Abstract
Acute respiratory failure has been and remains one of the main problems of modern medicine. Among the large number of high-tech methods of treating acute respiratory failure, adequate moisture and warming of the upper respiratory tract of the patient at all stages of the respiratory therapy are important. It should be noted that ensuring optimal moistening and warming of the inhaled gas mixture allows to avoid the development of many pulmonary complications. On the other hand, even with the use of the most modern treatment methods, inadequate microclimate in the upper respiratory tract can significantly reduce the effectiveness of their use. Thus, maintaining an adequate microclimate in the upper airways is normal, with various bronchopulmonary diseases and in conditions of respiratory support will improve the functional state of the lungs, prevent the development of many complications, reduce material costs and duration of treatment, reduce the mortality of this patient population. Despite the existence of the large database, the question of choosing the most effective technology to ensure homeostasis and protection of the upper respiratory tract in different clinical situations with different methods of respiratory support is still relevant. This dictates the necessity of continuing the research in this direction. This review is devoted to the current state of the problem of moistening, warming and filtering the breathing mix under conditions of prosthetic respiratory function.
Highlights
Even with the use of the most modern treatment methods, inadequate microclimate in the upper respiratory tract can significantly reduce the effectiveness of their use
Maintaining an adequate microclimate in the upper airways is normal, with various bronchopulmonary diseases and in conditions of respiratory support will improve the functional state of the lungs, prevent the development of many complications, reduce material costs and duration of treatment, reduce the mortality of this patient population
Заключение В настоящее время не вызывает сомнений необходимость адекватного кондиционирования дыхательной смеси при проведении любого вида респираторной поддержки у всех пациентов с ОДН различного генеза на всех этапах лечения
Summary
Использование ТВО у пациентов с хронической ДН, а также на этапе прекращения РП и отлучения от респиратора может сопровождаться клинически значимым увеличением работы дыхания, ростом ауто-ПДКВ, ретенцией углекислоты с развитием клинически значимого респираторного ацидоза, что не наблюдается при использовании увлажнителей испарительного типа. В соответствии с рекомендациями по использованию увлажнителей при проведении ИВЛ и НИВЛ AARC Clinical Practice Guideline (2012 год) безопасным для пациента является смена ТВО по крайней мере один раз в 48 часов [66]. В мета-анализе РКИ, выполненном в период с 1990 по 2003 год, выявили, что при использовании ТВО частота развития ВАП ниже, особенно у пациентов с продолжительностью ИВЛ более 7 суток, по сравнению с увлажнителями испарительного типа [48].
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