I-Ventilator Associated Pneumonia (VAP), eyaziwa ngokuba yiVentilator Acneired Pneumonia, i-pneumonia eyenza iiyure ezingama-48 okanye ngaphezulu emva kokuba isigulane sithotywe . I-pneumonia eqhubeka kwiiyure ezingama-48 zesigulana kwisigulane, okanye sasikho xa isigulane sifakwa kwi-ventilator, ayithathwa njenge-ventilator-edibeneyo ngenxa yokuba i-pneumonia yayingaphambi kokuba i-ventilator isetyenziswe.
Ukukhusela iVentilator Associated Pneumonia
Isigulane sinokukunceda ukukhusela umoya we-pneumonia ngokuthi ube ngowona mhle kwimpilo ngaphambi kokuhlinzwa. Oku kuthetha ukutshaya phambi kokuhlinzwa , ukunyamekela nayiphi na imiba yamazinyo enokuthi ibe khona kwaye iqhuba ukucoceka komzimba. Ngokubanzi, ukwenza umgudu wokuba ube sempilo engcono kakhulu ngokutya kakuhle, ukusebenzisa nokulandela imiyalelo yokusetyenziswa kwamachiza kunokuphucula impilo kunye nokukhusela ingxaki emva kokuhlinzwa.
Ngokomzekelo, ugqirha ogqirha nesifo sikashukela ohlola iswayi segazi rhoqo kwaye uthatha imishanguzo yazo ngokufanelekileyo iya kuba sempilo engcono kunesifo sikashukela esichasa iswekile segazi. Ukuphucula impilo yakho ngaphambi kokuba utyando luya kunceda kuphela ukuphucula umphumo wakho wokupasa, nokuba i-pneumonia iyaqhubeka okanye ayikho.
Thintelo
Izibhedlele ziye zavelisa iiprotoksi zokuthintela ngokukhawuleza izigulane ezixhomekeke kwi-ventilator ekuphuhliseni i-pneumonia.
Unokuva abantu abanonophelo bathetha "nge-VAP protocol" okanye "i-VAP" ithetha ukubandakanya ukukhusela kwisicwangciso sokunyamekela.
Iiprotoksi ziquka:
- Ukunyamekela komlomo rhoqo: nganye iiyure ezimbini ukuya kwezine umlomo kufuneka uhlambuluke kakuhle ukukhusela iibhaktheriya ukuba ziphindaphindiwe emlonyeni nasemqaleni.
- Ukubeka iibhedi ngentloko ephakamileyo ukuya kuma-30 ukuya kuma-45 degrees: Ezinye izigulane, abanokunyamezela esi sikhundla ngenxa yokulimala okanye ukugula, kodwa abo abanokunyamezela ukuba ikhanda labo liphakanyiswe liza kuba nzima ukuphucula imiphunga ngenkathi kuqhume umoya.
- Extubate ngokukhawuleza kunokwenzeka: Indlela efanelekileyo yokukhusela i-ventilator ehambelana ne-pneumonia ukuba ingabi kwi-ventilator. Ukususa ityhubhu yokuphefumula nokuvumela isigulane ukuba siphefumle ngokwabo ngokukhawuleza kunokwenzeka kukuthintela ukukhusela.
- Sebenzisa izixhobo ezilahlayo okanye uzinikezele izixhobo kumguli ngamnye ukukhusela ukungcola okuphakathi kwezigulane.
- Bathe isigulana rhoqo: Ukugcina isigulane sihlambulukile, kunye nokuhlambela imihla ngemihla usebenzisa i-skin cleaners cleanser eyaziwayo ukunciphisa amabhaktheriya kwesikhumba kunokunciphisa ukudluliselwa kweebhaktheriya kwesikhumba ukuya emlonyeni nasemaphaphu.
- Ukuhlanjululwa kwesandla kufuneka kuqhutywe ngaphambi kokuba uthinte i-tubenti ye-ventilator, ukubonelela ngononophelo lomlomo okanye ukutshatyalaliswa.
Ngubani Osemngciphekweni we-Ventilator-Associated Pneumonia
Abantu abanezifo ezingapheliyo zamaphaphu, ezifana neCOPD kunye nesifo se-asthma banakho ukuvelisa i-ventilator i-pneumonia. Ubukho benkinga yegazi, njengentlungu yesifo okanye ukubuyisela kwi-neurosurgery, yinto eyaziwayo yengozi ye-pneumonia.
Ababhemayo kunye nezigulane ezineengxaki ezininzi ezingapheliyo nazo zisemngciphekweni omkhulu kunomguli ogqirhayo.
Izinto ezinobungozi eziqhelekileyo
Isibilini eside: Isigulane esisele esiphezulu kwiphepha le-VAP, usuku olu-1 kwisipilisi lungcono kune-4. Izigulane zisengozini enkulu kwiintsuku zokuqala ezintlanu kwi-ventilator.
I-Reintubation: Isigulane siphefumlelwe ukuba siphefumle sisodwa size sibuye siphinde sabuyiselwe kwi-ventilator xa bengakwazi ukuhlangabezana neemfuno zabo ze-oxygen ngempumelelo.
I-Tracheostomy: Ukuvula ngokuvakalayo entanyeni, i-tracheostomy yenzelwa ukukhusela umonakalo kumathambo enobungozi emqaleni xa ixesha elide kwi-ventilator.
Olu vulo luyingozi eyaziwayo yentsholongwane njengoko inikeza enye indlela yokuba iibhaktheriya zingene.
Ukutshintshwa kwesekethe rhoqo: Kulo xesha i-tubing edibanisa isigulane kwisipilisi ishintshiwe.
Uxinzelelo lwe-endotracheal cuff is low low: Ibhulogi engena emlonyeni wesigulane ngokuqhelekileyo igxininiswe ukukhusela umoya ukuba ungabikho. I-tube ephantsi kokuhluthwa iya kuvumela umoya ukuvuza, kodwa kuya kuvumela ukuba imfihlo yomlomo ingene kwimiphunga, into ebalulekileyo yengozi ye-pneumonia.
Ukunyamekela okubi: Ukuba isigulane asikwazi ukuba nommandla womlomo kunye nomqala phambi kombhobho wokugqibela wokutshatyalaliswa ngokuchanekileyo, unethuba eliphezulu lokungena emiphakeni.
Uthutho lwezonyango oluphuma kwi-ICU: Oku kuthetha ukuba kuthathwa, ekhukweni, ukuvavanya okanye inkqubo, njengokwenza i-CT scan.
I-tube ye-NG isendaweni: I-tube yogubhu iyishubhu ebandakanywe kwimpumlo ize iphinde iphinde ikhuphe i-fluid ngokutshatyalaliswa okanye ukuvumela ukulawulwa kwamachiza, ukusetyenziswa kwamanzi okanye ukuthambisa i-tube kwisisu. Ngamanye amaxesha ityhuyibhile emide ingeniswa ngendlela efanayo kodwa ixhaswe kakhulu kwiphepha le-GI. Olu hlobo lwesitampu ebizwa ngokuba yi-NJ tube (i-naso-jejeunal tube) nayo ihamba neengozi yokunyuka kwe-pneumonia.
Unyango
Xa kunokwenzeka, i-sputum yenkcubeko kunye nobutyebi kufunyanwa ukuchonga ibhaktheriya ebangela ukusuleleka kwe-pneumonia. Iziza-antibiotics eziphambili, eziphathekayo ezahlukeneyo zeentlobo zebhaktheriya, zinikezelwa xa i-pneumonia ifunyaniswa. Ukuba iziphumo zobuninzi zibonisa ukuba enye i-antibiotics ingaba isebenze ngakumbi, i-antibiotics ingatshintshwa kamva kwiziphumo eziphuculweyo.
> Umthombo:
> Izinto ezijongene nobungozi Kwi-ICU ye-Pneumonia. JAMA. > ftp://72.167.42.190/cardinal/pdf/Risk_factors_for_ICU_acquired_pneumonia_VAP_Cook_JAMA_052798.pdf
> I-Ventilator Associated > I-Pneumonia kwi-ICU. Unonophelo oluBalulekileyo. > http://www.ccforum.com/content/18/2/208