Author/Editor		Sinkovič, Andreja
Title		Nove metode zdravljenja akutne dihalne odpovedi na Oddelku za intenzivno interno medicino
Translated title		New treatment methods of acute respiratory failure at The department of medical intensive care
Type		članek
Source		In: Hojs R, Krajnc I, Pahor A, et al, editors. Zbornik predavanj in praktikum 23. srečanje internistov in zdravnikov dru inske medicine Iz prakse za prakso; 2012 maj 25-26; Maribor. Maribor: Univerzitetni klinični center,
Publication year		2012
Volume		str. 82-7
Language		slo
Abstract		In every hospital only intensive care units can provide appropriate care of the critically-ill patients with life-threatening multiorgan failure syndrome due to specialized, skilled and educated personnel and sofisticated medical equipment. Among organ failures acute respiratory failure is most frequently present - even in more than 70% of critically-ill patients, necessitating respiratory support by mechanical ventillation. Acute respiratory failure is the consequence of different clinical conditions, including heart failure, infection and sepsis, poisonings, neurological diseases, etc. Contemporary guidelines for treatment of acute respiratory failure recommend low-pressure and low-volume mechanical ventilation with high PEEP and FiO2; in case of unresponsiveness to basic treatment additional measures are needed, including neuromuscular blockade, inhaled nitric oxyde (NO) and/or the use of extracoporeal circulation. NO inhalation improves oxygenation immediately and temporarily, acting as bridge to other causative treatments. Extracorporeal circulation, in particular the use of pumpless iLA (interventional lung assist) membrane effectively eliminates arterial CO2 in hypercapnic respiratory failure. Our conclusions are that new methods in treatment of acute respiratory failure improve survival of critically-ill and shortens in-hospital stay, what decreases psycho-physical burdon in patients, their relatives and intensive care personel and finally, the financial burdon of the hospitals.
Summary		Intenzivna enota je tisto mesto v bolnišnici, kjer je možna oskrba kritično bolnih z življenje ogrožujočimi večorganskimi odpovedmi zaradi visoko specializiranega, izurjenega in educiranega osebja ter uporabe ustrezne medicinske opreme. Med organskimi odpovedmi kritično bolnih je akutna dihalna odpoved najpogostejša, saj je prisotna celo pri več kot 70% bolnikov s potrebo po mehanični podpori dihanja. Akutna dihalna odpoved je posledica različnih kliničnih stanj, vključno težje oblike srčnega popuščanja, okužbe in sepse, zastrupitev, nevroloških bolezni, itd. Za zdravljenje akutne dihalne odpovedi sodobne smernice priporočajo uporabo umetne ventilacije z nižjimi volumni in tlaki ter visokim tlakom na koncu izdiha (PEEP) in visoko koncentracijo kisika v vdihanem zraku (FiO2), v primeru neodzinosti na zdravljenje pa dodatne ukrepe, vključno z nevromuskularno blokado, inhalacijo dušikovega oksida (NO) in uporabo zunaj telesnega obtoka. Inhalacija NO takoj, vendar prehodno izboljša oksigenacijo in deluje kot premostitev do učinka drugih terapevtskih strategij. Za akutno resipratorno odpoved se uveljavlja med metodami z zunajtelesnim krvnim obtokom uporaba iLA (interventional lung assist) membrane brez zunanje črpalke, ki učinovito odstrani CO2 iz arterijske krvi. Naši zaključki so, da uporaba novih metod zdravljenja akutne respiratorne odpovedi izboljša preživetje kritično bolnih in skrajša hospitalizacijo v intenzivnih enotah, kar zmanjša psiho-fizično breme bolnikov, njihovih svojcev in zaposlenih v intenzivnih enotah, končno pa tudi zmanjša finančno breme bolnišnice.
Descriptors		RESPIRATORY INSUFFICIENCY EXTRACORPOREAL CIRCULATION NITRIC OXIDE