i periferna. Dvije su osnovne vrste ECMO sustava, VA-ECMO i VV ECMO modalitet. VA-ECMO modalitet najčešće koristi u kardiotorakalnoj kirurgiji, jer za razliku od VV-ECMO potpore, uz respiratornu pruža i potporu kardiovaskularnom sustavu, VV-ECMO modalitet preferirana je potpora bolesnicima s teškim respiracijskim zatajivanjem zbog manjeg rizika od pojave komplikacija.

Tijekom proteklih nekoliko desetljeća broj centara koji provode ECMO nastavio je rasti, a ECMO unutar neonatalne i pedijatrijske populacije postao je uobičajena praksa. Kako su se ekspertize i iskustva s ECMO-om povećali, tako je i preživljavanje bivalo sve veće.
Bolesnici priključeni na izvantjelesnu membranoznu oksigenaciju su u pravilu hemodinamski nestabilni, a sama tehnologija je vrlo invazivna. U zbrinjavanju ovako zahtjevnih pacijenata vrlo je važan multidisciplinarni pristup gdje svi članovi tima moraju biti dobro educirani iz područja koje obavljaju.
U zbrinjavanju ovako zahtjevnih pacijenata medicinska sestra ima vrlo važno mjesto budući da je ona ta koja boravi uz bolesnika 24 sata dnevno. Osim medicinskog znanja vrlo je važno poznavati i tehničke karakteristike svih metoda liječenja kako bi se na vrijeme moglo reagirati i spriječiti komplikacije koje mogu biti po život opasne.

Abstract (english)

Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonal bypass, used as a temporary support of patients with cardiac and/or respiratory failure. Indications for ECMO include patient´s mortality risk larger then 50% and acute, potentially reversible cardiac and/or respiratory failure refractory to all conventional therapy measures. The main components of ECMO device are membrane oxygenator, in which blood is oxygenated and CO2 is removed by diffusion through semi permeable membrane, and pump which provides adequate blood flow through ECMO circuit. ECMO support is established by central or peripheral cannulation of patient´s circulatory system. There are two types of ECMO, VA-ECMO and VV-ECMO. VA-ECMO is mainly used in cardiothoracic surgery, because unlike VV-ECMO, it provides both cardiac and respiratory support. On the other hand VV- ECMO is preferred as a support to patients with severe respiratory failure, due to its generally lower risk of complications.
Over the past few decades, the number of ECMO centers continued to grow, and ECMO within the neonatal and pediatric populations has become common practice. As the expertise and experience with ECMO increased, so survival was increasing.
Patients connected to extracorporeal membrane oxygenation are generally hemodynamically unstable, and the technology itself is highly invasive. Providing such demanding patients is a very important multidisciplinary approach where all team members need to be well educated from the areas they are performing.
In nursing such demanding patients, the nurse has a very important place since she is the one who stays with the patient 24 hours a day. In addition to medical knowledge, it is very important to know the technical characteristics of all treatment methods in order to respond in a timely fashion to prevent complications that may be life-threatening.

• Keywords: Ekstrakorporalna membranska oksigenacija (ECMO); VA-ECMO; VV ECMO; uloga medicinske sestre
• Keywords (english): Extracorporeal membrane oxygenation (ECMO); VA-ECMO; VV ECMO; nursing management
• Language: croatian
• URN:NBN: urn:nbn:hr:105:330965
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-03-26 13:59:33