After rejuvenating procedures, each patient wants to get the desired result as quickly as possible and return to their usual routine of life, without wasting time on rehabilitation and dealing with possible side effects and complications. At the same time, any invasive procedure is stressful for the skin, requires a recovery period and is associated with the risk of adverse events. The discomfort associated with this type of exposure can be minimized by properly preparing the skin for invasive interventions. Svetlana Korkunda, PhD, Associate Professor of the Department of Combustiology, Reconstructive and Plastic Surgery at the Kharkov Medical Academy of Postgraduate Education, told how to do this in an interview for estet-portal.com.
What effect do enzymes have on the skin? What effect do they achieve?
Enzymes in the form that we use in the form of injections are practically no different from our own enzymes that work in our skin. Having studied the capabilities of recombinant enzymes, as well as applying in practice knowledge in the field of biochemistry, normal physiology and pathophysiology, we came to the conclusion that such drugs have many therapeutic and preventive effects when working in different protocols. Thus, substances are introduced from the outside that duplicate the work of the skin’s own enzymes and improve its functioning at the level of its own structures. Speaking about the actual clinical effects, we get a reduction in the volume of adipose tissue on the face and body and tissue tightening.
Carrying out invasive procedures on healthy and prepared tissues allows you to shorten the rehabilitation period, obtain a more pronounced result and a long-lasting effect.
How can enzyme therapy prolong the effect of powerful invasive procedures? (H2)
If we talk about the use of three enzymes, then their clinical effect is a reduction in the size of fat cells and an increase in the activity of processes occurring in connective tissue. Thus, further invasive techniques - be it volumetric volumization, threadplasty or a powerful hardware procedure - are used on healthy and prepared tissues, which naturally affects rehabilitation, the severity of the result, and the duration of the effect.
How do you assess the prospects for the use of enzyme therapy in aesthetic medicine?
The more I work with enzymes, the more opportunities and prospects I see for their use. If we started working exclusively in the context of local effects on adipose tissue, and then on scar tissue, then today protocols have been developed for use in rehabilitation regimes for patients after invasive procedures, for example:
- Aptos threadplasty;
- volumization with fillers;
- some surgical interventions;
- in the presence of inflammatory processes.
Therefore, the prospects for using enzyme therapy are quite large; the main thing is to understand the principle of action of products in tissues and receive the correct information not only from representatives, distributors and manufacturers, but also from independent sources, for example, textbooks on biochemistry and human physiology.
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Non-invasive ventilation
Over the past two decades, the use of non-invasive mechanical ventilation equipment has increased markedly. NIV has become a generally accepted and widespread tool for the treatment of acute and chronic respiratory failure both in hospitals and at home.
One of the leading manufacturers of medical respiratory devices is the Australian company ResMed
NIV - what is it?
Non-invasive ventilation refers to mechanical respiratory support without invasive access (ie, without an endotracheal or tracheostomy tube) using various known assisted ventilation modes.
The equipment supplies air to the patient interface through a breathing circuit. To provide NIV, various interfaces are used - nasal or oro-nasal mask, helmet, mouthpiece. Unlike the invasive method, the person continues to breathe on his own, but receives hardware support during inspiration.
When is non-invasive ventilation used?
The key to successful use of noninvasive ventilation is recognition of its capabilities and limitations, as well as careful patient selection (diagnosis and patient assessment). Indications for NIV are the following criteria:
- shortness of breath at rest;
- respiratory rate RR>25, participation of auxiliary respiratory muscles in the respiratory process;
- hypercapnia (PaC02>45 and its rapid increase);
- Ph level
- symptomatic lack of positive effect from oxygen therapy, hypoxemia and gas exchange disorders;
- increase in airway resistance by 1.5-2 times the norm.
To perform non-invasive ventilation, the patient must be conscious and able to follow the instructions of the doctors. There must be a clear prospect of stabilizing the patient within several hours or days after the start of respiratory support. Absolute contraindications for NIV are:
- coma;
- heart failure;
- respiratory arrest;
- any condition requiring immediate intubation.
Advantages of NIV
One of the advantages of non-invasive ventilation is the ability to carry out therapy at home.
Non-invasive ventilation allows you to help a patient with acute or chronic respiratory failure without resorting to endotracheal intubation or tracheostomy. The technique is simpler and more comfortable for the patient. Let us list the main advantages of NIV.
- A respiratory support session is easy to start and just as easy to complete.
- The patient retains the ability to speak, swallow, eat independently, and cough.
- The procedure does not cause complications that are possible with endotracheal intubation and tracheostomy, including mechanical damage to internal organs by the tube, bleeding, swelling of the glottis, infection of the respiratory tract, etc.
- The air passes through the respiratory tract, due to which it is humidified, purified and warmed naturally.
- NIV can be performed at an early stage of the disease, i.e. before the patient's condition becomes critical. This shortens the duration of treatment, reduces the number of complications, and also reduces the risk of readmission.
- In many cases, devices for non-invasive respiratory support can be used not only in a hospital, but also at home.
- There is no “respirator weaning” period after completion of treatment.
Non-invasive conscious ventilation also has some disadvantages and side effects. For example, it is impossible to apply high treatment pressure, because this leads to significant leakage from under the mask. There is no direct access to the respiratory tract, so it is impossible to sanitize it. It is also impossible not to mention the likelihood of aerophagia, aspiration of stomach contents and skin irritation in the areas where the contour is adjacent.
Non-invasive ventilation in CPAP and BIPAP modes
The terms CPAP and BIPAP are often used interchangeably with NIV. These are common methods of non-invasive respiratory support using special portable devices. Many modern ventilators used in intensive care units have the option of CPAP and BIPAP.
Portable respirators are low cost (relative to resuscitation stationary ventilators), and they effectively compensate for even high air leakage. But most often they do not provide advanced monitoring of the patient's condition in real time.
Most resuscitation respirators can operate in CPAP and BIPAP modes. But more often, portable devices are used to provide respiratory support to a conscious patient.
In CPAP (continuous positive airway pressure) mode, the device supplies air under constant positive pressure, and the patient breathes spontaneously (i.e., independently). The method is used in the management of patients with moderate to severe obstructive sleep apnea syndrome (OSA), as well as post-traumatic or postoperative acute respiratory failure.
Bi-level positive airway pressure (BIPAP) devices have a wider range of applications and different mode options. Unlike CPAP, they involve an increase in pressure as you inhale and a decrease in pressure as you exhale. Thanks to this, it becomes possible to use high treatment pressure, but the patient does not experience discomfort in the exhalation phase, overcoming the resistance of the air flow. Two-level ventilation allows you to relieve the respiratory muscles, reduce the respiratory rate and increase the tidal volume. And the presence of auxiliary modes in modern models helps to select the optimal treatment protocol in accordance with the diagnosis and needs of the patient.
CPAP and BIPAP machines to help patients with COVID-19
Over the past few months, the issue of mechanical ventilation has been raised frequently in connection with the COVID-19 pandemic. High demand for ventilators has caused their shortage. The Australian company ResMed, as a manufacturer of medical respirators, is taking the necessary measures to prioritize the production of devices to assist patients with severe respiratory failure. But due to the acute shortage of equipment at the moment, alternative ventilation options, incl. non-invasive respiratory support.
The COVID-19 pandemic has led to a shortage of ventilators. In this regard, primary care for patients with coronavirus infection and symptoms of acute respiratory failure can be carried out using CPAP and BIPAP machines.
CPAP and bipap therapy can be used to provide primary care to patients with COVID-19 who require respiratory support. According to clinical protocols and reports received from clinicians in Italy and China, non-invasive ventilation (including BPAP and CPAP) for patients with COVID-19 is recommended in the following scenarios.
- To provide respiratory support to patients with respiratory failure who have not yet progressed to more severe hypoxemia.
- To facilitate extubation and recovery after invasive ventilation.
- To reduce hospital stays by allowing patients who still require respiratory support and rehabilitation to transition to home care.
NIV cannot replace invasive ventilation in the most severe forms of COVID-19. But this therapy is important when triaging patients in medical institutions. CPAP and BIPAP machines provide supplemental oxygen for less severe cases and reduce dependence on invasive ventilation. In addition, they are relevant for countries where hospital bed capacity turned out to be insufficient during the ongoing pandemic.
The following ResMed brand devices are suitable for home therapy: Lumis series BIPAP devices, as well as the AirCurve 10 CS PaceWave servo ventilator. They can be connected to additional oxygen (up to 15 l/min), as well as a module with a pulse oximetry sensor to monitor blood oxygen saturation.
Long-term use of non-invasive ventilation: benefit or harm
There is an opinion that the longer a patient is on a ventilator, the more difficult it is for him to refuse a respirator. This gives rise to the fear of “forgetting how” to breathe without a device and the fear of suffocation if the device turns off for some reason. But such risks occur only with invasive ventilation, when the device literally breathes instead of the patient. In turn, long-term use of non-invasive ventilation does not cause addiction, because the patient breathes on his own, and medical equipment only helps him with this.
According to research results, long-term non-invasive respiratory support (including at home) can optimize gas exchange, reduce the load on the respiratory system and reduce the risk of subsequent hospitalizations in patients with COPD. One of the advantages of long-term NIV is the ability to provide rest to the respiratory muscles, which are in a state of chronic fatigue.
Long-term use of non-invasive ventilation improves sleep quality and well-being while awake. When NIV is discontinued even for a week, patients with chronic respiratory failure begin to have morning migraines again, shortness of breath appears, and their night saturation also worsens.
NIV for chronic respiratory failure is most often performed at night. First, it increases the total time of respiratory support. Secondly, it helps eliminate nocturnal hypoventilation and episodes of desaturation, which most often occur in the REM phase of sleep.
