Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 4

ANESTHESIOLOGY-REANIMATOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.474   |  

O.I. SVETLITSKAYA, I.I. KANUS

RESPIRATORY SUPPORT OF PATIENTS WITH ACUTE LUNG INJURY

SBE Belarusian Medical Academy of Post-Graduate Education,
The Republic of Belarus

Objectives. To improve the treatment results of an acute lung injury syndrome in patients with severe community-acquired pneumonia of viral and bacterial etiology by optimization of the respiratory support.
Methods. Complex examination of patients (n=216) with a severe community-acquired, viral and bacterial pneumonia who were treated in the intensive care unit (ICU) of Minsk City Emergency Hospital (2009-2013 yrs) has been conducted.
Results. It was established that 74,6% of patients with an acute lung injury of viral and bacterial etiology needed in respiratory support had excess body weight/obesity. The lowest parameters of the respiratory index: 114,3 mm Hg in patients with the 1st degree of obesity (3,25 points by LIS Scale) and 125,2 mm Hg in patients with the 3rd degree (2,25 points by LIS Scale) have been revealed in patients with the 1st and 3rd degree of obesity. In patients with body mass index (BMI) > 30 kg/m2 an early non-invasive lung ventilation (NILV) was applied, the early application of artificial lung ventilation (ALV) (if PaO2/FiO2 < 175 mm Hg one hour after NILV) with the compliance of principal postulates of safe ALV and performing recruitment maneuver immediately after intubation to prevent/eliminate atelectasis, that had a positive impact on the restoration of oxygenation and resulted in reduction of the artificial lung ventilation time and lethality rate in the intensive care unit.
Conclusions. The proposed concept of the respiratory support allowed making effective prosthesis of the respiratory organs function having lowered lethality in 3-folds. This method is characterized by the differentiated approach to the regimen choice of ventilation taking into the account severity of alveolar and capillary membrane injury and the accompanying diseases (excess body mass /obesity).

Keywords: acute lung injury, mechanical ventilation, community-acquired pneumonia, obesity
p. 474 480 of the original issue
References
  1. Aver'ianov AV. Sovremennye printsipy vedeniia bol'nykh s tiazheloi vnebol'nichnoi pnevmoniei [Modern principles of management of patients with severe community-acquired pneumonia]. Consilium Medicum. Bolezni organov dykhaniia. 2009;(1):2126.
  2. Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, Gubareva LV, Xu X, Bridges CB, Uyeki TM. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. Novel Swine-Origin Influenza A (H1N1). N Engl J Med. 2009 Jun 18;360(25):260515.
  3. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, Ramirez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Higuera A, Mondragon E, Cordova-Villalobos JA. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009 Aug 13;361(7):68089.
  4. Polushin IuS, Khrapov KN, Maiskaia MIu, Dikarev KV. Virusnaia pnevmoniia gripp A (H1N1), oslozhnennaia ORDS [Viral pneumonia influenza A (H1N1), complicated by ARDS]. Obshchaia Reanimatologiia. 2010;(3):1522.
  5. Ramsey C, Kumar A. H1N1: viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care. 2011 Feb;17(1):6471.
  6. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R.The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):81824.
  7. Matthay MA, Zemans RL.The acute respiratory distress syndrome: pathogenesis and treatment. Annu Rev Pathol. 2011;6:14763.
  8. Kurek VV, Pochepen' ON. Ostroe povrezhdenie legkikh i ostryi respiratornyi distress-sindrom: diagnostika, klinika, lechenie [Acute lung injury and acute respiratory distress syndrome: diagnosis, clinical treatment]: posobie dlia vrachei. Minsk, RB: DoktorDizain, 2009. 43 p.
  9. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD.Incidence and outcomes of acute lung injury. N Engl J Med. 2005 Oct 20;353(16):168593.
  10. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008 May;133(5):112027.
  11. Zambon M, Vincent JL. Are outcomes improving in patients with ARDS? Am J Respir Crit Care Med. 2009 Dec 1;180(11):115859.
  12. Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H 3rd, Hoth JJ, Mikkelsen ME, Gentile NT, Gong MN, Talmor D, Bajwa E, Watkins TR, Festic E, Yilmaz M, Iscimen R, Kaufman DA, Esper AM, Sadikot R, Douglas I, Sevransky J, Malinchoc M. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011 Feb 15;183(4):46270.
  13. Morgan OW, Bramley A, Fowlkes A, Freedman DS, Taylor TH, Gargiullo P, Belay B, Jain S, Cox C, Kamimoto L, Fiore A, Finelli L, Olsen SJ, Fry AM.Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010 Mar 15;5(3):e9694.
  14. Iashina LA, Ishchuk SG. Izbytochnaia massa tela, ozhirenie i patologiia legkikh: vzgliad pul'monologa [Excess body weight, obesity and lung disease: a view of pulmonologist]. Zdorov'ia UkraIni. 2011;(4):1415.
  15. Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol (1985). 2010 Jan;108(1):20611.
Address for correspondence:
220013, Respublika Belarus, g. Minsk, ul. P. Brovki 3, korpus 3, GUO Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya, kafedra anesteziologii i reanimatologii,
e-mail: goodlife@tut.by,
Svetlitskaya Olga Ivanovna
Information about the authors:
Svetlitskaya O.I. PhD, an associate professor of anesthesiology and reanimatology chair of Belarusian Medical Academy of Post-graduate Education.
Canus I.I. An Honored scientist, MD, professor of anesthesiology and reanimatology chair of Belarusian Medical Academy of Post-graduate Education.
Contacts | ©Vitebsk State Medical University, 2007