rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2005-5-61-64rmt-1224Research ArticleОСТРАЯ ДЫХАТЕЛЬНАЯ НЕДОСТАТОЧНОСТЬACUTE RESPIRATORY FAILUREРеспираторная терапия при остром повреждении лёгких с использованием вентиляции двумя фазами положительного давленияRespiratory Therapy for Acute Lung Lesion, by Using Biphasic Positive Pressure VentilationМарченковЮ. В.MarchenkovYu. V.МорозоваО. А.MorozovaO. A.ГУ НИИ общей реаниматологии РАМН, МоскваResearch Institute of General Reanimatology, Russian Academy of Medical Sciences, Moscow20052010200515Том I № 5 2005 г.6164Copyright © Марченков Ю.В., Морозова О.А., 20052005Марченков Ю.В., Морозова О.А.Marchenkov Y.V., Morozova O.A.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/1224Цель

Цель. Провести сравнительное исследование эффективности респираторной поддержки у больных с острым повреждением легких с использованием BIPAP, SIMV и aIPPV.

Материал

Материал. Обследовано 26 больных с острым повреждением легких, в структуру которых входили ОРДС (n=16), пневмонии (и=6) и пневмониты (n=4). Тяжесть состояния по шкале APACНЕ II составила от 18 до 24 баллов.

Результаты

Результаты. Использование BIPAP приводит к лучшей адаптации больного к респираторной поддержке, ограничению применения миорелаксантов и седативных средств, улучшению газообмена в легких и уменьшает отрицательное воздействие ИВЛ на гемодинамику. По сравнению с другими видами вспомогательной вентиляции легких BIPAP ускоряет переход от тотальной респираторной поддержки к самостоятельному дыханию.

Objective

Objective. To comparatively study the efficiency of respiratory support in patients with acute lung lesion, by applying BIPAP, SIMV, and aIPPV.

Subjects

Subjects. Twenty-six patients with acute lung lesion whose pattern included acute respiratory distress syndrome (n=16), pneumonia (и=6), and pneumonitis (n=4) were examined. The severity of disease was 18 to 21 APACHE II scale score.

Results

Results. The use of BIPAP leads to a better adaptation of a patient to respiratory support, to a reduction in the number of used myorelaxants and sedatives, and to improvement of gas exchange in the lung and diminishes the negative impact of artificial ventilation on hemodynamics. As compared with other types of assisted ventilation, BIPAP accelerates transfer from total respiratory support to spontaneous breathing.

ReferencesЗильбер А. П. Этюды критической медицины. Респираторная медицина. Петрозаводск; 1996.Зильбер А. П. Этюды критической медицины. Респираторная медицина. Петрозаводск; 1996.Кассиль В. Л., Лескин Г. С., Выжигина М. А. Респираторная поддержка. М.; 1997.Кассиль В. Л., Лескин Г. С., Выжигина М. А. Респираторная поддержка. М.; 1997.Bellone A., Barbieri A., Ricci C. Acute effects of non invasive ventilatory support on functional mitral regurgitation in patients with exacerbation of congestive heart failure. Care Med. 2002; 28 (9): 1348—1350.Bellone A., Barbieri A., Ricci C. Acute effects of non invasive ventilatory support on functional mitral regurgitation in patients with exacerbation of congestive heart failure. Care Med. 2002; 28 (9): 1348—1350.Blanch I., Fernandez R., Benito S. еt. аl. Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient. Chest 1987; 92: 451—454.Blanch I., Fernandez R., Benito S. еt. аl. Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient. Chest 1987; 92: 451—454.Calzia E., Lindren K. H., Witt S. et al. Pressure-time product and work of breathing during biphasic continous positive airway pressure and assisted spontaneous breathing. Amer. Respir. Critical Care Med. 1994; 150: 904—910.Calzia E., Lindren K. H., Witt S. et al. Pressure-time product and work of breathing during biphasic continous positive airway pressure and assisted spontaneous breathing. Amer. Respir. Critical Care Med. 1994; 150: 904—910.Dreyfuss D., Saumon G. Role of tidal volume, FRS, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Amer. Rev. Respir. Dis. 1993; 148: 1194—1203.Dreyfuss D., Saumon G. Role of tidal volume, FRS, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Amer. Rev. Respir. Dis. 1993; 148: 1194—1203.Foti G., Cereda M., Banfi G., et al. Simple estimate of patient inspiratory effort at different levels of pressure support. Abstr. Amer. Rev. Respir. Dis. 1993; 147: A876.Foti G., Cereda M., Banfi G., et al. Simple estimate of patient inspiratory effort at different levels of pressure support. Abstr. Amer. Rev. Respir. Dis. 1993; 147: A876.Froese A. B., Bryan A. C. Effect of spontaneous breathing with BIPAP on pulmonary gas exchange in patients with ARDS. Anesthesiology 1994; 41: 242—255.Froese A. B., Bryan A. C. Effect of spontaneous breathing with BIPAP on pulmonary gas exchange in patients with ARDS. Anesthesiology 1994; 41: 242—255.Gammon R. B., Shin M. S., Buchalter S. E. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 1992; 102 (2): 568—572.Gammon R. B., Shin M. S., Buchalter S. E. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 1992; 102 (2): 568—572.Gammon R. B., Shin M. S., Groves R. H. Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Amer. J. Respir. Crit. Care Med. 1995; 152: 1235—1240.Gammon R. B., Shin M. S., Groves R. H. Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Amer. J. Respir. Crit. Care Med. 1995; 152: 1235—1240.Horman Сh., Baum M., Putensen Ch. еt. al. Biphasic positive airway pressure (BIPAP) — a new mode of ventilatory support. Eur. J. Anasthesiol. 1994; 11 (1): 37—42.Horman Сh., Baum M., Putensen Ch. еt. al. Biphasic positive airway pressure (BIPAP) — a new mode of ventilatory support. Eur. J. Anasthesiol. 1994; 11 (1): 37—42.Kazmaier S., Rathgeber J., Buhre W. Comparison of ventilatory and haemodynamic effects of BIPAP and S-IMV/PSV for postoperative short-term ventilation in patients after coronary artery bypass grafting. Eur. J. Anaesthesiol. 2000; 17: 601—610.Kazmaier S., Rathgeber J., Buhre W. Comparison of ventilatory and haemodynamic effects of BIPAP and S-IMV/PSV for postoperative short-term ventilation in patients after coronary artery bypass grafting. Eur. J. Anaesthesiol. 2000; 17: 601—610.Lotti G. A., Brunner J. X., Breshi A. et al. Closed-loop control of airway occlusion pressure at 0.1 second (P 0,1) applied to pressure support ventilation: Algorithm and application in intubated patients. Crit. Care Med. 1996; 24:771—779.Lotti G. A., Brunner J. X., Breshi A. et al. Closed-loop control of airway occlusion pressure at 0.1 second (P 0,1) applied to pressure support ventilation: Algorithm and application in intubated patients. Crit. Care Med. 1996; 24:771—779.Putensen C., RasanenJ., Lopez F. A. Interfacing between spontaneous breathing and mechanical ventilation affects ventilation-perfusion distributions in experimental bronchoconstriction. Crit. Care Med. 1995; 151: 993—999.Putensen C., RasanenJ., Lopez F. A. Interfacing between spontaneous breathing and mechanical ventilation affects ventilation-perfusion distributions in experimental bronchoconstriction. Crit. Care Med. 1995; 151: 993—999.Putensen C., Rasanen J., Lopez F. A. Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Amer. J. Respir. Critical Care Med. 1994; 150: 101—108Putensen C., Rasanen J., Lopez F. A. Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Amer. J. Respir. Critical Care Med. 1994; 150: 101—108Rathgeber J., Schorn B., Falk V. et al. The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives. A prospective analysis in 596 patients following adult cardiac surgery. Eur. J. Anaesthesiol. 1997; 14 (6): 576—582.Rathgeber J., Schorn B., Falk V. et al. The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives. A prospective analysis in 596 patients following adult cardiac surgery. Eur. J. Anaesthesiol. 1997; 14 (6): 576—582.Staudinger T., Kordova H., Roggla M. et al. Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation. Crit. Care Med. 1998; 26: 1518—1522.Staudinger T., Kordova H., Roggla M. et al. Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation. Crit. Care Med. 1998; 26: 1518—1522.Sacchetti A. D., Russel H. H. Acute cardiogenic pulmonare edema: what's the largest in emergency treatment? Postgraduate Med. 1998; 2: 145—166.Sacchetti A. D., Russel H. H. Acute cardiogenic pulmonare edema: what's the largest in emergency treatment? Postgraduate Med. 1998; 2: 145—166.Stock M. C., Perel A. Mechanical ventilatory support. Baltimore: Williams and Wilkins; 1994. 277—286.Stock M. C., Perel A. Mechanical ventilatory support. Baltimore: Williams and Wilkins; 1994. 277—286.Viale J. P., Duperret S., Mahul P. et al. Time course evolution of ventilatory responses to inspiratory unloading in patients. Am. J. Respir. Crit. Care Med. 1998; 157: 428—434.Viale J. P., Duperret S., Mahul P. et al. Time course evolution of ventilatory responses to inspiratory unloading in patients. Am. J. Respir. Crit. Care Med. 1998; 157: 428—434.

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