Anestesi och intensivvårdssjuksköterskans hantering av mekanisk ventilation
- en litteraturstudie om minskning av atelektasbildning och förebyggande av komplikationer
Background Atelectasis is a commun respiratory complication related to general anesthesia and may contribute to pneumonia and acute respiratory failure. Atelectasis apear within 10 minutes after anesthetization and occur in 90% or more anesthezied patients regardless of age and gender. The aim of this study was to indentify if there are any evidence for which methods are ultimate or are most efficacious to reduce and prevent the formation of atelectasis. Methods This study is a descriptive litterature study where 28 scientific studies have been indentified for review and analysis. ResultsThe use of 100% oxygen during the induction of anesthesia favors the developement of atelectasis. This can be prevented by preoxygenation with oxygen content of 100% combined with a PEEP of 6-10 cmH2O. When free airway is secured, oxygenation with 100% was found to be unnecessary. In these cases the oxygen fraction could be reduced to 40%. Lungrecruitement manoeuvers have been described in different ways, however they have in common that the peak pressure should reach 40 cmH2O and this method has best efficacy when followed with a PEEP 5- 12 cmH2O. Low tidal volumes (VT 6 mL/kg) seem to be less perilous for patient with lung injuries. The use of a closed system during suction in the endotacheal tube cause less consequences in respiration and preoxygenation before suction should occur with low oxygen fraction (40-80%). However, if the patient is hypoxemic the use of 100% oxygen for preoxygenation is necessary. Prone position is a successful way to improve oxygenation in atelectatic lung areas. Conclusion The studies which have been analyzed report that nurse anesthesiologists and intensiv care nurses could prevent atelectasis by using different methods of ventilation during general anesthesia. Those nurses are responsible to have the knowledge that is needed to be able to discuss with the anesthisologist before the problems occur.