rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-5-24-31rmt-2268Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERМеханика дыхания и газообмен при остром респираторном дистресс-синдроме, ассоциированном с COVID-19Respiratory Mechanics and Gas Exchange in Acute Respiratory Distress Syndrome Associated with COVID-19ИбадовР. А.IbadovR. A.

100115, Ташкент, р-н Чиланзар, ул. Кичик халка йули, д. 10; 111800, Ташкентская область, Зангиатинский р-н, поселок Катартал

Ravshan A. Ibadov

10 Kichik Halka Yuli Str., Chilanzar district, 100115 Tashkent; Katartal settlement, Zangiata district, 111800 Tashkent region

СабировД. М.SabirovD. M.

100007, Ташкент, р-н Мирзо Улугбек, ул. Паркентская, д. 51

Djurabay M. Sabirov

51 Parkent str., Mirzo Ulugbek district, 100007 Tashkent

ИбрагимовС. Х.IbragimovS. Kh.

Сардор Хамдамович Ибрагимов

100115, Ташкент, р-н Чиланзар, ул. Кичик халка йули, д. 10

Sardor Kh. Ibragimov

10 Kichik Halka Yuli Str., Chilanzar district, 100115 Tashkent

dr.sardor.ibragimov@gmail.comБурхоновБ. Б.BurkhonovB. B.

100115, Ташкент, р-н Чиланзар, ул. Кичик халка йули, д. 10; 111800, Ташкентская область, Зангиатинский р-н, поселок Катартал

Bakhodir B. Burkhonov

10 Kichik Halka Yuli Str., Chilanzar district, 100115 Tashkent; Katartal settlement, Zangiata district, 111800 Tashkent region

ИбадовР. Р.IbadovR. R.

100115, Ташкент, р-н Чиланзар, ул. Кичик халка йули, д. 10; 111800, Ташкентская область, Зангиатинский р-н, поселок Катартал

Raufbek R. Ibadov

10 Kichik Halka Yuli Str., Chilanzar district, 100115 Tashkent; Katartal settlement, Zangiata district, 111800 Tashkent region

Республиканский специализированный научно-практический медицинский центр хирургии им. акад. В. Вахидова; Республиканская специализированная инфекционная больница Зангиота-1УзбекистанRepublican Specialized Scientific and Practical Medical Center for Surgery named after academician V.Vakhidov; Republican Specialized Infectious Diseases Hospital Zangiota-1UzbekistanЦентр развития профессиональной квалификации медицинских работниковУзбекистанCenter for the development of professional qualification of medical workersUzbekistanРеспубликанский специализированный научно-практический медицинский центр хирургии им. акад. В. ВахидоваУзбекистанRepublican Specialized Scientific and Practical Medical Center for Surgery named after academician V.VakhidovUzbekistanРеспубликанский специализированный научно-практический медицинский центр хирургии им. акад. В. Вахидова; Республиканская специализированная инфекционная больница Зангиота-1УзбекистанRepublican Specialized Scientific and Practical Medical Center for Surgery named after academician V.Vakhidov; Republican Specialized Infectious Diseases Hospital Zangiota-1Uzbekistan2022241020221852431Copyright © Ибадов Р.А., Сабиров Д.М., Ибрагимов С.Х., Бурхонов Б.Б., Ибадов Р.Р., 20222022Ибадов Р.А., Сабиров Д.М., Ибрагимов С.Х., Бурхонов Б.Б., Ибадов Р.Р.Ibadov R.A., Sabirov D.M., Ibragimov S.K., Burkhonov B.B., Ibadov R.R.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/2268Цель

Цель. Cравнить особенности респираторной механики и газообмена у пациентов с острым респираторным дистресс-синдромом (ОРДС), ассоциированным с COVID-19 и не связанным с COVID-19.

Материалы и методы

Материалы и методы. Обследовали 96 пациентов, которых разделили на две группы. В первую (основную) группу включили 48 пациентов с ОРДС, ассоциированным с COVID-19. Во вторую группу (сравнения) — 48 пациентов с ОРДС, не ассоциированным с COVID-19. Подбор пациентов осуществляли по принципу репрезентативности исходных характеристик по следующим критериям: возраст, пол, баллы по SAPS II, тяжесть течения, давление плато (Р-плато), индекс оксигенации (РаО₂/FiО₂) и артериально-альвеолярный градиент по кислороду (А-аО₂). Оценивали механику дыхания и параметры газообмена непосредственно после верификации ОРДС в 1-е, 3-и и 7-е сутки лечения: напряжение кислорода (PaO₂) и углекислого газа (PaCO₂) в артериальной крови, дыхательный объем (ДО), частоту дыхания (ЧД), минутный объем дыхания (МОД), положительное давление конца выдоха (ПДКВ, PEEP) и Рплато.

Результаты

Результаты. У пациентов основной группы были выше: ДО (9,7 против 5,1 мл/кг, p<0,001), ЧД (38 против 30 мин-1, p<0,001), МОД (27,7 против 10,5 л/мин, p<0,001). У пациентов группы сравнения выявили гиперкапнию (PaCO₂ 43 против 38 мм рт. ст., p<0,001), более низкие податливость дыхательной системы (30 против 48 мл/см водн. ст., p<0,001) и коэффициент вентиляции (VR) (1,5 против 2,0, р<0,01). Для пациентов основной группы требовались более низкие значения ПДКВ. Однако, несмотря на более высокую частоту интубации трахеи в группе сравнения (50% против 16,7%) на начальном этапе интенсивной терапии, к 7-му дню доля больных, получавших инвазивную ИВЛ была значимо выше в основной группе (33,3% против 14,6%).

Заключение

Заключение. На начальных стадиях (первые 7 дней) ОРДС, ассоциированный с COVID-19, характеризуется более высокими значениями ДО, ЧД и MОД, податливости легких, чем «типичный» ОРДС, при почти одинаковых значениях PaO₂/FiO₂.

Aim

Aim. To compare respiratory mechanics and gas exchange in patients with acute respiratory distress syndrome (ARDS) with and without COVID-19.

Material and methods

Material and methods. We examined 96 patients, who were divided into two groups. The main group included 48 patients with COVID-19-associated ARDS. The control group included 48 patients with ARDS not associated with COVID-19. Most characteristic patients were selected for the following baseline parameters: age, sex, SAPS II score, disease severity, plateau pressure (Pplateau), oxygenation index (PaO₂/FiO₂), and arterial-alveolar oxygen gradient (A-aO₂). Respiratory mechanics and gas exchange parameters assessed immediately after ARDS diagnosis and on days 1, 3 and 7 of treatment included arterial oxygen (PaO₂) and carbon dioxide (PaCO₂) pressure, tidal volume (Vt), respiratory rate (RR), respiratory minute volume (RMV), positive end expiratory pressure (PEEP), and Pplateau.

Results

Results. Patients in the main group had higher Vt (9.7 vs. 5.1 ml/kg, P<0.001), RR (38 vs. 30 min-1, P<0.001), and RMV (27.7 vs. 10.5 l/min, P<0.001). Control group patients showed hypercapnia (PaCO₂ 43 vs. 38 mmHg, P<0.001), lower respiratory compliance (30 vs. 48 ml/cm H₂O, P<0.001) and ventilation ratio (VR) (1.5 vs. 2.0, P<0.01). Lower PEEP values were required for patients in the main group. However, despite the higher rate of tracheal intubation in the control group (50% vs 16.7%) in the initial period of intensive care, the proportion of patients receiving invasive lung ventilation was significantly higher in the main group (33.3% vs.14.6%) by day 7.

Conclusion

Conclusion. The initial phase (the first 7 days) of ARDS associated with COVID-19 is characterized by higher values of Vt, RR and RMV, as well as lung compliance vs «typical» ARDS with almost identical PaO₂/FiO₂ values.

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