Artificial respiration does not serve the support or the replacement more insufficiently or existing their life-supporting function is a central component in the the emergency medicine and the intensive medicine. It distinctive between the controlled artificial respiration and the assisted artificial respiration.

The term artificial respiration is used in the professional emergency medicine, in the first assistance speaks one of the breath donation. Measures of the first assistance, which can be implemented by the Ersthelfer (a layman) and to be supposed, are there described.

Clinical application

Artificial respiration is used if the spontaneous respiration precipitates (Apnoe) or becomes insufficient. This can occur among other things in Narkose, with poisonings, cycle stop, neurological illnesses or head injuries, in addition with paralysis of the respiratory muscles due to back Mark lesions or the effect of Medikamenten.Eine row of lung illnesses or thorax injuries as well as heart diseases, shock and Sepsis artificial respiration-necessarily can likewise make one.

Dependent on the clinical situation the artificial respiration can be continued over few minutes in addition, over months. While the return to the spontaneous respiration to the routine Narkose a problem represents rarely, curing (the so-called Weaning) an intensive patient is after longer artificially respirating duration a difficult process, which can take days or weeks up.

Some patients with heavy brain damage, back Mark injuries or neurological illnesses attain the ability for spontaneous respiration not back and require therefore the continuous artificial respiration (home artificial respiration).

Techniques

Over and negative pressure artificial respiration

While the exchange of oxygen and carbon dioxide between blood and alveoles takes place by diffusion and requires no outside effort, the breathing air must be supplied to the gas exchange actively by the respiratory system. During the spontaneous respiration in the by the respiratory muscles a negative pressure is produced. The difference of pressure between atmospheric pressure and intrathorakalem pressure, developing thereby, produces one air flow with the negative pressure artificial respiration with iron lungs this mechanism is imitated. The iron lung produces a negative pressure in a chamber, which encloses and at the neck is sealed the body.

All other techniques of the artificial respiration are positive pressure artificially respirating, i.e. air is pressed by external positive pressure into the lungs. Actually the distinction between positive pressure and negative pressure artificial respiration is void, since 1955 could be already shown by material rains that with both procedures the same transpulmonale difference of pressure exists.

Mouth-to-mouth and bag artificial respiration

The simplest form of the artificial respiration is the breath donation, which is used in the Laienreanimation. By this one understands the artificial respiration with the Ausatemluft of the aid, thus either the "mouth-to-mouth" or "mouth-to-nose one " this technology is however limited, since with it no air enriched with oxygen can be given: Only 16 per cent oxygen portion can be achieved in such a way; in the comparison to it room air has 21 per cent oxygen, respirators can up to 100 per cent oxygen give. By the direct contact with body fluids exists with"Â… Always the small risk of the disease transmission, this one can minimize artificial respiration by the use of an artificially respirating assistance. Professional aids should to be seized therefore to aids as the artificially respirating bag, if the technology is controlled. An artificially respirating bag consists of a Gesichtsmaske, which is inverted over mouth and nose of the patient, in order to achieve a close conclusion; a flexible, compressible bag and a valve, which steer the air flow. A source of oxygen can be attached to a reservoir at the bag, in order to achieve a higher Sauerstoffkonzentration. This simple technology can be sufficient to artificially respirate an breath-insufficient or apnoeischen patient over hours.

Mechanical fans/respirators

In the and intensive medicine respirators are used by routine. These fans make a multiplicity possible of different artificially respirating modes, which are enough from the assisted spontaneous respiration (ASB) for completely controlled artificial respiration. Modern fans permit a continuous adaptation of the according to the condition of the patient.

With artificially respirated patients an inclination to the collapse of alveoles (Atelektasebildung) exists. By use of a PEEP (positive-end-expiratory pressure) one tries to keep open the lung at the end a breath cycle. In addition PEEP comes with disease pictures like e.g. Pneumonia, ARDS and pulmonary edema to the employment.

Secure the respiratory system

Mechanical artificial respiration can successfully and surely take place only if the respiratory system of the patient is kept open, i.e. if air can flow unhindered into those and out of the lungs. In addition leakages must be avoided, so that air flow and pressure ratios correspond to the adjusted values.

A further risk is aspiration pneumonia. With the aspiration stomach contents arrive over the esophagus and bronchial tube (trachea) into the lungs. By blockage of the airways or also by the acidity of stomach contents it can come to heavy impairments of the lung function. Measures for the avoidance of the aspiration hang the most effective protection of the situation of the individual patient off offer however endotracheale intubation.

A whole set of measures and devices offer protection against the collapse of the respiratory system, air leakages and aspiration:

• Gesichtsmaske - with the revival and the Narkose for smaller interferences a Gesichtsmaske is to be prevented often sufficiently around air leakages. The respiratory system of the unconscious patient is kept open either by manipulation of the lower jaw or by use of nasopharyngealen or oropharyngealen tubes. These guarantee an air flow by nose and/or mouth to the Pharynx. A Gesichtsmaske offers however no protection from aspiration face masks in addition also with awake patients for "non to invasiven" the artificial respiration uses. A goal that artificial respiration is a minimum of indisposition of the patient as well as of artificially respirate-induced complications non invasiven. The NIV is often used with kardialen or pulmonalen illnesses.
• Larynxmasken - the Larynxmaske (LMA) consists of a Tubus with inflatable Cuff, which is introduced to the Pharynx. It causes fewer pain within the laryngeal range (for it such within the throat range) than a Endotrachealtubus; however their aspiration protection is clearly underlaid for the Endotrachealtubus. Therefore the employment of the LMA requires a careful selection and observation of the who are applicable patients. Sometimes the Larynxmaske is used into the and in the emergency medicine.
• Kombitubus - with the combi Tubus it concerns a Doppellumen Tubus, which can to be put forward blindly and either (mostly) in the Oesophagus or in the trachea lie in such a way comes. After placing the combi Tubus the upper Cuff (in the Oropharynx) and the Cuff are blocked at the lower end the Tubus. Since the Tubus point lies usually in the Oesophagus, first over the oesophagealen thigh one artificially respirates for a test. Here air flows over small openings between proximal and distal Cuff into the lung. If with the Auskultation however not over the lung but over the Epigastrium a breathing is determined, then must be artificially respirated over the trachealen thigh as with a usual Tubus, which knows upper Cuff in this case is again deblocked. The combi Tubus is used v. A. in emergency with intubation impossibility, since it is too expensive for the routine employment.
• Endotracheale intubation or ugs. "Intubation" often applied at one artificially respirating duration from hours to weeks. A Tubus is inserted through either the nose (nasotracheale intubation) or the mouth (orotracheale intubation) and into the bronchial tube put forward. Tubes with inflatable Cuff in most cases come to the leakage and aspiration protection to the employment. Endotrachealtuben often cause pain and cough stimulus. If a patient is thus not unconscious or for other reasons, for the better tolerance of the Tubus medicines are mostly given (e.g. Sedativa, Opiate, rarely Muskelrelaxantien).
• Tracheotomy - if clear will that an artificial respiration is necessary during a longer period, can the tracheotomy the preference/advantage be given. A tracheotomy is an entrance by surgery put on to the bronchial tube. usually well tolerated, often also without gift of Sedativa. Long-term damage in the sense of bronchial tube narrowings (Trachealstenosen) is however pretty often. The consideration between long-term intubation and tracheotomy splits the intensive medical profession for over 40 years into two camps.

(Notes: The terminology for this procedure is possibly confusing. "Tracheotomy" the surgical interference is often called, as "Tracheostomie the minimalinvasive variant of this interference (Dilatationstracheostomie), while "the Tracheostoma is" the result of the operation.)

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