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Mechanical ventilation, airway management of patients

The occurrence of disease. Can be divided into the following ways: 2.4.1 tapping chest and back: a uniform two-hand tapping alternating chest and back, transfer the vibrations make the adhesive adhered to the bronchial tree obstruction slack off Tai bronchus, easy to cough up or attract out. For expectoration powerless, with the appropriate power tapping can assist expectoration, percussion auscultation before and after to determine the effect. 2.4.2 postural drainage: the use of body position change, to achieve the purpose of the gravity drainage of secretions. Easy to stay in the lung secretions of the bottom, constantly changing position can reduce the secretion retention. 2h usually stand 1, and keep the affected side in the last. Thoracic surgery, the patient or semi-sitting position to maintain the slope. Taking care not to turn over patients ventilator tube stretch, the condition allows, they can change their own position disengaged Zhu Huanzhe respirator. 2.4.3 Vibration expectoration: G5-type vibration expectoration with the U.S. instrument, each treatment 10-20min. 2.5 2.5.1 suction suction time of care: the modern view is suction aspiration of airway secretions should not as a routine operation, when the patients airway secretion retention performance, is the suction that * 979 * sign. Instead, because of excessive stimulation of the respiratory tract mucosa suction, so that secretions increase. Suction indications: airway or chest auscultation and sputum of song can be heard; cough or respiratory distress in patients with influenza; increased airway pressure, ventilator pressure alarm; blood oxygen pressure or oxygen saturation decreased. 2.5.2 choice of suction tube: use closed suction method: To do the following: during the suction before the first closed suction system connected, respectively, and were artificial airway (endotracheal intubation or tracheotomy), ventilator, suction device connected. Start suction, open suction device will rotate the airway switch to the green arrow button (that airway open), the suction tube into the airway along the cuff, to the desired depth, press suction control lever while pulling out the suction tube will sputum suction. After suction, suction tube withdrawn until the catheter tip to see the full black marker, will switch control knob to the airway red arrow (indicating airway closure), with normal saline and switch on the side of the interface is connected, according to the negative pressure control handle, flush suction tube. Advantages: to ensure the continuity of ventilatory support, to prevent cross infection and reduce the time and goods consumption. Over the years we need to use the suction method suction ventilator with the patient during the process of artificial airway temporary separation, interruption of mechanical ventilation, leading to hypoxia in patients with arterial oxygen saturation led to decreased heart rate, especially the application of PEEP in patients , due to sudden decompression of the airway so that the symptoms get worse, and even cause myocardial ischemia, arrhythmia and even cardiac arrest. Through clinical comparison, closed suction is better than open suction advantage. 2.6 Oral Care: tracheotomy or intubation in patients with normal oral chewing reduce or stop, can easily lead to oral mucosa or gum infections, ulcers. Correct oral hygiene rinse at least 2 times a day, with hydrogen peroxide plus saline, 1:5000 nitrofurazone, 4% sodium bicarbonate mouthwash, etc., yarn ball cleaning and then rinse mouth with a syringe, catheter attract . Mouth taboo coma patients. Daily oral care early in the morning before the secretion samples collected, the smear and bacterial culture examination, clinical care and medication. 2.7 Psychological care: conscious use of breathing machines for the treatment of patients, detailed explanations and language can play to enhance patient comfort the spirit of self-confidence and the role of ventilation treatment. Mechanical ventilation to patients that the purpose of and in line with the method; often ask patients about their feelings and use gestures, nodding or shaking his head, eyes closed, wide open methods such as communication, attitude and kind, to increase patient's sense of security, the operation should be gentle; have written could allow patients to write their feelings and demands out of reference for the medical treatment; if necessary exchange of family members of patients and patients sometimes get good results. Long-term use may produce ventilator-dependence, we should always encourage patients to increase confidence, enhance self-breathing, for the early off-line. 3 is both artificial airway experience to ensure that the airway open, preventing airway obstruction is not smooth or the main measures,[link widoczny dla zalogowanych], but also patients and ventilator connection the only way. Reasonable, timely and effective establishment of artificial airway, and proper care to ensure the implementation of ventilator function, one of effective measures to prevent complications 【. 4