Ventilator Associated Pneumonia (VAP), inozivikanwawo seVentilator Acquired Pneumonia, inonzi pneumonia inokura maawa 48 kana kupfuura mushure mekunge murwere achinzwa . Pneumonia inowedzera mumaawa 48 ekutanga emurwere panguva yekufambisa, kana kuti yaivepo apo murwere akaiswa pane ventilator, haifaniri kutaridzirwa kuti ventilator-yakabatanidzwa nokuti pneumonia yakanga iripo vasati vashandise kushandiswa.
Kudzivirira Ventilator Associated Pneumonia
Murwere anogona kubatsira kudzivirira ventilator yakawana pneumonia kuburikidza nokuva noutano hwakanakisisa huripo pamberi pokuvhiyiwa. Izvi zvinoreva kusasvuta vasati vambovhiyiwa , kutarisira chero dambudziko remazino rinogona kuvapo uye rinoshandisa zvakanakisisa utsanana hwehutano. Muzvizhinji, kuedza kuve muhutano hwakanakisisa kuburikidza nokudya zvakanaka, kudzidzira uye kutevera mirairo yekushandiswa kwemishonga kunogona kuvandudza utano uye kudzivirira zvinetso pashure pokuvhiyiwa.
Somuenzaniso, chirwere chinorwara nechirwere cheshuga chinotarisa shuga yavo yeropa nguva dzose uye inotora mishonga yavo zvakakodzera ichava noutano huri nani kupfuura munhu ane chirwere cheshuga anorega shuga yavo yeropa. Kugadzirisa hutano hwako usati wapera chirwere kunongobatsira kuvandudza mhinduro yako yekugadzira, ingava pneumonia inokura kana kwete.
Kudzivirira
Zvipatara zvakagadzira zvirongwa zvekudzivirira hutachiona hutachiona hunotarisira ventilator kubva pakuvandudza pneumonia.
Unogona kunzwa vanotsigira vachitaura nezve "VAP protocol" kana kuti "VAP bundle" zvinoreva kusanganisira kuvhara muurongwa hwekuchengeta.
Mitemo inowanzobatanidza:
- Kuramba uchichengeta muromo: Maawa maviri kusvika mana mana muromo unofanirwa kucheneswa zvakakwana kudzivirira mabhakitiriya kuti asawanda mumuromo uye pamutsipa.
- Kugadzirisa mubhedha nemusoro wakakwira kusvika kune makumi matatu kusvika kune makumi mashanu: Vamwe varwere, vangarega kubvumira nzvimbo iyi nekuda kwekukuvadza kana kurwara, asi avo vanogona kubvumira kuti musoro wavo wakasimudzire hauzokwanisi kukudziridza pneumonia panguva yevhotera.
- Bvisa nokukurumidza sezvinobvira: Nzira yakanakisisa yekudzivirira ventilator inobatanidza pneumonia ndeyokuti irege kuva pane ventilator. Kubvisa kufema kubvumira uye kubvumira murwere kufema pachavo pakarepo kana zvichibvira ndicho chinhu chikuru chekudzivirira.
- Shandisa zvigadziriswa zvinoshandiswa kana kutsaurira midziyo kumurwere mumwechete kuti udzivise kuputika kwepakati pakati pevarwere.
- Bhatisa murwere nguva dzose: Kuchengeta murwere kuchena, pamwe nekugeza zuva nezuva kushandura ganda zvakakodzera kuchenesa kunozivikanwa kuderedza mabhakitiriya paganda kunogona kuderedza kushandiswa kwebhakitiriya kubva paganda kusvika kumuromo nemapapu.
- Kuchenesa kutsva kwemaoko kunofanira kuitwa vasati vabata ventilator tubing, vachipa muromo kana kuchengeta.
Ndiani Ari pangozi yeVentilator-Associated Pneumonia
Vanhu vane zvirwere zvisingaperi zvepapupa, zvakadai seCOPD uye asthma zvinowanzoita kuti ventiloni iwane pneumonia. Kuvapo kwehutano hwemagariro, zvakadai sekutambudza musoro kana kudzoka kubva kuuropiyurori, inowanzozivikanwa pangozi yepineumonia.
Vakasvuta nevarwere vane mararamiro akawanda asingagumi vari pangozi yakanyanya kupfuura yevamwe varwere.
Zvinowanzoitika Nengozi
Nguva yakareba intubation: Nguva refu murwere anoramba ari pane ventilator inowedzera njodzi yeVAP, zuva rimwe pane ventilator iri nani kupfuura 4. Varwere vari pangozi yakanyanya mumazuva mashanu ekutanga pane ventilator.
Kubvumazve: Murwere anoremekedzwa kuzvifemera ari oga uye akadzoka zvakare uye akadzoserwa pavhoteri apo asingakwanisi kubudirira kugadzirisa zvinodiwa zve okisijeni.
Tracheostomy: Kuvhurwa kunogadziriswa mumutsipa, tracheostomy inoitwa kuitira kudzivirira kukanganisa kumasumbu akaoma emutsipa panguva yakareba kwenguva yakareba pamhepo.
Uyu mukova inonzi inozviisa pangozi yehutachiona sezvo inopa imwe nzira yemaktheria ekupinda.
Kakawanda kutendeuka kuchinja: Ndiko apo kubata kwekubatanidza murwere kusvika kumhepo inopisa kunoshandurwa.
Endotracheal kapu inomanikidzwa yakanyanya kwazvo: Iyo tube inopinda mumuhuro wevarwere inowanzogadziriswa zvinyorovedzi kudzivirira mhepo kuti irege kunyura. Bhuku rinenge risina kukanganiswa richaita kuti mweya irege kunyura, asi inobvumirawo kuvigwa mumuromo kunoputira mumapapu, chinhu chikuru chinowanzokonzera pneumonia.
Murombo mashoma ekutsvaga: Kana murwere asingakwanisi kuva nemuromo wemuromo uye nehuro mukati mekuguma kweputi yakagadzirirwa zvakanaka kubvisa zvipfeko, pane mukana wakanyanya wekupindira kupinda mumapapu.
Kutakura murwere kunze kweCIU: Izvi zvinoreva kuti kutorwa, mumubhedha, kuongororwa kana nzira, yakadai seT CT scan.
NG tube iri munzvimbo: A nasogastric tube inopinza inoputirwa mumhino uye ichidzika mukati memoyo kuti ibvise mvura yakasviba nekutsvaira kana kubvumira kushandiswa kwemishonga, mvura kana kuti kudyidzana kwemuviri mukati mudumbu. Dzimwe nguva tipe yakareba inogona kuiswa mumutambo mumwechete asi inodyidzwa zvakadzama muGI tract. Iko rudzi rwehuputi inowanzonzi seJ NJ tube (naso-jejeunal tube) inouyawo nehuwandu hwehutachiona hwepneumonia.
Kurapa
Kana zvichikwanisika, chimiro chekudzivirira uye kunzwisisika kunowanikwa kuti uone mabhakitiriya anokonzera chirwere chepneumonia. Mishonga yakakura-inorwisa mabhakitiriya, iyo inobata zvakasiyana-siyana zvemarudzi emabhakitiriya, anowanzopiwa apo pneumonia inowanikwa. Kana zvakaguma zvekunzwisisa zvinoratidza kuti imwe mishonga inorwisa mabhakitiriya inogona kuva yakagadzirisa, mushonga unorwisa mabhakitiriya unogona kuchinjwa mushure mekugadzirisa mhinduro.
> Kwakabva:
> Njodzi Zviitiko ZveCI Acquired Pneumonia. JAMA. > ftp://72.167.42.190/cardinal/pdf/Risk_factors_for_ICU_acquired_pneumonia_VAP_Cook_JAMA_052798.pdf
> Ventilator Associated > Pneumonia muI ICU. Kutarisira Kunokosha. > http://www.ccforum.com/content/18/2/208