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Mechanical ventilation in the treatment of severe traumatic brain injury application

: Measuring the patient's spontaneous breathing frequency, tidal volume and minute volume, calculated according to body requirement to be supplied respirator minute ventilation. This decomposition of minute ventilation and the number of IMV tidal volume, breathing machine out of adjustment. With the improvement of spontaneous breathing, and gradually reduce the frequency of IMV to further enhance the spontaneous breathing exercise, usually every 3-4 hours to reduce IMV frequency 2 / O, 2/min. When the IMV frequency reduced to 2 to 3 times / min,[link widoczny dla zalogowanych], TV400 ~ 50OraL, the arterial blood gases to maintain normal breathing machine can be deactivated in favor of oxygen breathing on his own, close observation. ② Psv weaning: spontaneous breathing rV measuring the size and frequency, adjust PSV pressure on the MV maintenance to normal levels, although the increase in spontaneous breathing Tv PSV pressure level gradually decreased, until clinical studies to achieve the 5 ~ 7cmH: O level after endotracheal tube use in weaning oxygen, close observation. 2 Results A total of 38 patients mechanical ventilation 8640h, mechanical ventilation, the longest 45d, shortest 3h, 3h ~ 7d of which 12 cases, 8 ~ 14d in 18 cases, 15d above 8 cases. All patients after mechanical ventilation were 10 ~ 20rain SPO within the improvement and achieve the target oxygen saturation. In blood gas analysis before weaning were normal. Complication of mechanical ventilation did not occur. The group of 38 patients 3 died, died of brain death, the mortality rate of 7.89%,[link widoczny dla zalogowanych], the survival of patients followed up for 6 months after injury ADL grade, fully returned to normal in 10 cases, good recovery in 12 cases, 9 cases of moderate dysfunction , 3 cases of severe dysfunction, vegetative state in 1. 3 Discussion severe head injury patients, especially those who, due to deep coma, poor cough reflex and swallowing reflex, combined with many accompanied by symptoms such as vomiting or rhinorrhea very vulnerable to human aspiration lung injury,[link widoczny dla zalogowanych], or with chest injury, or serious after trauma ALUARDS, these patients are very likely to cause more severe hypoxemia. Chest injury patients, patients with respiratory muscle fatigue or failure, often leading to respiratory kinetics,[link widoczny dla zalogowanych], which causes lack of lung ventilation, can lead to more severe hypoxemia, and hypoxia will aggravate cerebral edema, increased brain damage Therefore, traumatic brain injury patients, to correct the hypoxemia is extremely important. The common clinical patients given high flow oxygen, although it is still not correct the hypoxemia. Mechanical ventilation in critically ill patients is an important means of life support, at this stage the technology is quite mature, and have been able to be safely used in patients. The group of 80 patients were confirmed by high-flow oxygen remains after more severe hypoxemia, with the mechanical ventilation, the hypoxemia are quickly alleviated, repeated review of blood gas analysis were within the normal range. The starting point of this group of patients treated hypoxemia on mitigation rather than through hyperventilation to reduce intracranial pressure, so the hyperventilation on the impact of the absence of intracranial pressure Design and Research. Study by this group of cases,[link widoczny dla zalogowanych], our experience is: (1) For patients with severe traumatic brain injury, especially with the chest injury, there difficult to correct the hypoxemia, should adopt a positive strategy of mechanical ventilation support. (2) ventilation mode choice, and more to PSV or SIMV mainly due to more independent factors are involved in the ventilation process is conducive to feedback regulation of body parameters and mechanical ventilation equipment, coordinated, more recently, in the physiological state, which to significantly reduce the complications of mechanical ventilation, and better ensure patient safety. (3) estimate the short term is difficult to awake and take a long time in mechanically ventilated patients, should be an early tracheotomy for mechanical ventilation, which is more conducive to the discharge of phlegm, but also conducive to the control of lung infection, so as soon as possible offline . (4) should follow the principle of individualized treatment, fine adjustment, should be experienced and specialized training received ventilation in the treatment of the physician to adjust the ventilation equipment, and periodically review a short time blood gas analysis, and, accordingly, and clinical manifestations of respiratory patients machine. 【
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