UPV and multi-organ tour, shock and sepsis

Multiorgan failure

 * !!! Unfavorable effects of UPV on individually organs add up → fail often lungs, kidneys , liver , heart circulation ,…
 * Can't to forget and effect of UPV on intracranial pressure (ICP) – acc type and " suitability " both " positive " and " negative "


 * Influence on intra-abdominal pressure - it increases with everyone unfavorable consequences.

Influence on ICP

 * At hypoventilation, hypoxia , hypercapnia with intracranial pressure fast increases.


 * Monitoring Both SaO 2 and ETCO2 are standard at acute treatment cranial accident / trauma.


 * Ventilation with high PEEP ( sometimes but otherwise cannot ) increases risk difficult drain of blood from the brain → increase intracranial pressure.

Influence on intra-abdominal pressure

 * Occurs with UPV to increase intrathoracic pressure ( especially with PEEP) → transfer increased pressure on intra-abdominal compartment → increase intra-abdominal pressure gradually causes aggravated blood flow splanchnic including kidneys - worse drain + own influence pressure → failure mentioned organs.


 * Condition can result in 'Abdominal Compartment Syndrome  - an analogy with a compartment syndrome e.g. _ on limbs.

Hypovolemic shock

 * Increase intrathoracic pressure and shortage fluids will reduce venous return → decrease fulfillment just chambers → work will increase just chambers → lower shortage issue _ fluids and low venous return → decreases and fulfillment left chambers → cannot raise CO ( minute volume ) (CO= TOxTF ) → circulation collapses.

Cordial issue and UPV and their influence on oxygenation organism

 * By increasing saturation i pick up delivery oxygen to the organism by units %.


 * By increasing Hb i pick up delivery oxygen to the organism by dozens %.

→ DO2 [ml/l] = CO x [(Hb x SaO2 x 1,39) + (PaO2 x 0,003) ],
 * By increasing CO I raise delivery oxygen by hundreds %.

→ For good oxygenation peripheral tissue is needed not only Good ventilation ( i.e. the way _ _ get oxygen to the blood ), but also circulation ( as get oxygen in the blood to the periphery ).

Sepsis and complications of UPV

 * If the patient intubated as a result of ARDS at sepsis it often happens significantly dependent on PEEP and O2.


 * !!! Attention on suction - either for example increase O2 or to perform after suction recruitment maneuver.


 * Frequent positioning on semi-hips, vibrating massages and RHC help significantly mobilization mucus.
 * * Retention there is frequent mucus the cause emergence stagnant pneumonia → patients with OTI and UPV are already after two days susceptible to emergence Fans pneumonia, the risk still multiplies , if introduced _ nasogastric or – jejunal probe.

Prevention emergence pneumonia

 * Consistent toilet respiratory honor closed system.


 * Special OTI cannulas with microcuff system ( price !!!).


 * Consistent suction supraglottic space ( if possible - price !!!), otherwise suction secretions from the mouth.


 * Consistent hygiene mouth ( chlorhexidine ).


 * If already arises promptly react → RHC, ATB acc sensitivity.


 * Regular subscriptions biological of material → closed system ( sterile test tube which we will incorporate into the suction circuit ), bronchoscopically carried out sampling → microbiology, microscopic higher _ ( fast results !!!).


 * Raised position _ upper by half bodies !!!

Continuous cleansing methods (CVVH) and UPV

 * Contradiction between sufficient depth sedation to limit mobility (to ensure sufficient flow rate smooth and trouble-free dialysis ) X as shallow as possible sedation and sufficient RHC required for mobilization of secretions, conservation muscular forces and the shortest possible UPV.

Links

 * Ventilation failure ( pathophysiology )


 * Syndrome acute respiratory distress


 * Syndrome multiorgan dysfunction


 * Hypovolemic shock


 * Hemodialysis


 * Intracranial hypertension


 * Endotracheal intubation


 * Artificial pulmonary ventilation / Secondary school ( nurse )