Caring for a patient in a coma after a stroke at home

Caring for bedridden patients after a stroke: how to achieve a quick recovery?

Issues discussed in the material:

• What is a stroke
• How to provide first aid for a stroke
• How to care for bedridden patients after a stroke at home
• What are the advantages of a private boarding house for elderly people who have suffered a stroke?

Stroke is a disease associated with impaired blood supply to the brain. After suffering a stroke, the patient’s quality of life may decrease; functional limitations often arise or a complete loss of legal capacity occurs (the person falls into the category of “bedridden patient”). In addition, such a pathology can lead to death. Rehabilitation of patients who have suffered a stroke takes quite a long time. With timely assistance and the availability of well-planned recovery measures, significant results in improving health can be achieved. To do this, it is necessary to organize effective care for a bedridden patient after a stroke.

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Resuscitation after hemorrhagic stroke

When considering individual cases of hospitalization after a stroke in the intensive care unit, the first thing to note is the consequences of hemorrhage. Coma occurs more often precisely after a hemorrhagic stroke, with open hemorrhage, hypertensive crisis, leukemia, hemophilia and other catastrophic consequences.

Very rarely, a hematoma forms in the cerebellum or brainstem; more often it occurs when blood vessels rupture in the subcortical zone. In this case, resuscitation requires a detailed EEG and MRI of the brain to determine the focus of the formation after a stroke and discuss the possibility of its elimination.

It is advisable to place the patient in a neurological intensive care unit in the first hour and a half after the onset of a stroke. After a study of the cerebrospinal fluid, a blood test and a doctor’s conclusion regarding the operation (and its implementation), the rehabilitation period begins. A patient after a stroke needs continuous monitoring, but must remain at rest.

• Aminocaproic acid 5% intravenous drip.
• 2000 units of heparin.
• Also, to normalize blood pressure after a stroke, it is necessary to use dehydration therapy in the form of taking mannitol or Lasix.
• It is advisable to introduce sodium hydroxybuterate solution and antioxidants in order to speed up metabolism.
• Trasylol-type inhibitors and enzymes.

What is a stroke

During a stroke, normal blood circulation in the brain is disrupted. Often the pathology develops without any noticeable preconditions, quite suddenly. The patient’s general condition worsens, cell damage occurs in the brain, which often leads to irreversible processes in the body or even death.

What are the causes of stroke? Doctors mainly highlight changes in blood composition (the appearance of blood clots, embolism) and atherosclerosis.

In sources, a description of the disease is first found in the works of Hippocrates. Later, the Greek surgeon Galen (200s AD) called this pathological condition apoplexy.

During an attack, control over areas of the brain that are responsible for certain body functions is lost.

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It is extremely difficult to completely neutralize the consequences of a stroke; it depends on many factors. It is important to monitor your health and body signals.

Who is at risk? As a rule, these are men over 50, people suffering from obesity, diabetes, diseases of the cardiovascular system, alcohol abusers, smokers, drug addicts.

Stroke is associated with damage to the blood vessels of the brain and narrowing of the lumen in them. What are the causes of this pathology?

• Atherosclerosis or cholesterol plaques on the walls of blood vessels.
• Diabetes mellitus types I and II, hormonal changes.
• Use of nicotine, drugs and improper use of medications.
• Sedentary lifestyle, lack of mobility, stress.
• Taking antibiotics and oral contraceptives in combination with alcohol.
• Old age and the associated wear and tear of the tissues of the heart and blood vessels, their fragility, spasms.

One of the main and most common causes of stroke is high blood pressure. Typically, people with high blood pressure are more at risk; 70% of strokes occur in people with high blood pressure (more than 140 over 90). Problems in the functioning of the heart provoke the formation of blood clots, which, in turn, lead to strokes.

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How long do they stay in the intensive care unit?

In this department, the day is not divided into day and night: medical workers attend to patients every minute. The intensive care unit is a closed area of ​​the hospital. This is a forced measure that is necessary so that no one and nothing distracts doctors from saving human life.

After all, some of the patients will never be able to leave the cold walls of the intensive care unit.

Relatives of such patients are worried because they do not know how long they have been in intensive care. How resuscitation treatment is carried out, what factors are associated with the length of a patient’s stay in the “rescue” department, you will learn from our article.

Resuscitation is a department of a hospital where emergency actions are carried out to eliminate violations of the vital functions of the body. No one can answer how many days the patient will spend between life and death. Recovery time is always individual and depends on the type of injury, the patient’s condition and the presence of concomitant complications that appeared after the injury.

For example, after the operation, blood flow and spontaneous breathing were restored. However, at this stage a complication is diagnosed: cerebral edema or infection. Therefore, monitoring the patient’s condition in the intensive care unit will continue until all complications are eliminated. After this, the patient will be transferred to a regular ward.

It is important to understand that relatives, acquaintances and friends cannot visit the patient in the intensive care unit. This rule applies to all visitors with rare exceptions. Let's tell you why.

All visitors bring a lot of bacteria and viruses on their clothes, bodies and hands. They are absolutely safe for a healthy person. But for patients in serious condition, they will cause a complex infection. Moreover, patients themselves can infect visitors.

There are several patients in the general intensive care unit. Their location does not depend on gender: patients are undressed and connected to numerous equipment.

Not everyone will be able to calmly react to such an appearance of people close to them. Therefore, people who are worried about the condition of their relatives need to wait until the patients are transferred to therapy.

Let us consider the features of resuscitation treatment in patients whose critical health condition is associated with the most common pathologies: stroke and heart attack.

Stroke

A stroke is a dangerous change in the blood circulation of the brain. He spares neither women nor men at any age.

Moreover, 80% of stroke cases are characterized by ischemic pathology and only 20% by the hemorrhagic type.

How long a stroke will keep a person in the hospital depends on several factors:

• Localization and size of brain tissue damage;
• Severity of symptoms;
• Presence or absence of coma;
• Functioning of systems and organs: breathing, heartbeat, swallowing and others;
• Possibility of relapse;
• Presence of concomitant diseases.

As you can see, the patient will stay in the intensive care unit as long as his condition requires. Patients in the department are carefully examined every day, making a verdict on their further stay in the hospital.

It should be noted that in case of pathological changes in the brain, the patient is required to stay in intensive care for 3 weeks. This time is needed for the doctor so that he can track possible relapses and prevent them.

General standardization of stroke treatment involves a month. This period is approved by the Ministry of Health for the complete recovery of the patient. However, on an individual basis, the period of therapy is extended if it is determined that the patient needs further treatment and rehabilitation.

Stroke therapy includes 3 stages.

The first therapeutic course consists of basic treatment measures:

• Improve the functioning of the respiratory system;
• Adjust hemodynamics;
• Eliminate elevated body temperature and psychomotor disorders;
• Fight cerebral edema;
• Provide proper nutrition and care to the patient.

After restoration of the primary functions of the body, differentiated treatment follows. It depends on the type of stroke and the patient's condition.

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Hemorrhagic stroke:

• Eliminate cerebral edema;
• Adjust intracranial and blood pressure indicators;
• Assess the need for surgical intervention.

Ischemic stroke:

• Restore good blood circulation in brain tissue;
• Improve metabolism;
• Eliminate manifestations of hypoxia.

The larger the affected area in the brain tissue, the more time the patient will need to recover.

Also, relatives should know what happens to the patient when he falls into a coma. This dangerous complication occurs only in 10% of cases.

A comatose state occurs due to instantaneous dissection of the brain vessels. No one knows how long it will last.

Diagnostic and corrective therapy for comatose state consists of the following actions:

• Using constant hardware monitoring, the functioning of vital human organs and systems is monitored;
• Measures against pressure ulcers are used;
• The patient is fed through a feeding tube;
• The food is ground and heated.

Note!

If the patient is in an extremely serious condition, he may be placed in an induced coma. This is necessary to perform emergency brain surgery.

After the patient comes to his senses, therapy is aimed at combating the consequences of the attack: restoring speech and motor activity.

The reason for transfer to a general ward is the following improvements in the patient’s well-being:

• Stable pulse and blood pressure readings within an hour of diagnosis;
• Having the ability to breathe independently;
• Full awareness of the speech addressed to him, the opportunity to contact the attending physician;
• Complete exclusion of relapse.

Treatment is carried out in the neurological department. Therapy consists of taking medications and rehabilitation exercises aimed at developing motor activity.

What are the types of stroke?

There are two types of stroke depending on the mechanism of occurrence.

1. Ischemic stroke or cerebral infarction.

This type of stroke is the most common. People aged 60 years and older are at risk. Such patients have a history of diabetes and heart pathologies. In this case, the blow occurs as a result of the formation of an atherothrombotic plaque or thrombus in a cerebral artery, which closes the lumen of the vessel. As a result, brain cells are left without oxygen and die. It also happens that air bubbles accumulate in the arteries, interfering with the flow of blood. Either the artery is compressed due to a tumor or as a result of injury.

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2. Hemorrhagic stroke (intracerebral and subarachnoid).

Its cause is a cerebral hemorrhage. Intracerebral stroke often occurs in people aged 45–60 years, patients with cerebral atherosclerosis, hypertension, arterial hypertension, and blood diseases. This is a rarer type of stroke, but also more dangerous to life and health: the wall of the defective artery ruptures, causing hemorrhage. The reason for this may be an aneurysm (protrusion of the artery wall), atherosclerosis, which leads to disruption of the integrity of the vascular wall, as well as increased blood pressure.

A subarachnoid stroke is a hemorrhage into the subarachnoid space (a cavity between the pia and arachnoid membranes of the brain and spinal cord filled with cerebrospinal fluid). People aged 30–60 years are susceptible to it. Among the reasons are smoking, chronic alcoholism (or even one-time consumption of alcohol in excessive quantities), arterial hypertension, and obesity.

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In addition to the main types of stroke, after which bedridden patients require full care, there is also a transient ischemic attack (the so-called mini-stroke). During such an attack, blood flow to the brain is briefly blocked. Typically, the duration of such a stroke does not exceed five minutes, and all the usual symptoms are present: impaired coordination of movements and speech, dizziness, numbness on one side of the body.

Often a person does not even realize that he has suffered a mini-stroke, since there are no visible consequences of such a blow, and all body functions return to normal quite quickly. But it is important to understand that if you do not pay attention to this signal from the body in time and do not take action, then within the next six months you can suffer a full blow with more severe consequences. Under no circumstances should you let the situation take its course.

Any type of stroke is a very serious danger to human life and health. In order to save the patient from death or severe consequences of a stroke, it is necessary to immediately call an ambulance, doctors will determine the type of stroke, the degree of brain damage and begin treatment.

How to recognize a stroke and provide first aid

In order not to miss precious time during an attack, you need to know the main signs of a stroke:

• loss of consciousness or state of “stupefaction”;
• drowsiness or sudden agitation;
• rapid heartbeat and dizziness;
• increased sweating, nausea, and in some cases vomiting;
• possible disturbance of orientation in space;
• visual disturbances, loss of sensitivity, articulation disorders.

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You should know how to confirm a possible stroke, even without being a doctor. To do this, you need to carry out a number of tests:

• Ask the person suspected of having a stroke to raise their hands, palms up. If it's really a punch, one arm will go up correctly and the other will swing out to the side or stay down.
• Invite the person to raise both arms up at the same time. During an attack, your arms will rise at different speeds and to different heights.
• Let the patient stick out his tongue. In the event of a stroke, it will be bent or twisted to the side.
• Ask them to say a phrase. During a stroke, a person will speak as if drunk, and articulation may be impaired.
• Ask the patient to smile and show his teeth. An asymmetrical, crooked smile is a sign of a stroke.

If you see any of the above signs, immediately call an ambulance or take the person to the doctor. The correct sequence of actions and quick reaction in the event of a stroke will help reduce the sad consequences of the attack and increase the chances of the most positive outcome. How should you behave in such a situation?

• Try to remain calm and do everything so that the patient does not get nervous; do not rush around and wring your hands: this will not bring any results.
• If you can, measure the pressure, check the patient’s pulse, his breathing.
• Identify the signs of a stroke: facial asymmetry, curved tongue, speech problems, lack of coordination.
• Call an ambulance.
• Lay the patient on his back or side, slightly raising his head and torso, or horizontally. If signs of nausea occur, turn your head to the side.
• Provide first aid if necessary; if there is no breathing, the heartbeat is weak, the pupils are dilated, perform simple resuscitation measures (artificial respiration, chest compressions).
• Open the windows, unbutton your shirt, unbutton your belt - let nothing interfere with the access of oxygen.
• Observe what happens to the patient, what changes in his condition.

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According to statistics, if you bring a patient with signs of a stroke in the first three hours after their appearance to a medical institution, where he will receive proper care, then:

• in 50–60% of cases, patients with severe forms of stroke survive;
• in 75–90% of cases, patients who have suffered a mild form of it recover completely;
• in 60–70% of cases, the abilities of brain cells are completely restored.

Time is the most valuable resource in a stroke situation. To prevent serious brain damage, it is important to act quickly and not panic. If help is provided to the patient in a timely manner, then there is every chance of his recovery and normal life in the future.

After a stroke: how long do patients stay in hospital?

Stroke is an acute condition that occurs in every 3-4 people out of 1000. Approximately 80% of cases are due to ischemic hemorrhage. It is considered less dangerous than hemorrhagic and is not complicated by severe consequences. Many patients and relatives are interested in how long they stay in the hospital with a stroke immediately after the attack and during the recovery period.

However, there is no clear answer to this question - it all depends on the complexity of the patient’s condition, the type of stroke, the person’s age and many other factors. A comatose state, especially experienced in old age, greatly complicates treatment and rehabilitation.

There are 3 stages of a patient’s stay in the hospital after a stroke: pre-hospital, treatment in intensive care or intensive care, and stay in the general ward, where rehabilitation begins.

The minimum number of days is strictly regulated by law: a person stays in hospital for 21 days, if vital functions are not impaired. If these functions are violated, the period is extended to 30 days.

However, whether a person is ready for discharge by this date cannot be regulated.

If 30 days is not enough, the hospital conducts a medical and social examination, and, if necessary, extends the length of stay in the hospital.

The examination also establishes the process of individual rehabilitation of the patient.

After a stroke, the patient is kept in the intensive care unit for no more than 3 weeks after the attack.

During this period, doctors take care that serious complications do not arise due to the improper functioning of certain systems, mainly the brain.

All patients are hospitalized, regardless of the form of hemorrhage. The length of stay in a clinical setting depends on the following factors:

• severity of symptoms of the disease;
• the lesion after a stroke is large or small;
• if a person is in the hospital with a stroke, and he experiences severe confusion or transition into a coma, then the length of stay in intensive care increases;
• the degree of damage to internal organs, inhibition of their functions;
• concomitant pathologies and the presence of high blood pressure, the need for its constant monitoring.

If the serious condition persists, the person is kept in the intensive care unit until the danger to life disappears. Basic therapy in the rehabilitation department of a hospital, where a person is admitted after a stroke, consists of the following areas:

• activities for daily care of the patient, monitoring his nutrition;
• maintaining the functioning of the respiratory system, combating any disorders;
• prevention of overheating, cerebral edema, vomiting and other pathological conditions of a person after a stroke.

If a person has suffered a hemorrhagic stroke, then the main goal of the hospital staff is to remove cerebral edema, reduce cranial pressure and normalize blood pressure. Surgical intervention may be required if, after 1-2 days in intensive care, a deterioration in health is observed.

In case of an ischemic stroke, it is necessary to improve blood circulation so that the damaged areas of the brain receive sufficient oxygen and nutrients. At the same time, metabolic processes are restored. The duration of therapy in both cases is determined by the characteristics of complications.

The countdown of the legislative 21 days begins with the transfer of the patient from the intensive care unit to the intensive care unit.

During the entire period, the doctor monitors the patient every day. A set of measures is used aimed at reducing complications.

When transferred to a general ward of a hospital after a stroke, the patient must meet the following requirements:

• he does not need a ventilator;
• the person is conscious, he not only lies, but can move if there is no paralysis;
• the pulse is normal, and pressure drops do not occur;
• the risk of recurrent stroke is reduced.

Only if all indicators are normal does the person continue to lie in the general ward of the hospital, in the neurology department. This is where the rehabilitation period begins, which includes drug therapy and a set of therapeutic exercises.

After 3 weeks in the general ward, the patient is sent home for further outpatient treatment. If a person was working at the time of the attack, he is issued a certificate of incapacity for work. In this case, the length of sick leave depends on the type of pathology and disorders that arose against the background of a stroke.

After a minor stroke, the patient does not stay in the hospital for more than 21 days, and he can begin work only 3 months after discharge. If the hemorrhage was average, then the period increases to 4 months.

In severe forms of stroke, a disability is often assigned, and the person is released from his usual work. A medical and social examination must establish and assign a disability group.

It should be noted that patients after a rupture of an aneurysm leading to a hemorrhagic stroke remain in intensive care for at least 60 days. After this, they receive sick leave for at least 4 months.

How long you stay in hospital with a severe stroke, as in other cases, depends on the patient’s condition. But there is one peculiarity: if it was a hemorrhagic stroke with a rupture of an aneurysm, then after 4 months of rehabilitation the sick leave can be extended at the request of the patient without an examination (based on the opinion of the supervising doctor).

You can shorten the length of stay in the hospital after a stroke by writing a waiver of medical services, taking the patient home and then hiring a nurse.

In this case, the person is constantly visited by a therapist and transmits information about his condition to the responsible medical institution.

There are situations when a patient suffers a new attack of stroke and ends up back in the intensive care unit. He could receive treatment either at home or in hospital. In this case, therapy is extended without commission for another 2.5 months. A repeat course of treatment is prescribed.

In any clinical situation, the length of stay in a hospital depends on the patient’s well-being and the doctor’s information. But there is another condition in which the prognosis is the most disappointing - coma.

Coma occurs only in 10% of cases after all strokes. A person in a coma always lies in a hospital; it is impossible to keep him at home. The duration of treatment in such a situation cannot be predicted. The person must be constantly monitored by medical personnel.

• strict control of vital signs provided by medical equipment: heartbeat, brain activity, blood pressure level;
• the use of anti-decubitus mattresses, as well as constant turning of the person every 3-6 hours;
• feeding through a tube with special mixtures, juices and medical nutrition in ground, heated form.

An artificial coma is administered if a person has a massive stroke or the doctor assesses his condition as serious. They are also put into a coma if there is a need for brain surgery. Recovery from a coma occurs over a long period of time, not in 1 day.

Duration of sick leave

So, sick leave is issued only when the threat to life has passed, the person has left intensive care after a stroke and has undergone a course of treatment. There is no single standard for setting deadlines. It all depends on the disorder, the amount of skills lost and the recovery process:

• in case of micro-stroke and minor violations, sick leave is issued for 3 months;
• moderate stroke is treated for at least 3 months, it can be increased without commission to 4 months;
• with a severe stroke, rehabilitation is often required for 6-8 months, and the person is given temporary disability.

If during rehabilitation, while on sick leave, a repeated relapse occurs, then treatment is extended for 2.5 months.

The length of time a patient spends in the hospital after a stroke depends on many factors. It should be remembered that doctors do not have the right to discharge a patient earlier than 21 days after transfer to the intensive care unit from intensive care. If the hemorrhage is followed by a coma, things are more complicated, and the days are counted individually after the person leaves this state. Sick leave after a hemorrhage is issued for an average of 3 months with the possibility of extension.

The incidence of strokes in Russia is very high, and out of every ten stroke patients, eight people end up in the clinic with an ischemic stroke, and two people with hemorrhage.

Both types of damage provoke serious consequences, and they usually happen unforeseen.

In this case, the question becomes relevant: how long are stroke patients treated, how long do they stay in the hospital after a stroke, and what are the prognoses for home treatment.

In case of stroke, assistance to patients can be divided into several stages:

• prehospital care – provided by others or a team of doctors before admission to a medical facility,
• providing assistance in the clinic - performing an operation or treatment in the intensive care unit, intensive care unit,
• the patient's stay in the general ward.

If we can say about the first two stages that the length of stay there is unpredictable and depends on the health of the patient and his condition after the operation, then the third stage is regulated by law. There are instructions from the Ministry of Health, according to which stroke patients, after passing through the acute period, are transferred to a general ward, the duration of stay in it is from 21 to 30 days.

Patients whose vital functions are not impaired are kept in an intensive care ward for three weeks. Simply put, these are those patients with a mild form of stroke whose body has found the strength to restore activities that were not seriously affected.

Stroke patients with more serious disorders, whose body was unable to overcome the abnormalities caused by the stroke, remain in a stable and serious condition for 30 days.

• 1 Specifics of the resuscitation state

Care for bedridden patients after a stroke in a hospital

In a medical institution, nurses provide care for bedridden patients after a stroke. They ensure that IVs are placed and patients take medications, carry out special procedures, feed, change linen, and change clothes.

In addition, care includes the prevention of bedsores, thromboembolic complications, pulmonary congestion, and contractures. Rehabilitation measures must be started as early as possible (of course, taking into account the severity of the person’s condition), even if the patient is bedridden. Early activation can help the rapid formation of compensatory mechanisms and even the disappearance of manifestations of the disease.

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A bedridden patient is unable to take care of himself. Such patients need help with the simplest things: feeding, changing clothes, combing. Daily hygiene procedures even more require assistance. Washing your face, brushing your teeth, wiping your body, and washing your face are done daily, and your hair is washed once a week. It is important to dry your head well and wipe all areas of the body dry with a towel, paying special attention to the folds of the skin. In addition, to prevent diaper rash, special creams are used.

To avoid constipation in the patient, it is necessary to monitor the quality of the intestines: a large amount of fluid and fiber consumed, as well as exercise, will help prevent the negative consequences of paralysis. If a bedridden patient is unable to urinate on his own, a catheter is placed; in addition, adult diapers may be used in the hospital.

Increased attention should be paid to the prevention of complications: bedsores, venous thrombosis, muscle contractures, congestive pneumonia.

How to care for a bedridden patient after a stroke at home

It is ideal if a bedridden patient after a stroke undergoes rehabilitation in a hospital under the supervision of professionals. But such care is available to only a few, because it costs a lot. Therefore, most victims of the disease have to recover at home, where they are looked after by relatives or special caregivers.

The vast majority of people who have suffered a stroke have problems with motor activity. This may be paralysis of one half of the body. But, unfortunately, often victims remain completely incapacitated and helpless. Caring for a bedridden patient after a stroke at home requires time, attention and effort.

Such patients are slow, and it is quite difficult for them to perform any actions. Therefore, relatives must be patient and understanding. It is very important to carry out all rehabilitation measures carefully and efficiently; the overall outcome of the disease depends on this. Manipulations included in caring for a bedridden patient:

1. Regularly change the patient’s position.

A bedridden patient should not be in one position for more than 2–3 hours; it is necessary to change his position, even if he is paralyzed. This is part of the treatment procedures.

• On the back. In this case, the paralyzed arm and leg should be placed on pillows so that the hand and foot do not hang down. It is important to place the shoulders and hip joints at the same level. The head should not bend at the cervical spine.
• On the healthy side. Paralyzed limbs are also placed on pillows in front. The leg is bent at the knee and hip joint.
• On the sore side. You should not allow yourself to fall on your stomach. The affected arm should be slightly brought forward, the healthy arm should be slightly to the side or behind the back. The paralyzed leg should be straightened at the hip joint, but can be bent at the knee. The healthy leg, bent at both joints, is brought forward and laid out on a pillow.

Nursing care in the intensive care unit

Caring for patients in the intensive care unit and intensive care wards is a complex set of measures, on which the outcome of the disease largely depends. Carrying out most of these activities is the responsibility of nursing staff. However, it must be remembered that the organization of care is entrusted to the doctor, and he must master all manipulations in full. This applies, first of all, to the ability to observe the sanitary and hygienic regime in the department, perform resuscitation, and care for patients in serious and unconscious condition. A rapid change in the patient's condition requires close monitoring of the patient, clear orientation in the environment and professional observation. It is no coincidence that the manuals quote Lindsay’s words: “For one error due to ignorance, there are ten errors due to oversight.”

In any surgical hospital, the resuscitation service occupies a leading position in providing medical care to patients. Large institutions have their own intensive care unit (ICU). In less powerful hospitals there is a department of anesthesiology and intensive care, and intensive care is provided in special intensive care wards (ICU).

These departments are located on the same floor as the operating unit. It is undesirable to place it on the ground floor, since this will inevitably cause a crowd of relatives of patients, which will negatively affect the functioning of the department. The operating mode of the ICU is approaching the operating unit. From the point of view of compliance with sanitary and epidemiological measures, three zones are distinguished: 1) a high-security medical zone, which includes wards and manipulation rooms; 2) border zone (general regime), covering the corridor part; 3) area of ​​office premises (staff room, nursing room).

The main departments of the ICU are the resuscitation room, wards, biochemical express laboratory, dressing room, material room, equipment room, resident room, nurse room, etc.

The intensive care room is designed to provide care to patients who are in critical condition. Here they adhere to the operating mode of the operating room, perform long-term artificial ventilation, catheterize the great vessels, perform tracheostomy, hemosorption sessions and other types of extracorporeal detoxification, bronchoscopy and other methods of intensive treatment. There can be from two to six patients in the room, isolated from each other by special lightweight hanging screens. Among the necessary equipment of the resuscitation room there should be monitors for constant monitoring and recording of the main parameters of the functioning of vital organs and systems (pulse, blood pressure, respiratory rate, etc.), defibrillators, anesthesia equipment, suction, a mobile X-ray machine, sets of surgical instruments for venipuncture , tracheostomies, medication kits and other equipment. The length of stay of patients in the room depends on the patient’s condition; when the functions of organs and systems are stabilized, they are transferred to the intensive care ward.

Intensive care wards are designed for close monitoring of patients with a relatively stable condition of vital organs and systems. In the ward, the beds are positioned in such a way that access to the patient is ensured from all sides, based on 8-24 square meters. m for 1 bed. Here, patients do not see resuscitation measures, the lights are turned off at night, and patients can rest. A glazed window is made between the rooms, through which constant visual monitoring of the patient’s condition is carried out.

It is recommended to allocate an isolation ward , in which one patient is hospitalized in cases where it is necessary to isolate him from other patients, for example, with tetanus, open form of tuberculosis and other diseases.

One of the most important units of the intensive care unit is the clinical-biochemical express laboratory . It performs standard tests around the clock (clinical analysis of blood and urine, clotting and bleeding time, blood glucose levels, urine diastasis, the amount of total protein, bilirubin, urea and amylase in the blood serum), which allow monitoring the condition of the main vital organs and systems in patients in this department.

In addition to these premises, it is advisable to allocate an office for extracorporeal detoxification , where lymphosorption and hemosorption, plasmapheresis and hemodialysis are performed, as well as an equipment room in which currently unused equipment is stored.

Working in an ICU is associated with occupational hazards and difficulties, including constant stay among patients in serious condition. In this regard, special rooms are allocated for doctors and nurses where they can rest during their free time from work, and breaks for meals are regulated.

In accordance with the order of the Ministry of Health, to ensure the operation of the ICU, its medical staff is staffed at the rate of 4.75 times the rate of doctors for 6 beds. The same calculation is used to determine the number of junior nurses for patient care and medical laboratory assistants. 2 times more nurses are required (4.75 rates for 3 beds) and an additional 1 nurse rate for 6 beds for daytime work.

The department maintains accounting and reporting documentation, including making entries in the medical history, filling out a resuscitation card and an intensive care card. At the same time, significant assistance is given to the unification of forms for appointment sheets, observations, and referrals for tests.

Compliance with the sanitary and epidemiological regime in the ICU is aimed at limiting as much as possible additional infection of patients in serious condition and reducing the risk of developing nosocomial infections. The fact is that when providing anesthesiological and resuscitation services, as well as during intensive care, such technical techniques and methods as venipuncture and catheterization of the great vessels, laryngoscopy, tracheal intubation, and puncture of the epidural space are used. In this case, new entry points for infection inevitably arise.

To comply with the anti-epidemic regime, the resuscitation and intensive care service is isolated from other departments of the hospital, wards for postoperative, somatic, “clean” and infected patients are profiled, thus separating their flows, and also provide a separate entrance for staff. Visits to the ICU by non-employees are strictly limited. Doors to the department must be kept closed at all times. On the doors they recommend the inscription “Resuscitation! No entry allowed! To enter you need to call, the staff opens the doors with their own key. Relatives are admitted in exceptional cases.

To reduce microbial contamination in the premises of the department, it is recommended to install mobile recirculating air purifiers (VOPR-0.9, VOPR-1.5).

All objects that come into contact with the patient's skin and mucous membranes must be clean and disinfected. For this purpose, laryngoscopes, endotracheal tubes, catheters, mandrins, masks, and needles are sterilized. Hoses, pipes, and other parts of anesthesia and breathing equipment are sterilized; they must be replaced for each patient. The devices themselves are sterilized in a special chamber at least every other day. After each patient, the bed is subjected to special treatment and filled with bedding that has undergone chamber treatment.

Bed linen is changed every day. It is necessary to have an individual, preferably disposable, towel and liquid soap from a bottle.

At the beginning of the working day in the office premises, the department staff puts on a change of shoes and clothes (shirt, trousers, robe, cap). When entering the treatment area, put on a mask and change the gown intended for work in this ward. Before working with a patient, wash your hands twice with a brush and soap and treat them with an antiseptic solution. The mask is changed every 4-6 hours, and the gown and cap are changed daily.

The NICU is regularly cleaned. The wards and resuscitation room are wet cleaned 4-5 times a day using disinfectants. After this, the premises are treated with bactericidal lamps. Once a week, general cleaning is carried out, after which mandatory bacteriological control of walls, equipment and air is carried out. It is advisable to organize the functioning of the department in such a way that one of the rooms is free and exposed to bactericidal lamps.

ICU patient population. In the intensive care unit, hospitalization of patients is indicated: 1) with acute and life-threatening circulatory disorder; 2) with acute and life-threatening respiratory distress; 3) with acute hepatic-renal failure; 4) with severe disturbances of protein, carbohydrate, water-electrolyte metabolism and acid-base balance; 5) after complex operations accompanied by disorders and a real threat of dysfunction of vital organs and systems; 6) who are in a comatose state due to traumatic brain injury, hypoglycemic and hyperglycemic and other comas; 7) after resuscitation, clinical death and shock in the recovery period.

As a result, the ICU patient population can be combined into several groups. The first of them consists of patients after surgery, which was performed under anesthesia (post-anesthesia) with not completely normalized vital functions. It is especially numerous in those medical institutions where there are no recovery rooms at the operating units. These patients stay in the department until the previously suppressed functions are completely normalized.

The second and most responsible group consists of patients in critical condition after injury, poisoning, exacerbation or worsening of chronic pathology. The duration of their stay in the department is calculated in days and weeks; it is on them that the maximum efforts of staff and material resources are spent.

In accordance with the order of the Ministry of Health, care for dying patients with incurable diseases is not within the competence of the ICU. However, due to forced circumstances, such patients are often placed in this department. They constitute the third group of patients (“hopeless”). They support the functions of vital organs and systems.

Patients with a persistent vegetative state (lack of mental abilities), which arose as a result of delayed or imperfect resuscitation, as well as with traumatic brain injury and a number of other circumstances, constitute the fourth group. In principle, these patients should not be in the ICU, but as a rule, no other place for such patients is found, and they remain here for months, receiving adequate feeding and proper hygienic care.

Finally, the fifth group includes the so-called “patients” with “brain death” . Their brain death is legally recorded, and their organs can be used for transplantation to other patients in order to save their lives. In such people, the viable state of these organs is maintained with the help of artificial circulation, artificial ventilation, transfusion and correction of metabolic processes in the body.

In the ICU, 4 types of patient monitoring . The most accessible is physical monitoring of the patient’s condition. At the same time, the presence or absence of consciousness and facial expression are determined, the patient’s motor activity and position, the color of the skin and visible mucous membranes are assessed, and the condition of drains, probes and catheters is monitored. This also includes determining the respiratory rate, measuring the patient’s pulse, blood pressure and body temperature. The frequency of these studies is determined individually each time, and all information is recorded in a formalized observation chart.

Monitoring includes automatic monitoring of heart rate and respiration rate, blood pressure, level of peripheral blood oxygen saturation, body temperature, and bioelectrical activity of the brain. It allows you to simultaneously obtain information about vital systems in many respects.

Laboratory monitoring of the patient involves systematic monitoring of hemic indicators (number of red blood cells, hemoglobin, hematocrit), as well as determination of the volume of circulating blood, plasma, protein, electrolyte and acid-base state of the blood, indicators of the coagulation system, biochemical criteria (total protein, urea, creatinine , amylase in blood serum).

Finally, combined observation combines all of the above types of monitoring the patient’s condition. It gives the most complete picture of the patient and is optimal.

Caring for patients in serious and unconscious condition

When organizing care for patients in the ICU, it is necessary to remember the exceptional importance of hygiene measures. The patient's body is wiped daily with warm water with the addition of alcohol, vinegar or cologne, after placing an oilcloth under it. To prevent hypothermia after this procedure, the patient is immediately wiped dry. In case of involuntary urination or defecation, wash and dry the skin after each contamination. To avoid additional difficulties in caring for unconscious patients, it is not recommended to wear underwear on them. When changing bed linen, turn the patient on his side or transfer him to a gurney.

If there are no contraindications, the patient is washed in the morning. Particular attention is paid to the treatment of the oral cavity. To do this, grab the patient’s tongue with a gauze napkin with your left hand and pull it out of the mouth, and use the right hand to use the toilet. Then the tongue and oral mucosa are lubricated with glycerin. Before treating the oral cavity, remove removable dentures, wash them thoroughly and store them dry. In unconscious patients, these prostheses are removed immediately upon admission to the department.

Before rinsing the mouth, the patient is given a semi-sitting position, the neck and chest are covered with an oilcloth apron, and a tray is placed under the chin. In severe cases, keep the patient in a horizontal position with his head turned to one side. The corner of the mouth is pulled back with a spatula, and the oral cavity is washed with a 0.5-1% solution of soda or a 0.01-0.05% solution of potassium permanganate using a syringe or rubber balloon so that the liquid does not enter the respiratory tract.

The eyes are washed with boiled water or saline using a sterile piece of cotton wool. To do this, the patient’s head is tilted back, a tray is placed on the side of the temporal region for the flowing liquid, which is used to irrigate the eyes from a can or a special vessel - undine.

The nasal passages are treated with a cotton swab moistened with Vaseline or menthol oil.

If vomiting occurs, remove the pillow from under the head and turn the head to the side. A tray or towel is placed at the corner of the mouth. After vomiting, wipe the outside of the cheeks and mouth with a towel and the inside with a gauze pad.

When caring for patients in a serious and unconscious state, exceptional importance is given to the prevention of bedsores and hypostatic pneumonia. To do this, use the entire arsenal of known means and methods to prevent their development. An important role in this belongs to the use of a functional bed and therapeutic exercises.

Severely ill patients are spoon-fed using mobile over-bed tables of various designs. Liquid food is served using a sippy cup. In case of unconsciousness, artificial nutrition is carried out using a funnel and a probe inserted into the stomach. Often the tube is left in place for the entire feeding period, sometimes it is removed at night. For the purpose of artificial nutrition, they resort to nutritional enemas or carry it out parenterally.

Care of critically ill patients

A critical condition is understood as an extreme degree of any pathology that requires artificial replacement or support of vital functions [Zilber A.P., 1995]. There are pre-agony, agony and clinical death. Being a type of dying, they are characterized by an extreme degree of decompensation of blood circulation and breathing. Without immediate treatment, biological death inevitably occurs - an irreversible condition in which the body becomes a corpse.

Removing patients from a critical condition is carried out through a series of activities that actually constitute resuscitation (reanimation). It includes artificial ventilation, artificial circulation and anti-ischemic protection of the cerebral cortex.

Artificial blood circulation is carried out in case of cessation of cardiac activity, regardless of the cause that caused it. To do this, perform indirect cardiac massage .

The effectiveness of indirect cardiac massage is ensured by the fact that the victim is placed on a hard surface (hard couch, wide bench, stretcher with a wooden shield or the floor). They unbutton the clothes that are constricting the body and stand to the left of the person being resuscitated. The palm of one hand is placed on the lower third of the sternum, the other palm is placed on the back of the first hand. Typically, the intensity of pressure is maintained by the body weight of the person performing resuscitation. After each push, the arms relax, the chest expands freely, and the cavities of the heart fill with blood. In this way, artificial diastole is carried out. Indirect massage is carried out rhythmically with a compression frequency of 50-60 times per minute.

To increase the effectiveness of indirect massage, simultaneous compression of the chest and artificial inhalation are recommended. In this case, intrathoracic pressure increases even more, and a larger volume of blood flows to the brain.

It is known that the human heart is located in the mediastinum and is located between the sternum and the spine. When the patient is in a state of agony or clinical death, muscle tone is lost and the chest becomes susceptible to mechanical compression. In this regard, when pressing on the sternum, it shifts 3-5 cm towards the spine. As a result of compression of the heart, artificial systole is performed. Blood enters the systemic and pulmonary circulation. During compression of the sternum, the descending aorta is compressed, and most of the blood volume rushes to the upper torso and to the brain, thereby providing blood flow to 70-90% of normal levels.

During indirect cardiac massage, excessive pressure on the chest, as well as its intractability, causes fracture of the ribs with damage to the pleura, liver and other internal organs. Therefore, the efforts made should be moderate and always correspond to the assigned tasks.

Before performing artificial ventilation, ensure patency of the upper respiratory tract. When they are filled with liquid contents, lower the head end or turn the person being resuscitated to one side, open his mouth, remove mucus and vomit, and then wipe the oral cavity. The next stage of assistance is to tilt the head of the person being revived and move the lower jaw forward. In this case, the tongue moves away from the back wall of the pharynx and the patency of the airways is restored.

Then, tightly closing the nostrils of the person being resuscitated and placing a 3-4-layer gauze napkin on the open mouth, they begin mouth-to-mouth artificial respiration. Another option is mouth-to-nose breathing, for this they also check and restore the patency of the airways, tightly close the mouth of the person being revived and inhale through the nose. The rhythm of inhalations is 10-12 per minute, exhalation is carried out passively.

In a hospital setting, artificial respiration is supported using a machine. To do this, the patient is inserted into the respiratory tract through the mouth or nose (intubated), and a respirator is connected to the tube. In order to prevent the flow of mucus and gastric contents along the endotracheal tube into the trachea, the cuff is inflated and thus the airway system is sealed. When caring for such a patient, make sure that the cuff on the endotracheal tube is not overly inflated. Otherwise, there will be a violation of blood circulation in the mucous membrane with the subsequent development of bedsores. To restore normal blood circulation in this area, air is released from the cuff every 2-3 hours.

In cases where long-term, more than 5-7 days, ventilation of the lungs is necessary, as well as when it is impossible to perform intubation through the mouth due to anatomical features, in case of trauma, tumor diseases of the upper respiratory tract, in case of severe inflammation in the nasopharynx and larynx, artificial respiration is performed through a tracheostomy - artificial tracheal fistula.

During artificial ventilation of the lungs using a breathing apparatus (respirator), constant monitoring is required to monitor the patient's condition and monitor the effectiveness of the measures taken. In the event of a rapid drop in pressure in the “device-patient” system, which most often occurs due to the disconnection of tubes, hoses, endotracheal tubes and tracheostomy, the tightness of the airway system must be quickly restored.

A sudden increase in pressure in this system is dangerous. As a rule, it is associated with the accumulation of mucus in the respiratory tract, bulging of the cuff, and the occurrence of inconsistency in the operation of the apparatus and the spontaneous breathing of the patient. At the same time, the air is urgently released from the cuff and the cause of the trouble is eliminated, switching to manual ventilation.

Caring for an existing respirator includes systematically and thoroughly wiping the device, timely pouring distilled water into the humidifier, emptying the moisture collector and monitoring the correct outflow of condensed moisture from the hoses.

During long-term artificial ventilation of the lungs, the tracheobronchial tree is sanitation . To do this, use a sterile catheter 40-50 cm long and up to 5 mm in diameter. It is inserted into the trachea through a tracheostomy or endotracheal tube. 10-20 ml of furatsilin solution or other medicine is poured into the catheter. A suction (electric or water jet) is then connected to the catheter and the liquefied sputum is aspirated. To reduce the vacuum and prevent suction of the mucous membrane to the catheter, periodically open the side hole on its tip. The procedure is repeated 2-3 times until the tracheobronchial tree is drained and is performed wearing a mask or a plexiglass “visor” protecting the face, protecting oneself from infection with the removed contents.

Tracheostomy care . In intensive care practice, when respiratory failure develops due to an obstruction located above the vocal cords, tracheostomy is performed. To maintain the gaping condition, a special tracheostomy tube, made of metal, plastic or rubber, and consisting of outer and inner curved cylinders, is inserted into the fistula tract.

The main objectives of tracheostomy care are to maintain good patency of the tracheostomy tube, prevent infection of the respiratory tract and drying out of the mucous membrane of the tracheobronchial tree.

If there is copious mucus discharge from the trachea, it is aspirated every 30-40 minutes using a sterile catheter. Before this, the cannula is delimited from the surrounding surface with a sterile napkin, and sterile gloves and a mask are put on.

If the mucus is very thick, then it is first diluted with proteolytic enzymes or a 5% sodium bicarbonate solution by inhalation in the form of an aerosol or instillation of 1-2 ml of solution into the trachea. After an exposure of 3-4 minutes, the liquefied sputum is aspirated with a catheter. Before this, the patient’s head is turned in the opposite direction from the bronchus being sanitized. The procedure lasts for 12-15 seconds. After sanitization, the catheter is washed with an antiseptic solution and wiped with a sterile cloth. The manipulation is repeated 2-3 times with an interval of at least 2-3 minutes. Upon completion of the procedure, the catheter is sterilized.

The cannula or its inner tube is removed from the trachea at least once a day, cleaned and sterilized.

If the rules of asepsis are violated during tracheostomy care, due to technical errors in suctioning mucus, as well as during aspiration of vomit, purulent tracheobronchitis develops. Its appearance is indicated by viscous purulent greenish sputum with a putrid odor. To treat tracheobronchitis, antibiotics are prescribed, but the key to success is adequate sanitation of the tracheobronchial tree, which is carried out taking into account the previously described principles. Endoscopic sanitation of the trachea and bronchi is effective.

In patients with tracheostomy, stomatitis often occurs, and fungal and anaerobic microflora rapidly develops in the oral cavity. Therefore, you need to periodically irrigate the oral cavity and wipe it with a swab moistened with an antiseptic solution, preferring hydrogen peroxide or boric acid.

A patient with a tracheostomy does not speak, and while maintaining consciousness, he can communicate using signs or specially prepared cards with pre-written phrases. If there is a sudden appearance of voice or breathing through the mouth (nose), you need to think about the cannula falling out of the trachea and restore its original state.

Sometimes the patient experiences violent, hoarse, so-called stridor breathing with the participation of auxiliary muscles, which indicates obstruction of the cannula with thick mucus. These symptoms are eliminated by immediately replacing the cannula, clogged with mucus and drying crusts, with a spare one. To prevent the mucous membrane from drying out, use damp, double-folded gauze pads to cover the tracheostomy. When inhaling oxygen, it is always moistened using a Bobrov jar or other devices filled with 96° alcohol or water.

Once the need for a tracheostomy is complete, the tube is removed, the skin around the wound is treated with an antiseptic solution, the tissue defect is covered with an adhesive plaster and a sterile bandage is applied. The patient is warned that at first, when talking and coughing, it is necessary to hold the bandage with your hand. At first it gets wet quickly and needs to be changed frequently. As a rule, the fistula heals on its own within 6-7 days.

Caring for the dying

Death is the cessation of spontaneous blood circulation and respiration, accompanied by irreversible damage to all brain functions. The process of the onset of irreversible pathological changes in the body is called dying. There are several types of dying.

The first group consists of patients who die during unsuccessful cardiopulmonary resuscitation with three possible outcomes: 1) death occurs immediately after the cessation of resuscitation measures; 2) a multi-day and multi-week post-resuscitation illness develops, which is also referred to as dying; 3) a persistent vegetative state occurs with irreversible loss of cerebral cortex function.

The second group includes elderly patients in whom there is a gradual decline in vital functions with preserved or inadequate consciousness.

The third type of dying is observed in severe pathology, which is fundamentally curable, but due to various circumstances is not amenable to intensive therapy (acute lung injury syndrome, cardiogenic shock, peritonitis).

Finally, the fourth group includes dying due to an incurable disease (injury incompatible with life, malignant tumor).

All of these types of dying inevitably end in death, and dying inherently becomes a diagnosis. If a recovering patient requires intensive therapy, medical actions aimed at eliminating physical suffering, as well as effects on the psyche, then a dying patient does not need intensive treatment.

In this regard, in recent decades, so-called comfortable supportive care has been increasingly developed. Its feature is: 1) limitation of invasive methods (catheterization, puncture); 2) reduction of diagnostic procedures; 3) careful hygienic care; 4) adequate pain relief; 5) adequate nutrition; 6) psychological comfort, which is provided by the environment of relatives, a psychotherapist, a priest or tranquilizers. Transfer to comfortable supportive care is carried out at the decision of the patient himself or his legal representatives on the recommendation of a doctor who provides complete information about the nature of the pathology and prognosis.

A special group consists of patients with a persistent vegetative state. They are characterized by the fact that they do not suffer, because there is no consciousness, for the same reason they cannot decide to stop or change treatment, and will never be cured. With adequate care, this condition can last for years. Most often, patients with a persistent vegetative state die from urinary tract infections and pulmonary complications.

Proper medical care for patients with a persistent vegetative state includes:

• Adequate nutrition and hydration, which is usually provided by gastric tube;
• · providing physiological functions naturally using a catheter, enema;
• · hygienic care, including treatment of the oral cavity, which is often a source of infection;
• · conducting physiotherapy, gymnastics and massage;
• · prevention and treatment of infectious, inflammatory and necrotic complications (hypostatic pneumonia, bedsores, mumps, urinary tract infection).

Legal aspects of resuscitation

In accordance with Russian health legislation, cardiopulmonary resuscitation is not indicated :

• · if death occurred against the background of a full range of intensive therapy, which turned out to be ineffective for this pathology due to the imperfection of medicine;
• · in case of a chronic disease in the terminal stage of its development (malignant neoplasm, cerebrovascular accident, injury incompatible with life), the hopelessness of the condition is determined by a council of doctors and recorded in the medical history;
• · if more than 25 minutes have passed since cardiac arrest;
• · if the patient has previously documented his refusal of cardiopulmonary resuscitation.

Cardiopulmonary resuscitation is stopped :

• · if during the course of the events it turned out that they were not shown;
• · if within 30 minutes there are no signs of its effectiveness (constriction of the pupils, the appearance of spontaneous breathing, improvement in skin color);
• · if there is repeated cardiac arrest.

Handling a corpse

After death is confirmed, clothing and valuables are removed from the deceased. They make an inventory and hand them over to the senior nurse for safekeeping. In the event that it is not possible to remove valuables, this is recorded in the medical history in the form of an act.

The body is laid on its back, the lower jaw is tied with a bandage and the eyelids are closed. On the thigh of the deceased they write his last name, first name and patronymic, as well as his age and the department in which he was located. In addition to this information, the accompanying note indicates the medical history number, diagnosis and date of death. The corpse is covered with a sheet, left in the department for 2 hours until cadaveric spots appear (an absolute sign of death) and only then sent to the morgue.

A conversation with the relatives of the deceased becomes a difficult test . This constitutes a whole art, aimed at caring for the feelings of people who have lost their neighbors (first of all), and for the well-being of the medical workers themselves. To do this: 1) inform about the death during a personal conversation, and not by telephone; 2) conduct the conversation in an environment appropriate to the situation; 3) they talk as a team, but the most authoritative one should speak; 4) simply explain the essence of the misfortune, without “pressuring” science, without accusing the patient of violating the regime, etc.; 5) at the right moment, the “authoritative” one comes out, and the most “cordial” one continues the conversation.

What a nurse should be able to do when caring for a bedridden patient after a stroke

It happens that loved ones cannot constantly be at home next to a relative affected by the disease, because someone has to work. In this case, you can hire a nurse. A nurse will provide more professional care for a bedridden patient after a stroke at home. Such a specialist has a range of knowledge that will not only make life easier for you and your loved one, but will also improve their well-being and health. The nurse understands the mechanisms of the disease and knows how to cope with its consequences.

So, what are the responsibilities of a nurse:

• Carrying out basic care procedures. Despite their relative simplicity, they are included in the list of medical procedures. A nurse can have any work experience, the main thing is to know the theoretical foundations and be able to apply them in practice.
• Setting up IVs and injections. These procedures are performed only by people with specialized education, and if the nurse has one, she can independently ensure that the patient takes medications without inviting a nurse.

• Carrying out preventive measures regardless of the severity of the person’s condition. Often this part of the nurse’s work is the most difficult, since after a stroke a bedridden patient cannot move independently. Therefore, when hiring a nurse, it is necessary to take into account the weight and other parameters of the patient and look for a specialist who will be able to cope with this.
• Dressing bedsores or other wounds. These manipulations also require special skills and education.
• Ensuring that patients take medications. Patients after a stroke are prescribed a large number of medications. These medications ensure the restoration of all body systems after an attack. Therefore, it is very important to drink them on time and not skip them.

Who needs a ventilator and why: 7 answers from an anesthesiologist-resuscitator

In Russia, the number of confirmed cases of coronavirus is increasing every day. At the same time, the number of severely ill patients who may require an artificial lung ventilation (ventilator) device is also increasing. An anesthesiologist-resuscitator at one of the city hospitals in Yekaterinburg answered seven questions from the E1.ru portal that will help you understand how this device works and what it is needed for.

What is a ventilator?

This is high-tech medical equipment that delivers a breathing mixture into the lungs, saturates the blood with oxygen and removes carbon dioxide from the lungs.

Artificial ventilation is used in the practice of an anesthesiologist-resuscitator in various situations. A modern ventilator analyzes many parameters and has many sensors that ensure the effectiveness and safety of the procedure. This allows you to set up an individual mode for each resuscitation patient.

Carrying out artificial ventilation can be compared to flying on an airplane. It has its own take-off, its own landing and turbulence zones.

Where are ventilators used?

Ventilators are used for general anesthesia, especially during long and complex surgical procedures. In this case, the patient is transferred to mechanical ventilation in the operating room during anesthesia.

This makes surgery more convenient for the surgeon and safer for the patient, and anesthesia more manageable. This improves the results of surgical interventions. After the operation is completed, the patient wakes up and is removed from artificial respiration.

Ventilators are also used in acute respiratory failure to save a person’s life. It doesn’t matter what causes the respiratory failure.

Patients are transferred to artificial respiration in case of injuries, strokes, poisoning, or brain damage to prevent hypoxia (oxygen starvation). It can also occur when the lungs are damaged by bacterial or viral pneumonia or coronavirus infection.

After mechanical ventilation will a person be able to breathe on his own?

There is an opinion among people that once a person is on a ventilator, it is no longer possible to remove it. This is wrong. Artificial ventilation allows the patient to survive a critical condition and minimize his energy costs. Then a person can direct all the body’s forces to fight the disease.

The ventilator protects the central nervous system from oxygen starvation. When the disease subsides, the person is removed from the device.

Modern devices have various modes that can take into account the patient’s breathing attempts and help him breathe on his own.

How do doctors understand that a patient needs to be transferred to mechanical ventilation?

In each situation, the anesthesiologist-resuscitator makes a decision individually. He bases it on laboratory values, on the clinical picture and is consistent with various protocols for the management of respiratory failure.

There are certain criteria by which the doctor assesses a person’s condition and the extent of damage to the lung tissue.

The patient's level of oxygen and carbon dioxide in the blood is checked, blood acidity, respiratory rate, skin color, oxygen saturation are determined (this is the proportion of oxygenated hemoglobin relative to total hemoglobin in the blood. - Ed.).

How does a ventilator work?

The device blows a certain volume of air into a person, and the person exhales it. The human chest is rigid. This can be compared to how we inflate a balloon. In order for it to deflate, you just need to open the valve, no additional effort is needed. The same is the case with exhalation during artificial ventilation.

During mechanical breathing, the doctor sets many parameters: air flow, oxygen content in the inhaled mixture, pressure under which breathing is carried out, end-expiratory pressure, breathing frequency. There are a lot of criteria.

When a person’s breathing is restored, you can activate a mode in which the device only helps him take an effective breath. He seems to predict a person’s desire to breathe. This helps a person adapt to independent breathing.

Once a person's breathing becomes effective, they can be disconnected from the machine.

How does a ventilator help with COVID-19?

Absolutely the same as with other respiratory failure. During a coronavirus infection, gas exchange in the lungs, their physical properties, and the ability to saturate the blood with oxygen are disrupted.

With coronavirus infection, the patient experiences shortness of breath, and the muscles that provide breathing are exhausted. As a result, a person begins to spend too much energy on each act of inhalation. Transferring to mechanical ventilation helps the patient save energy and direct it to fight the disease. In addition, this allows you to combat oxygen starvation.

If the condition of the lungs improves and the person can breathe on his own, then he is removed from artificial ventilation. Thus, mechanical ventilation is a method that helps the patient survive a critical condition. This is the respiratory cocoon of the ventilator through which the respiratory mixture is delivered to the patient

How long can a person be on a ventilator?

In my practice, there were people who were on artificial respiration for several months. All this time, the doctor assessed their condition and changed the auxiliary modes of the device. And after that, people succeeded or failed to restore their breathing.

There are many ways to train patients to breathe spontaneously. It is the art of the resuscitator to “separate” a person from the apparatus.

It is difficult to say how long it will take a patient diagnosed with COVID-19 to regain his own breathing if he is connected to a machine.

While clinical indications require mechanical ventilation, anesthesiologists and resuscitators perform it. And it doesn’t matter what the pathology is caused by - coronavirus, pneumococcus, influenza virus or another disease.

Advantages of private boarding houses that provide comprehensive care for bedridden patients after a stroke

Today, a bedridden patient can be treated in special boarding houses for the elderly. Such institutions provide rehabilitation after a stroke. This is an excellent opportunity to provide the patient with proper care, especially when the person cannot move or speak.

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Still, it is difficult to equip an ordinary apartment with everything a bedridden patient needs, especially if we are talking about an old building where there is not even an elevator. The nursing home that cares for such people has special beds, conveniently organized space, ramps, etc.

Private boarding houses provide:

In a special institution, each bedridden patient has an individual rehabilitation program, which depends on the severity of the stroke and the degree of damage to the body. Such a program includes the following elements:

• Activities aimed at improving brain function. This organ is the first to suffer after a stroke, losing its functionality. To eliminate problems, specialists select a course of special medications.
• Physical training. Caring for a bedridden patient after a stroke involves, first of all, restoration of the musculoskeletal system. All exercises are selected individually and depend on the patient’s well-being. A medical worker monitors the performance of gymnastics, monitors the main health indicators, and measures pulse and blood pressure.
• Exercises to restore speech. A bedridden patient has great difficulty with articulation, and sometimes cannot pronounce words at all. During rehabilitation, doctors conduct motor skills and rhetoric exercises with the patient.
• Restoring self-care skills. Patients learn to take care of themselves again. A nurse is always with bedridden patients.

• Psychotherapeutic support. Of course, it is impossible to maintain a positive attitude when you have lost the ability not only to do your usual activities, but even to move and speak. Care for such people includes support from a psychotherapist. These specialists help get out of depression and set the patient up to work on themselves.
• Medication support. Health care workers ensure that medications are taken in full, according to the schedule and in compliance with all necessary rules and regulations.

In addition, when implementing a rehabilitation program, boarding house staff can evaluate the patient’s progress and make changes to it. This makes it possible to improve the dynamics of recovery of all indicators of the patient’s health.

As a result of a stroke, a person's life is turned upside down. The body stops listening, performing the most primitive actions causes enormous difficulties, and sometimes becomes simply impossible. The patient loses faith in himself, in life, and becomes depressed. This also becomes a blow for loved ones. Someone quits their job and becomes a nurse, someone starts working twice as hard to hire a medical worker and provide full care to the patient. We don’t even need to talk about the fact that the loss of a loved one’s legal capacity is, in principle, a tragedy.

But it is important to remember that competent care for a bedridden patient after a stroke, hard work to overcome the consequences of the disease, work on one’s psychological state, and faith in the success of rehabilitation can work wonders. Properly organized events will definitely bear fruit. Yes, it also happens that a person will never be able to restore all body functions 100 percent. However, it is possible to significantly improve the patient's condition and return him to the joys of life. It is important not to lose fortitude, be patient and work in the right direction.

Mandatory actions for caring for a comatose patient

If this care is provided by a nurse for an unconscious patient, her responsibilities include the following procedures:

• daily treatment and moisturizing of the oral and nasal cavities;

prevention of bedsores - diligent washing, careful blotting dry and treating the skin in problem areas (see above);

• daily emptying of the intestines and bladder of the patient, if necessary, use of an enema;
• strict adherence to doctor's orders;
• monitoring and recording the patient’s temperature and pulse;
• observing his skin color and breathing;
• applying wet swabs to the patient’s eyelids (if they are slightly open) to avoid drying out the mucous membrane of the eyes;
• turning the patient's head elevated to one side in case of vomiting (so that the vomit does not enter the windpipe), and after it ends, cleaning the oral cavity with a sterile napkin;
• Communication with such a patient is mandatory! Despite the fact that he is in a coma, he hears everything, so we need to tell him the news, play his favorite music, and then the process of his recovery from the coma and his final recovery will be more favorable.
• Feeding a patient in a coma. If the patient can swallow, carefully spoon-feed easily digestible, high-calorie pureed foods. If this is not possible, feeding should be done through a feeding tube.

Our home visiting service offers nursing services for a patient in a coma at home and in the hospital.

Source: nurseassist.ru

A patient in a coma usually requires intensive care and often resuscitation. In this regard, treatment of the patient should be carried out in an intensive care unit, where it is possible to provide the necessary examination, monitoring, treatment and care.

Intensive therapy consists of correction and maintenance of basic vital functions (posyndromic treatment). The following goals are set during treatment: prevention and treatment of hypoxia and cerebral edema; ensuring normal ventilation of the lungs (if indicated - tracheal intubation or tracheotomy, mechanical ventilation), maintaining general and cerebral hemodynamics, improving metabolism; detoxification, fight against cerebral edema, hyperthermia; compensation for disturbances in water-electrolyte metabolism; restoration and preservation of WWTP, carrying out anti-shock measures if necessary, meeting the energy needs of the body; control over the functions of the pelvic organs, prevention and treatment of complications (atelectasis, pulmonary embolism, pulmonary edema, pneumonia), prevention and treatment of bedsores, etc.

In parallel with resuscitation measures, measures are taken to clarify the diagnosis (clarification of medical history, clinical and laboratory tests, as well as the necessary additional examination methods). Based on the most probable ideas about the underlying disease that caused the development of coma, etiological and pathogenetic therapy should be carried out, the nature of which may be different, but in all cases the goal is the same - to remove the patient from a comatose state as quickly as possible.

Etiological and pathogenetic treatment measures depend on the results of clinical and laboratory studies. These may include the administration of insulin for ketoacidosis, the use of appropriate antidotes, plasmapheresis for poisoning, treatment with large doses of vitamin B, for alcoholic coma, Wernicke's syndrome, the appointment of naloxone or an overdose of narcotic drugs, treatment with antibiotics (for purulent meningitis), the administration of anticonvulsants ( for status epilepticus), hemodialysis (for renal failure), etc.

In order to remove from a comatose state patients with traumatic brain injury, accompanied by the development of an epidural or subdural hematoma, in some cases of cerebral hemorrhage, as well as with intracranial neoplasms, especially with occlusion of the cerebrospinal fluid ducts, severe cerebral edema, displacement and herniation of brain tissue, it is indicated neurosurgical intervention.

During the treatment of a comatose patient, careful care is required to ensure the maintenance of vitality and the prevention of complications.

After removing the patient from a comatose state, special attention should be paid to the treatment of pathological manifestations that led to the development of a coma, as well as (if necessary) rehabilitation measures.

Source: coma.su