Managements of the Patient under long term Ventilator treatment

Abstract

For the last ten years, there has been a remarkable progress in the artificial ventilator treatment in every field in the hospital, so that a long term artificial ventilation is now practical and indication for it has expanded in numbers of diseases. Concurrently, many problems inherent to it have appeared in front.
These problems consist of two parts. First problem is concerned with a choice of the most suitable measure to secure the airway of the patient with respiratory failure. Measures include orc-endotracheal, naso-endotracheal intubation and tracheostomy. They should be evaluated in terms of the followings: promptness and risk in establishing them, how long they will be needed, easiness in fixing the tabes in right position, and in maintaining them patent and clean, probable difficulties encountered when discontinuing or re-establishing them and comfort of the patient. Needless to mention, misplased or occuluded tubes in the trachea can be lethal. Therefore, once the patient is intubated, whatever the measure might be, frequent and close observation is mandatory.
Second problem is concerned with humidification of the airway. Intubation, bypassing the physiological humidifying apparatus, i.e. the upper respiratory tract, causes drying out the mucus membrane of the lower respiratory tract which leads to the depressed function of the cilia. This in turn leads to accumulation of sputum in the periphery of the lungs, then the lungs tend to become atelectatic and are rendered to get infected. So, the humidity must be supplemented by a humidifier or a nebulizer. Frequent suctioning in the trachea with a catheter in order to fascilitate excretion of the sputum is also mandatory, Unfortunately, it is painstaking to do the tracheal suction in an aseptic way. Besides, the most common cause of death of the patient under long term artificial ventiltion is pulmonary infection. To gain specimen of tracheal aspirate for organism to culture and to take chest film once evervday if possible, are the recommended measures prevent or find the infection in early stage.