Complications in Preserving the Airway in Intensive Care Unit Patients

Autor: Ismet Suljević, Sanita Beharić, Ismana Šurković
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Zdroj: Acta clinica Croatica
Volume 51.
Issue 3.
ISSN: 1333-9451
0353-9466
Popis: Maintaining the airway in patients in intensive care unit (ICU) is often a vitally important issue for successful treatment of patients. The aim of the study was to identify the complications as the most common causes of difficult ventilation in ICU patients. This retrospective study included 12 patients with difficult pulmonary ventilation, aged 12-70 years, 8 male and 4 female. All patients were intubated for a period of 7-14 days on mechanical ventilation. Due to the need of prolonged mechanical ventilation, the patients underwent surgical tracheotomy and tracheal cannula was placed in five patients. Patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. All patients underwent regular intensive clinical observation and diagnosis, x-ray, CT and MRI. They all were administered antibiotic therapy as well as symptomatic and supportive therapy. Five patients underwent tracheotomy. In one patient with Down syndrome, tracheal rupture occurred two hours after general anesthesia. He developed massive pleural, mediastinal and subcutaneous emphysema. Seven patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. In two patients, therapeutic bronchoscopy with lavage was repeated twice, and in one patient bronchoscopy was repeated 4 times over a 6-month period. Eight patients died and four patients survived. Of the patients with polytrauma, two were in vigil coma, one survived for 6 months, while the other died from respiratory failure. In conclusion, it is important to promptly recognize and appropriately treat complications while maintaining airway in ICU patients, especially those with multiple trauma or conditions after extensive surgery. Preventing hypoxemia as a result of hypoxia has a far-reaching significance for the clinical course and success of patient treatment.
Održavanje dišnog puta kod bolesnika u jedinici intenzivnog liječenja (JIL) je često vitalno važan problem u uspješnom liječenju bolesnika. U našem radu prikazuju se komplikacije kao najčešći uzroci otežane ventilacije bolesnika u JIL. U ovu retrospektivnu studija bilo je uključeno 12 bolesnika s otežanom plućnom ventilacijom, u dobi od 12-70 godina, 8 muškog i 4 ženskog spola. Svi bolesnici su bili intubirani kroz razdoblje od 7-14 dana, na mehaničkoj ventilaciji, zbog potrebe produžene ventilacije. Kod bolesnika s unilateralnom atelektazom dijela pluća provedena je bronhoskopija i lavaža dišnih putova. Kod svih bolesnika se redovno provodila intenzivna klinička opservacija i dijagnostika, RTG, CT, MRI. Svi bolesnici su bili pod antibiotskom zaštitom, uz ostalu simptomatsku i suportivnu terapiju. Kod 5 bolesnika učinjena je traheotomija. Jedan bolesnik s Downovim sindromom imao je rupturu traheje dva sata nakon opće anestezije. Razvio se masivni pleuralni, medijastinalni i potkožni emfizem. Kod 7 bolesnika s unilateralnom atelektazom dijela pluća rađena je bronhoskopija i lavaža dišnih puteva. Kod 2 bolesnika terapijska bronhoskopija s lavažom ponavljana je dva puta, dok se kod jednog bolesnika bronhoskopija ponavljala 4 puta u razdoblju od 6 mjeseci. Osam bolesnika je umrlo, dok su 4 bolesnika preživjela. Od bolesnika s politraumom dva su bila u stanju vigilne kome, jedan je preživio 6 mjeseci, dok je drugi umro zbog respiracijske insuficijencije. Zaključuje se kako je komplikacije u očuvanju dišnog puta kod bolesnika u JIL važno pravodobno prepoznati i primjereno liječiti, naročito kod bolesnika s politraumom ili stanjima nakon ekstenzivnih operacijskih zahvata. Spriječena hipoksemija kao posljedica hipoksije ima dalekosežan utjecaj na klinički tijek i uspjeh u liječenju bolesnika.
Databáze: OpenAIRE
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