Preparations 

Features of resuscitation in children. Technique for artificial lung ventilation: description, rules, sequence of actions and algorithm for conducting mechanical ventilation. Sudden Infant Death Syndrome

The technique of mechanical ventilation is considered in this review as a combination of physiology, medicine and engineering principles. Their association contributed to the development of mechanical ventilation, revealed the most urgent needs for improving this technology and the most promising ideas for the future development of this direction.

What is resuscitation

Resuscitation is a complex of actions, which includes measures to restore suddenly lost vital body functions. Their main goal is the use of methods for carrying out artificial ventilation of the lungs in order to restore cardiac activity, respiration and vital activity of the body.

The terminal state of the body implies the presence pathological changes. They affect areas of all organs and systems:

  • brain and heart;
  • and metabolic systems.

Methods of carrying out require taking into account the peculiarity of the organism that the life of organs and tissues continues a little even after the heart and breathing have completely stopped. Timely resuscitation allows you to achieve effective bringing the victim to his senses.

Artificial ventilation, also called artificial respiration, is any means of assisting or stimulating respiration, a metabolic process associated with general exchange gases in the body through ventilation of the lungs, external and internal respiration. It may take the form of manually delivering air to a person who is not breathing or is not making sufficient effort to breathe. Or it could be mechanical ventilation using a device to move air from the lungs when the person is unable to breathe on their own, such as during surgery to general anesthesia or when the person is in a coma.

The objective of resuscitation is to achieve the following results:

  • the airways must be clear and free;
  • it is necessary to carry out IVL in a timely manner;
  • circulation needs to be restored.

Features of the IVL technique

Pulmonary ventilation is achieved by a manual device for blowing air into the lungs, either with the help of a rescuer who delivers it to the patient's organ by mouth-to-mouth resuscitation, or with a mechanical device designed for this procedure. Last method proved to be more effective than those involving manual manipulation of the patient's chest or arms, such as the Sylvester method.

Mouth-to-mouth resuscitation is also part of what makes it an important first aid skill. In some situations, this method is used as the most effective if there is no special equipment such as opiate overdoses. The performance of the method is currently limited in most protocols for healthcare professionals. junior medical workers it is recommended to perform mechanical ventilation in each case when the patient is not breathing properly.

Sequence of actions

The technique of artificial ventilation of the lungs is to carry out next steps:

  1. The victim is laid on his back, his clothes are unbuttoned.
  2. The head of the victim is thrown back. To do this, one hand is brought under the neck, the other gently raises the chin. It is important to throw back the head as much as possible and open the mouth of the victim.
  3. If there is such a situation when it is impossible to open your mouth, you should try to put pressure on the area of ​​\u200b\u200bthe chin and make the mouth automatically open.
  4. If the person is unconscious, move lower jaw forward by inserting a finger into the mouth.
  5. If you suspect that there is an injury in the cervical spine, it is important to gently tilt your head back and check for obstructed airways.

Varieties of IVL techniques

Designed to bring a person to his senses the following ways performing artificial ventilation:

  • "mouth to mouth";
  • "mouth to nose";
  • "mouth-device-mouth" - with the introduction of an S-shaped tube.

The technique of artificial lung ventilation requires knowledge of some features.

When performing such operations, it is important to monitor whether the heart has stopped.

Signs of this condition may include:

  • The appearance of a sharp cyanosis or pallor on the skin.
  • Absence of pulse in the carotid arteries.
  • Lack of consciousness.

If the heart stops

In case of cardiac arrest, closed heart massage should be performed:

  • A person quickly fits on his back, it is important to choose a hard surface for this.
  • The resuscitator kneels on the side.
  • It is necessary to put the palm of the base on the area of ​​\u200b\u200bthe sternum of the victim. At the same time, do not forget that you can not touch the xiphoid process. On top of one hand lies the other hand with the palm of your hand.
  • Massage is performed with the help of vigorous jerky movements, the depth of which should be four to five centimeters.
  • Each pressure should alternate with straightening.

Fulfillment implies following procedures during artificial ventilation of the lungs:

  • Tilt the head as much as possible to straighten the airways.
  • Pushing the lower jaw forward so that the tongue does not sink.
  • Easy mouth opening.

Features of the mouth-to-nose method

The technique of carrying out artificial ventilation of the lungs using the "mouth-to-nose" method implies the need to close the victim's mouth and push the lower jaw forward. It is also necessary to cover the area of ​​\u200b\u200bthe nose with the help of lips and blow air into it.

It is necessary to blow simultaneously into the oral and nasal cavities with care in order to protect the lung tissue from possible rupture. This concerns, first of all, the carrying out IVL(artificial lung ventilation) for children.

Rules for performing chest compressions

Cardiac triggering procedures should be performed in conjunction with mechanical ventilation. It is important to ensure the position of the patient on a hard floor or boards.

You will need to perform jerky movements with the use of gravity own body rescuer. The frequency of pushes should be 60 pressures in 60 seconds. After that, you need to perform ten to twelve pressures on the chest area.

The technique of carrying out artificial ventilation of the lungs will show greater efficiency if it is carried out by two rescuers. Resuscitation should continue until breathing and heartbeat are restored. It will also be necessary to stop actions in the event that the biological death of the patient has occurred, which can be determined by characteristics.

Important Notes When Performing CPR

Rules for holding mechanically:

  • ventilation can be done by using an apparatus called a ventilator;
  • insert the device into the patient's mouth and manually activate it, observing the required interval when introducing air into the lungs;
  • breathing may be assisted by a nurse, physician, physician assistant, respiratory therapist, paramedic, or other the right person, squeezing a bag valve mask or a set of bellows.

Mechanical ventilation is called invasive if it involves any instrument that penetrates the mouth (eg, endotracheal tube) or skin (eg, tracheostomy tube).

There are two main modes of mechanical ventilation in two departments:

  • forced-pressure ventilation, where air (or other gas mixture) enters the trachea;
  • negative pressure ventilation, where air is essentially sucked into the lungs.

Tracheal intubation is often used for short-term mechanical ventilation. The tube is inserted through the nose (nasotracheal intubation) or mouth (orthotracheal intubation) and advanced into the trachea. In most cases, products with inflatable cuffs are used for leakage and aspiration protection. Cuffed intubation is considered to provide the best protection against aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, unless the patient is unconscious or otherwise anesthetized, sedatives usually prescribed to ensure tube tolerance. Other disadvantages are damage to the mucous membrane of the nasopharynx.

History of the method

General Method external mechanical manipulation, introduced in 1858, was the "Sylvester Method", invented by Dr. Henry Robert Sylvester. The patient lies on his back with his arms raised above his head to aid inhalation and then pressed against his chest.

The shortcomings of mechanical manipulation led doctors in the 1880s to develop improved methods of mechanical ventilation, including Dr. George Edward Fell's method and a second one consisting of a bellows and breathing valve to pass air through the tracheotomy. Collaboration with Dr. Joseph O "Dwyer led to the invention of the Fell-O" Dwyer apparatus: bellows and instruments for inserting and removing a tube that was advanced down the trachea of ​​patients.

Summing up

Features of artificial lung ventilation in emergency is that it can be used not only by healthcare professionals (mouth-to-mouth method). Although for greater effectiveness, the tube must be inserted into the airway through the hole made surgically, which only paramedics or rescuers can do. This is similar to a tracheostomy, but the cricothyrotomy is reserved for emergency lung access. It is usually used only when the pharynx is completely blocked or if there is a massive maxillofacial injury that prevents the use of other aids.

Peculiarities of artificial ventilation of the lungs for children consist in the careful carrying out of procedures simultaneously in the oral and nasal cavities. Using a respirator and oxygen bag will help make the procedure easier.

When carrying out artificial ventilation of the lungs, it is necessary to control the work of the heart. Resuscitation procedures are stopped when the patient begins to breathe on his own, or he has signs of biological death.

Equipment: Diapers, oilcloth, napkins. 1 pair of sterile gloves, kidney tray, rubber can, boiled water. class B waste container, sterile gauze wipes.

Preparation for manipulation:

1. Explain the procedure to mom, get consent.

2. Sanitize your hands

Performing manipulation:

1. Lay the child with a raised head end, turn his head to the side.

2. Close the neck and chest of the child with oilcloth and a diaper.

3. Place the kidney tray in front of the child's mouth.

4. After stopping vomiting, use a rubber canister with boiled water to irrigate the oral cavity, tilting the child's head over the tray. Wipe baby's lips with a tissue.

5. Give 1-2 teaspoons of boiled water to drink.

End of manipulation:

3. Wash, dry your hands.

19. Technique of IVL for a child by various methods a. Ambu bag with mask

Equipment: Tissue roller, sterile gauze wipes, mask, Ambu bag,

electric pump, class B waste container, sterile gloves.

Preparation for manipulation:

Performing a manipulation:

1. Take the child's head back, put a roller under the shoulders, bring the lower jaw in front (relative to the position of the child).

2. Attach the Ambu bag to the mask.

3. Put the mask firmly on the child's nose and mouth.

4. Hold the mask on the child's face with one hand: press the nose with the 1st finger, and the chin with the 2nd finger, 3,4 and 5 fingers pull the child's chin up.

5. free hand squeeze the bag until the chest rises, then release the bag to exhale, and then inhale again.

6. The frequency of ventilation should be at least 40 breaths per 1 minute. (in newborns) and 20 breaths (in older children).

7. Continue mechanical ventilation until spontaneous breathing appears or the doctor arrives.

End of manipulation:

1. Process reusable medical devices in accordance with industry standard and regulations for disinfection and pre-sterilization cleaning.

2. Disinfect medical waste in accordance with San.PiN.2.1.3. 2630 -10 "Rules for the collection, storage and disposal of waste from medical and preventive institutions."

3. Wash, dry your hands.

B. Mouth-to-mouth breathing

Equipment: Tissue roller, sterile gauze wipes, electric suction, Class B waste container, sterile gloves.

Preparation for manipulation:

1. Sanitize hands. Put on gloves.

2. Put the child on a horizontal hard surface and free from clothing.

3. Examine the upper respiratory tract, if necessary, remove vomit or mucus using an electric suction, a finger, a napkin.

Performing a manipulation:

1. Take the child's head back, put a roller under the shoulders,

bring the lower jaw forward (relative to the position of the child).

2. Put a napkin on the area of ​​​​the mouth and nose of the child.

3. Inhale and press your mouth tightly against the child's mouth and nose.

4. Forcefully exhale the contents of your lungs without forcing the exhalation.

5. Take two deep breaths with an interval of 5 seconds and a duration of 1.5-2 seconds each.

6. Check the presence of respiratory movements of the chest and the movement of air from the mouth and nose of the child during exhalation.

7. The frequency of ventilation should be at least 40 breaths per 1 minute. (in newborns) and 20 breaths (in older children).

8. Continue mechanical ventilation until spontaneous breathing appears or the doctor arrives.

End of manipulation:

1. Process reusable medical devices in accordance with industry standard and regulations for disinfection and pre-sterilization cleaning.

2. Disinfect medical waste in accordance with San.PiN.2.1.3.2630 - 10 "Rules for the collection, storage and disposal of waste from medical and preventive institutions."

3. Wash, dry your hands.

Artificial lung ventilation (ALV) devices are devices that provide a periodic flow of respiratory gases into the patient's lungs to ensure or maintain ventilation of the lungs. The principles of operation of respirators may be different, but in practical medicine, artificial lung ventilation devices operating on the principle of blowing are mainly used. Energy sources for them can be compressed gas, electricity or muscle power.

Apparatus for manual ventilation of the lungs

Ventilation of the lungs with an Ambu bag

For manual ventilation of the lungs intensive care usually self-expanding counterlungs are used. well-known manufacturers of these devices are the firms "Ambu" (Denmark), "Penlon" (Great Britain), "Laerdal" (Norway). The bag has a valve system that regulates the direction of the gas flow, a standard connector for connecting to a face mask or endotracheal tube, and a fitting for connecting to an oxygen source. When the bag is compressed by hand, the gas mixture enters the patient's respiratory tract, exhalation occurs into the atmosphere. The ventilation parameters depend on the frequency and intensity of bag compressions. To prevent the possibility of barotrauma, most self-expanding bags have a "safety valve" to vent excess pressure from excessive forceful compression to atmosphere.

Self-expanding counterlungs are commonly used for short-term mechanical ventilation during resuscitation and during patient transport.

During anesthesia, manual ventilation of the lungs is usually carried out using a breathing bag or the fur of an anesthesia machine.

Devices for automatic lung ventilation

Automatic respirators are mainly used for continuous ventilation in intensive care units and during anesthesia. Currently produced in the world a large number of various devices for artificial ventilation of the lungs, which, according to their technical and functional characteristics are divided into several groups. However, one can try to formulate General requirements for modern respirators.

The device provides the ability to ventilate the lungs in a controlled and one or more auxiliary modes, allow in a wide range to regulate the frequency of ventilation, tidal volume, the ratio of the phases of the respiratory cycle, the pressure and speed of the gas flow during inhalation and positive end-expiratory pressure, oxygen concentration, temperature and humidity of the respiratory mixture. In addition, the device must have a built-in monitoring unit that controls, at a minimum, the occurrence critical situations(depressurization of the breathing circuit, a drop in tidal volume, a decrease in oxygen concentration). Some modern ventilators have such an extensive monitoring system (including gas analyzers and respiratory mechanics recorders) that they allow for precise control of ventilation and gas exchange with little or no help from laboratory services.

Since many ventilation indicators are strictly interconnected, it is fundamentally impossible to create a respirator with absolutely independent adjustment of all settings. Therefore, in practice, it is traditionally customary to classify ventilators according to the principle of changing the phases of the respiratory cycle, or rather, according to which of the established parameters is guaranteed and cannot be changed under any conditions. In accordance with this, respirators can be controlled by volume (tidal volume is guaranteed), by pressure (the set inspiratory pressure is guaranteed) and by time (the invariance of the duration of the respiratory cycle phases is guaranteed).

In pediatric practice, for traditional (conventional) ventilation, devices such as time-cyclic respirators ("Sechrist", USA; "Bear", USA; "Babylog", Germany) and volumetric respirators ("Evita", Germany) are most often used. Puritan-Bennet, USA).

When ventilating the lungs in newborns and children younger age preference is given to time-cyclic respirators with constant circulation of gas in the breathing circuit. The advantages and disadvantages of devices of this type are presented in the table.

Child ventilator

The tables show the devices that carry out artificial ventilation of the lungs in young children:

Table. Respirators time-cyclic

In children weighing more than 10-15 kg, the tidal volume to a much lesser extent, compared with newborns, depends on changes in the aerodynamic resistance of the respiratory tract and lung compliance. Therefore, when ventilating children older than 2-3 years, preference is usually given to bulk respirators (table).

Table. Volumetric respirators

V Lately one of the methods of non-traditional artificial lung ventilation - high-frequency oscillatory ventilation - has gained some popularity. With such ventilation of the lungs, the device generates fluctuations from 6 to 15 Hz (360-900 breaths per 1 min.). With oscillatory ventilation, the tidal volume is less than the volume of the anatomical dead space and gas exchange in the lungs is carried out mainly due to diffusion.

Oscillatory ventilators are divided into "true" oscillators ("Sensormedics", USA) and flow interrupters ("SLE", UK). In addition, there are so-called hybrid oscillators that combine the features of flow breakers and oscillatory fans ("Infrasonic Infant Star", USA). The latter device also allows you to combine traditional convective ventilation with oscillatory ventilation. Some features noted during oscillatory ventilation are noted in the table.

Table. Oscillatory fans

Carrying out artificial ventilation of the lungs

For ventilation of the lungs, expiratory (i.e., exhaled revitalizing air) methods of artificial lung ventilation are used - from mouth to mouth or from mouth to nose.

In young children, artificial ventilation of the lungs is done as follows: the volume of air must be sufficient to ensure adequate chest excursion for the baby. In this case, the duration of inspiration is reduced to 1 - 1.4 s. For the purpose of mechanical ventilation in a child under the age of 1 year, the nose and mouth are simultaneously covered, and in older children, artificial ventilation of the lungs is performed using the mouth-to-mouth method.

Artificial ventilation mouth to mouth

Carrying out artificial ventilation of the lungs in children from mouth to nose is necessary if:

  • convulsive compression of the jaws in a patient;
  • the occurrence of difficulties in ensuring sealing during mechanical ventilation from mouth to mouth;
  • injury to the lips, tongue, lower jaw.

First, the revivalist performs 1 - 2 test breaths. If there is no chest excursion, the airway restoration should be repeated. If after that there is no chest excursion during test breaths, therefore, there is an obstruction of the respiratory tract with a foreign body. In such cases, it is necessary to resort to methods of its removal.

If, with correctly performed test breaths, a chest excursion is observed in a child, then the airways are passable. In such cases, the next step should be to determine the safety of the activity of the heart. Such an assessment is performed by registering the pulse on large main vessels: carotid or brachial arteries.

Feeling the pulse in children

The brachial pulse is usually measured in children under 1 year of age, because their short, rounded neck makes it difficult to register the carotid pulse. The brachial artery is palpated along inner surface the upper part of the shoulder between the elbow and shoulder joints.

The femoral artery pulse can be determined in children of any age group. Most often, this is done by trained personnel. The femoral artery is palpated in the inguinal region below the inguinal ligament, approximately midway between the pubic articulation and the anterior iliac spine.

The carotid pulse is usually examined in a child older than 1 year. To do this, the child's head is thrown back, the thyroid cartilage is determined by palpation, and then the fingers are lowered into the space between the trachea and the sternocleidomastoid muscle. The artery is palpated gently, trying not to pinch it completely.

If the activity of the heart is preserved, then assistance is limited to the implementation of measures A and B: the airway is maintained and artificial ventilation is performed. In this case, mechanical ventilation is performed with a frequency of pressure on the sternum 20 times per 1 min (the duration of the entire respiratory cycle is 3 s). Special attention is given to maintain airway patency during exhalation.

Artificial ventilation complications

These are complications arising from the rupture of the alveoli and the accumulation of air in the surrounding spaces and tissues. These complications can develop spontaneously in newborns (out of connection with therapeutic procedures), but more often occur with artificial or assisted ventilation of the lungs, as well as when using the PPD technique.

Air leak syndrome - a complication after mechanical ventilation

The pathogenesis of these complications of mechanical ventilation is well understood. The introduction or retention of excess air in the lungs leads to an increase in intra-alveolar pressure and rupture of the base of the alveoli. Air seeps through the cells of the capillary network and spreads through the perivascular spaces towards the root of the lung. Although perivascular spaces may to a large extent expand, the accumulating air inevitably compresses the surrounding vessels, creating prerequisites for lung hypoperfusion.

Further, air can penetrate into the mediastinum (pneumomediastinum), the pleural cavity (pneumothorax), and sometimes into the pericardial space (pneumopericardium). In rare cases, air from the mediastinum spreads down through holes in the diaphragm and accumulates in the retroperitoneal space, and from there breaks into abdominal cavity(pneumoperitoneum).

Interstitial emphysema - a complication after mechanical ventilation

The accumulation of air in the interstitial space may not have any clinical manifestations. However, if severe interstitial emphysema develops in ventilated children, there is usually an increase in oxygen demand, as well as a trend towards an increase in PaCO2. Thus, ventilation disorders come to the fore, while critical disorders associated with vascular compression are usually not observed. The progression of interstitial emphysema in about 50% of cases leads to the development of pneumothorax.

Interstitial emphysema can only be diagnosed by x-ray. Typical features while there are cystic and linear enlightenment. Linear enlightenments vary considerably in width, look quite rough and do not branch out. They are well visible both in the center and along the periphery of the lung fields, so they are easy to distinguish from air bronchograms, which have a more even outline, branching structure and are not visible on the periphery of the lungs. Accumulations of small cystic lucencies give the lung a characteristic spongy appearance. The process, as a rule, captures both lungs, although in rare cases one lung, or even one lobe, may be affected.

Unfortunately, there is no definitive treatment for interstitial emphysema. Therapeutic measures should be aimed at minimizing peak inspiratory pressure, inspiratory time and positive end-expiratory pressure. In severe cases good effect can be obtained using high-frequency artificial lung ventilation.

Pneumothorax in children - a complication after mechanical ventilation

Spontaneous asymptomatic pneumothorax occurs in 1-2% of newborns. Most probable cause its development is considered to be high negative values ​​of intrapleural pressure that occur during the first breaths of the child. Predisposing factors are early gestational age and respiratory distress syndrome. It is known that premature babies with RDS, pneumothorax is observed 3.5-4 times more often than with any other pathology.

Only in 10-20% of cases spontaneous pneumothorax has clinical manifestations in the form of tachypnea and cyanosis. At the same time, the vast majority of children require only an increase in the concentration of oxygen in the respiratory mixture and do not need puncture or drainage of the pleural cavity.

Severe pneumothorax is much more common in newborns receiving respiratory support. According to various researchers, in newborns with RDS who are on mechanical ventilation, pneumothorax is observed in 35-50% of cases. As a rule, this is a severe tension pneumothorax, requiring immediate diagnosis and emergency treatment.

Diagnosis of tension pneumothorax is usually not difficult. The child's condition suddenly deteriorates sharply, generalized cyanosis appears. Often one can note a clear protrusion of the affected half of the chest, bloating. Valuable diagnostic sign is the displacement of the apex beat in opposite side. During auscultation, there is a sharp weakening of respiratory sounds, deafness of heart sounds, tachycardia. An early diagnostic sign is a decrease in the voltage of the QRS complex on the heart monitor by about 2 times. A certain help in the diagnosis can be provided by transillumination of the chest with a fiber-optic light guide (transillumination method). There is a bright glow of the affected area. The diagnosis is confirmed by X-ray examination. The picture shows the accumulation of air in the pleural cavity, the collapsed lung and the displacement of the mediastinum in healthy side.

Practice shows that with tension pneumothorax, drainage of the pleural cavity is always required, therefore, puncture is permissible only in absolutely urgent situations.

The skin in the drainage area (4-5 intercostal space along the anterior or mid-axillary, or 3 intercostal space along the mid-clavicular line) is treated with a disinfectant solution and local anesthesia is performed with a 0.5-1.0% novocaine solution. A skin incision 1 cm long is made along the upper edge of the rib, then the intercostal muscles are bluntly separated. A drainage tube with a diameter of 2.5-3.5 mm is inserted into the pleural cavity with the help of a trocar in an upward and forward direction to a depth of 2-3 cm. After fixation, the drainage is connected to a constant suction system with a vacuum of 10 cm of water. Art. Then perform a control X-ray examination. If the drain is patent and the lung does not fully expand, another drain tube may be inserted.

Pneumopericardium in children - a complication after mechanical ventilation

Pneumopericardium is a much rarer complication than pneumothorax or interstitial emphysema. It is often associated with right interstitial emphysema, but may also occur with pneumomediastinum and/or pneumothorax. The severity of clinical manifestations of pneumopericardium varies widely. Often, it is diagnosed incidentally on follow-up radiography by the characteristic dark rim of air accumulated in the pericardial space and surrounding the heart. However, tense pneumopericardium leads to cardiac tamponade and therefore requires emergency treatment. The development of this complication can be suspected with a sudden sharp deterioration in the patient's condition, increased cyanosis. Heart tones during auscultation are sharply muffled or not heard at all.

To evacuate air, it is necessary to perform a puncture of the pericardium. The cannula on a G21 needle is connected through a 3-way stopcock to a 10 ml syringe. The puncture is performed under the costal arch to the left of the xiphoid process. The needle is directed upward at an angle of 45o to the horizontal plane and 45o to middle line. When the needle is inserted, the plunger of the syringe is pulled, creating a slight vacuum. At a depth of approximately 1 cm, the needle reaches the pericardial space and air begins to flow into the syringe. After puncture, in about 50% of cases there is a re-accumulation of air. In this case, the cannula is left in the pericardial space, connected to the water valve.

Spontaneous pneumomediastinum occurs in approximately 0.25% of all newborns. Its genesis is the same as that of spontaneous pneumothorax. This complication occurs somewhat more often after ventilation with an Ambu bag in delivery room, as well as in children with RDS and meconium aspiration syndrome. Clinically, pneumomediastinum after mechanical ventilation is usually manifested by tachypnea, deafness of heart tones, and sometimes cyanosis. The diagnosis is made by X-ray examination. The most informative side projection, which clearly shows the zone of enlightenment, located behind the sternum or in the upper part of the mediastinum, if the child is in an upright position. On a direct roentgenogram, sometimes accumulated air in the mediastinum separates the shadow of the heart from the thymus gland. This radiological sign is called "butterfly wings" or "sails".

Air from the mediastinum usually resolves spontaneously and no additional therapeutic measures are required.

Restoring the normal functioning of the circulatory system, maintaining air exchange in the lungs is the primary goal. Timely resuscitation measures allow avoiding the death of neurons in the brain and myocardium until blood circulation is restored and breathing becomes independent. Cardiac arrest in a child due to a cardiac cause is extremely rare.

CPR in children

For infants and newborns, the following causes are distinguished: suffocation, SIDS - sudden infant death syndrome, when an autopsy cannot establish the cause of termination of life, pneumonia, bronchospasm, drowning, sepsis, neurological diseases. In children after twelve months, death occurs most often due to various injuries, strangulation due to illness or a foreign body entering the respiratory tract, burns, gunshot wounds, and drowning.

Doctors divide little patients into three groups. The algorithm for resuscitation is different for them.

  1. Sudden circulatory arrest in a child. Clinical death during the entire period of resuscitation. Three main outcomes:
  • CPR ended with a positive outcome. At the same time, it is impossible to predict what the patient's condition will be like after the clinical death he has suffered, how much the functioning of the body will be restored. There is a development of the so-called postresuscitation disease.
  • The patient does not have the possibility of spontaneous mental activity, the death of brain cells occurs.
  • Resuscitation does not bring a positive result, doctors ascertain the death of the patient.
  1. Poor prognosis for cardiac pulmonary resuscitation in children with severe trauma, in a state of shock, complications of a purulent-septic nature.
  2. Resuscitation of a patient with oncology, developmental anomalies internal organs, severe injuries whenever possible carefully planned. Immediately proceed to resuscitation in the absence of a pulse, breathing. Initially, it is necessary to understand whether the child is conscious. This can be done by shouting or lightly shaking, while eliminating jerky movements patient's head.

Indications for resuscitation - sudden circulatory arrest

Primary resuscitation

CPR in a child includes three stages, which are also called ABC - Air, Breath, Circulation:

  • Air way open. The airway needs to be cleared. Vomiting, tongue protrusion, foreign body may be an obstruction in breathing.
  • Breath for the victim. Carrying out measures for artificial respiration.
  • Circulation his blood. Closed heart massage.

When performing cardiopulmonary resuscitation of a newborn baby, the first two points are most important. Primary cardiac arrest in young patients is uncommon.

Ensuring the child's airway

The first stage is considered the most important in the CPR process in children. The algorithm of actions is the following.

The patient is placed on his back, neck, head and chest are in the same plane. If there is no trauma to the skull, it is necessary to throw back the head. If the victim has an injured head or upper cervical region, it is necessary to push the lower jaw forward. In case of loss of blood, it is recommended to raise the legs. Violation of the free flow of air through the respiratory tract in baby may be exacerbated by excessive flexion of the neck.

The reason for the ineffectiveness of measures for pulmonary ventilation may not be correct position child's head relative to the body.

If there are foreign objects in the oral cavity that make breathing difficult, they must be removed. If possible, tracheal intubation is performed, an airway is inserted. If it is impossible to intubate the patient, mouth-to-mouth and mouth-to-nose and mouth-to-mouth breathing is performed.


Algorithm of actions for ventilation of the lungs "mouth to mouth"

Solving the problem of tilting the patient's head is one of the primary tasks of CPR.

Airway obstruction leads to cardiac arrest in the patient. This phenomenon causes allergies, inflammatory infectious diseases, foreign objects in the mouth, throat or trachea, vomit, blood clots, mucus, sunken tongue of the child.

Algorithm of actions during ventilation

Optimal in the implementation of artificial ventilation of the lungs will be the use of an air duct or face mask. If it is not possible to use these methods, an alternative course of action is to actively blow air into the nose and mouth of the patient.

To prevent the stomach from stretching, it is necessary to ensure that there is no excursion of the peritoneum. Only the volume of the chest should decrease in the intervals between exhalation and inhalation when carrying out measures to restore breathing.


Duct application

When carrying out the procedure of artificial ventilation of the lungs, the following actions are carried out. The patient is placed on a hard, flat surface. The head is slightly thrown back. Observe the child's breathing for five seconds. In the absence of breathing, take two breaths lasting one and a half to two seconds. After that, stand for a few seconds to release air.

When resuscitating a child, inhale air very carefully. Careless actions can provoke a rupture of lung tissue. Cardiopulmonary resuscitation of the newborn and infant is carried out using the cheeks for blowing air. After the second inhalation of air and its exit from the lungs, a heartbeat is probed.

Air is blown into the lungs of a child eight to twelve times per minute with an interval of five to six seconds, provided that the heart is functioning. If the heartbeat is not established, proceed to other life-saving actions.

You need to carefully check for foreign objects in the oral cavity and upper respiratory tract. This kind of obstruction will prevent air from entering the lungs.

The sequence of actions is as follows:

  • the victim is placed on the arm bent at the elbow, the baby's torso is above the level of the head, which is held with both hands by the lower jaw.
  • after the patient is laid in the correct position, five gentle strokes are made between the patient's shoulder blades. The blows must have a directed action from the shoulder blades to the head.

If the child cannot be placed in the correct position on the forearm, then the thigh and the leg bent at the knee of the person involved in resuscitation of the child are used as a support.

Closed heart massage and chest compressions

Closed massage of the heart muscle is used to normalize hemodynamics. It is not carried out without the use of IVL. An increase in intrathoracic pressure causes blood to be ejected from the lungs into circulatory system. The maximum air pressure in the lungs of a child falls on the lower third of the chest.

The first compression should be a trial, it is carried out to determine the elasticity and resistance of the chest. The chest is squeezed during a heart massage by 1/3 of its size. Chest compression is performed differently for different age groups patients. It is carried out due to pressure on the base of the palms.


Closed heart massage

Features of cardiopulmonary resuscitation in children

Features of cardiopulmonary resuscitation in children are that it is necessary to use fingers or one palm for compression due to the small size of patients and fragile physique.

  • Infants are pressed on the chest only thumbs hands
  • For children from 12 months to eight years old, massage is performed with one hand.
  • For patients older than eight years, both palms are placed on the chest. like adults, but measure the force of pressure with the size of the body. The elbows of the hands during the massage of the heart remain in a straightened state.

There are some differences in CPR that is cardiac in nature in patients older than 18 years of age and CPR resulting from strangulation in children with cardiopulmonary failure, so resuscitators are advised to use a special pediatric algorithm.

Compression-ventilation ratio

If only one physician is involved in resuscitation, he should deliver two breaths of air into the patient's lungs for every thirty compressions. If two resuscitators are working at the same time - compression 15 times for every 2 air injections. When using a special tube for IVL, a non-stop heart massage is performed. The frequency of ventilation in this case is from eight to twelve beats per minute.

A blow to the heart or in children is not used - can be seriously injured rib cage.

The frequency of compressions is from one hundred to one hundred and twenty beats per minute. If the massage is performed on a child under 1 month old, then you should start with sixty beats per minute.


Remember that the child's life is in your hands.

CPR should not be stopped for more than five seconds. 60 seconds after the start of resuscitation, the doctor should check the patient's pulse. After that, the heartbeat is checked every two to three minutes at the moment the massage is stopped for 5 seconds. The state of the pupils of the reanimated indicates his condition. The appearance of a reaction to light indicates that the brain is recovering. Persistent dilation of the pupils is an unfavorable symptom. If it is necessary to intubate the patient, do not stop resuscitation for more than 30 seconds.

To restore breathing in children under 1 year of age, mechanical ventilation is carried out "from mouth to mouth and nose", in children older than 1 year - by the method "from mouth to mouth". Both methods are carried out in the position of the child on the back. For children under 1 year old, a low roller is placed under their backs (for example, a folded blanket), or slightly lifted upper part the torso with a hand brought under the back, the child’s head is slightly thrown back. The person providing assistance takes a shallow breath, hermetically covers the mouth and nose of a child under 1 year old or only the mouth in children older than a year old, and blows air into the respiratory tract, the volume of which should be the smaller than less baby. In newborns, the volume of inhaled air is 30-40 ml. With a sufficient volume of air blown in and air entering the lungs (and not the stomach), chest movements appear. After completing the blow, you need to make sure that the chest is lowering.

Blowing an excessively large volume of air for a child can lead to serious consequences - to rupture of the alveoli and lung tissue and air to escape into the pleural cavity.

Remember!

The frequency of inspirations should correspond to the age-related frequency of respiratory movements, which decreases with age.

The average NPV in 1 minute is:

In newborns and children up to 4 months - 40

In children 4-6 months - 35-40

In children 7 months - 35-30

In children 2-4 years old - 30-25

In children 4-6 years old - about 25

In children 6-12 years old - 22-20

For children 12-15 years old - 20-18 years old.

Features of indirect heart massage in children

In children chest wall elastic, so indirect heart massage is performed with less effort and with greater efficiency.

The technique of indirect heart massage in children depends on the age of the child. For children under 1 year old, it is enough to press on the sternum with 1-2 fingers. To do this, the assisting person lays the child on his back with his head to himself, covers him so that the thumbs are located on the front surface of the chest, and their ends are on the lower third of the sternum, the rest of the fingers are placed under the back.

For children older than 1 year to 7 years, heart massage is performed, standing on the side, with the base of one hand, and for older children - with both hands (as adults).

During the massage, the chest should sag by 1-1.5 cm in newborns, by 2-2.5 cm in children 1-12 months old, 3-4 cm in children older than a year.

The number of pressures on the sternum for 1 minute should correspond to the average age-related pulse rate, which is:

In newborns - 140

In children 6 months - 130-135

In children 1 year old - 120-125

In children 2 years old - 110-115

In children 3 years old - 105-110

In children 4 years old - 100-105

In children 5 years old - 100

In children 6 years old - 90-95

In children 7 years old - 85-90

In children 8-9 years old - 80-85

In children 10-12 years old - 80

In children 13-15 years old - 75