UPV and multi-organ tour, shock and sepsis
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Multiorgan failure[edit | edit source]
- !!! 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[edit | edit source]
- 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[edit | edit source]
- 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 [edit | edit source]
- 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[edit | edit source]
- 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 % .
- By increasing CO I raise delivery oxygen by hundreds % .
→ DO2 [ml/l] = CO x [(Hb x SaO2 x 1,39) + (PaO2 x 0,003) ],
→ 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[edit | edit source]
- 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[edit | edit source]
- 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[edit | edit source]
- 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.
Literature[edit | edit source]
- PASSED, Paul, et al. Basics artificial pulmonary ventilation. 2. edition. Prague : Maxdorf, c2005. ISBN 80-7345-059-3.
