rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2007-3-65rmt-1023Research ArticleОСТРАЯ ДЫХАТЕЛЬНАЯ НЕДОСТАТОЧНОСТЬACUTE RESPIRATORY FAILUREНеинвазивная вентиляция легких при ОРДС у кардиохирургических больныхNoninvasive Ventilation in Cardiosurgical Patients with Acute Respiratory Distress SyndromeБаутинА. Е.BautinA. Ye.-ХубулаваГ. Г.KhubulavaG. G.-НаумовА. Б.NaumovA. B.-ОсовскихВ. В.OsovskikhV. V.-20072006200733Том III № 3 2007 г.6565Copyright © Баутин А.Е., Хубулава Г.Г., Наумов А.Б., Осовских В.В., 20072007Баутин А.Е., Хубулава Г.Г., Наумов А.Б., Осовских В.В.Bautin A.Y., Khubulava G.G., Naumov A.B., Osovskikh V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1023

Цель исследования . Оценить эффективность комбинированного применения традиционной респираторной поддержки и неинвазивной вентиляции лёгких (НВЛ) в терапии ОРДС после кардиохирургических вмешательств. Материалы и методы. В исследование был включен 31 больной. Основу терапии ОРДС составляла респираторная поддержка, соответствующая принципам «безопасной ИВЛ», во всех случаях использовали эндобронхиальное введение препарата природного сурфактанта. Условием продолжения исследования и выполнения рандомизации было достижение индекса оксигенации (PaO2/FiO2), равного 200 при проведении ВВЛ в режиме PS + CPAP. После простой рандомизации пациентам основной группы (16 больных) выполняли экстубацию с последующим переводом на НВЛ. У пациентов контрольной группы (15 больных) продолжали традиционную вспомогательную вентиляцию легких в режиме PS + CPAP. Результаты. Как в основной, так и в контрольной группах удавалось поддерживать адекватные показатели газообмена, центральной гемодинамики и доставки кислорода на всех этапах исследования. Продолжительность традиционной ИВЛ/ВВЛ достоверно преобладала в контрольной группе (128,9±22,4 ч против 67,6±12,5 ч, p<0,01). В основной группе повторный перевод на ИВЛ потребовался в трех случаях (частота реинтубаций 18,8%). В контрольной группе на самостоятельное дыхание были переведены 13 больных (86,7%), однако три пациента в дальнейшем были вновь заинтубированы (частота реинтубаций составила 23,1%). В контрольной группе было отмечено 4 случая вентилятор-ассоциированной пневмонии (26,6%), в основной группе инфекционных осложнений не отмечалось. Перевод на НВЛ способствовал снижению сроков лечения в отделении реанимации (152,3±16,5 ч против 185,6±10,1 ч в контрольной группе, p<0,01). Исследование не выявило достоверных различий в летальности (18,8% в основной группе, 33,3% в контрольной, p<0,05), что, вероятно, связано с малым числом наблюдений. Заключение. Использование НВЛ как компонента респираторной поддержки при ОРДС у больных, перенесших оперативные вмешательства на сердце, позволяет поддержать адекватный газообмен и транспорт кислорода к тканям, способствует сокращению частоты и тяжести осложнений респираторной поддержки, сроков пребывания больных в отделении реанимации. Применение НВЛ не сопровождается увеличением частоты реин-тубации трахеи. Ключевые слова: ОРДС, респираторная поддержка, неинвазивная вентиляция легких.

Objective: to evaluate the efficiency of the combined use of traditional respiratory support and noninvasive ventilation (NV) in the therapy of acute respiratory distress syndrome (ARDS) after cardiosurgical interventions. Subjects and materials. The study included 31 patients. The basis for ARDS therapy was respiratory support that met with the principles of safe artificial ventilation (AV); a natural surfactant was endobronchially administered in all cases. The condition for study continuation and randomization was the achievement of the oxygenation index (PaO2/FiO2) up to 200 during assisted ventilation (AV) in the pressure support (PS) + continuous positive airway pressure (CPAP) mode. After simple randomization, the study group patients (n=16) underwent extubation, followed by transfer for NV. Traditional assisted PS+CPAP ventilation was continued in the control group patients (n=15). Results. In both study and control groups, adequate gas exchange, central hemodynamic, and oxygen delivery values could be maintained at all stages of the study. The duration of traditional AV/AV was significantly higher in the control group (128.9±22.4 versus 67.6±12.5 hours; p<0.01). In the study group, retransfer for AV was required in 3 cases (reintubation rate 18.8%). In the control group, 13 (86.7%) patients were transferred for spontaneous respiration); however, 3 patients were further intubated again (reintubation rate 23.1%). In this group, there were 4 (26.6%) cases of ventilator-associated pneumonia; in the study group, infectious complications were absent. Transfer for NV promoted a reduction in the time of treatment in an intensive care unit (152.3±16.5 versus 185.6±10.1 hours in the control group; p<0.01). The study revealed no significant differences in mortality rates (18.8 and 33.3% in the study and control groups, respectively; p<0.05), which is likely to be associated with a small number of observations. Conclusion. The use of NV as a component of respiratory support in ARDS in patients after cardiac intervention makes it possible to maintain adequate gas exchange and tissue oxygen transport, to reduce the frequency and severity complications due to respiratory support and the length of stay in an intensive care unit. NV does not increase the rate of tracheal intubation. Key words: acute respiratory distress syndrome, respiratory support, noninvasive ventilation.

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The authors declare that there are no conflicts of interest present.