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Year 2014 Vol. 22 No 4
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).
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220013, Respublika Belarus, g. Minsk, ul. P. Brovki 3, korpus 3, GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra anesteziologii i reanimatologii,
Svetlitskaya Olga Ivanovna
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”.