TOPICAL ISSUES OF TREATMENT OF PATIENTS DEPENDENT ON ARTIFICIAL RESPIRATION UNIT

Tracheostomy is a necessary operation, which should be carried out among seriously ill patients who depend on artificial respirator unit, with no possibility of their extubation within 5-7 days from the beginning of mechanical ventilation. Common advantages of tracheostomy over tracheal intubation are the reduction of respiratory dead space, the possibility of discontinuing the patient's sedation, easier approach to the lower respiratory tract, more accurate sanitation of the tracheobronchial tree, the prevention of mucous membrane and laryngeal cartilages changing, etc. According to different sources, if carried out in the early stages, tracheostomy may minimize mechanical ventilation complications. However, the time of shifting a patient to tracheostoma ventilation remains controversial. Currently the transcutaneous tracheostomy is more preferable, because emergency physicians carry it out without the participation of any other specialists. However, the available literature has insufficient evidence concerning the frequency and severity of posttracheostomic complications in a long-term period depending on the technique chosen. A research was conducted in order to define the microbiologic pattern with antimicrobial susceptibility among patients who underwent an open surgical tracheostomy. There is no such information on tracheobronchial tree microflora after percutaneous tracheostomy. The question of the decannulation of patients is widely covered in both foreign and domestic sources, but no common method is found at present. In summary the selection of the procedure (percutaneous dilatational or conventional surgical one) should be based on a patient's individual features (constitutional peculiarities, the severity of the patient's condition, nature of prior disease, etc.). It is necessary to find a lean approach to determine the time for the tracheostomy application. A narrow examination of the frequency and severity of posttracheostomic stenoses after percutaneous tracheostomy in comparison with the surgical method is very important. The tracheobronchial tree microbiologic pattern in patients after transcutaneous tracheostomy must be analyzed. It is also essential to develop a unified protocol for the patients' decannulation.

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