Respiratory Therapy for Acute Respiratory Distress Syndrome in Cardiosurgical Patients
https://doi.org/10.15360/1813-9779-2005-5-65-68
Abstract
The purpose of the present investigation was to improve the outcomes of intensive care in patients with acute respiratory distress syndrome after cardiac surgery under extracorporeal circulation.
Materials and methods. Respiratory therapy was analyzed in 43 patients with acute respiratory distress syndrome after surgery under extracorporeal circulation. According to the procedure of artificial ventilation (AV), the patients were divided into 2 groups: 1) those who had undergone routine tracheal intubation (n=23) AND 2) THOSE who had received noninvasive intubation through a nasal mask (n=20). The respiratory parameters, blood gas composition, central hemodynamic parameters, respiratory support time, and the pattern of complications were analyzed.
Results. Noninvasive artificial ventilation permits one to make the patients active in earlier periods and take a spontaneous breath, recovers the respiratory index earlier, reduces the level of positive end-expiratory pressure, the frequency of infectious complications of the tracheobronchial tree, and length of stay in an intensive care unit as compared with endotracheal AV.
Conclusion. The findings suggest that noninvasive AV is highly effective and yields better results of treatment in patients with acute respiratory distress syndrome.
About the Authors
T. V. Zagorodnyaya
The 3rd Central Military Clinical Hospital named after A. A. Vishnevsky, Krasnogorsk, Moscow Region
A. N. Korniyenko
The 3rd Central Military Clinical Hospital named after A. A. Vishnevsky, Krasnogorsk, Moscow Region
M. V. Ketskalo
The 3rd Central Military Clinical Hospital named after A. A. Vishnevsky, Krasnogorsk, Moscow Region
References
1. Hammon J. W. Jr., Edmunds L. H. Jr. Extracorporeal Circulation: Organ Damage. In: Cohn L. H., Edmunds L. H. Jr, (eds). Cardiac Surgery in the Adult. New York: McGraw Hill; 2003. 361—388.
2. Allardyce D., Yoshida S., Ashmore P. The importance of microembolism in the pathogenesis of organ dysfunction caused by prolonged use of the pump oxygenator. J. Thorac. Cardiovasc. Surg. 1966; 52: 706.
3. Tonz M., Mihaljevic T., von Segesser L. K. et al. Acute lung injury during cardiopulmonary bypas: are the neutrophils responsible? Chest 1995; 108: 1551.
4. Chenoweth D. E., Cooper S. W., Hugli T. E. et al. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. N. Engl. J. Med. 1981; 304: 497.
5. Royston D., Fleming J. S., Desai J. B. et al. Increased production of peroxidation products associated with cardiac operations. J. Thorac. Cardiovasc. Surg. 1986; 91: 759.
6. Craddock P. R., Fehr J., Brigham K. L. et al. Complement and leukocytemediated pulmonary dysfunction in hemodialysis. N. Engl. J. Med. 1977; 296: 769.
7. Hammerschmidt D. E., Stroncek D. F., Bowers T. K. et al. Complement activation and neutropenia during cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 1981; 81: 370.
8. McGowan F. X., del Nido P. J., Kurland G. et al. Cardiopulmonary bypass significantly impairs surfactant activity in children. J. Thorac. Cardiovasc. Surg. 1993; 106: 968.
9. Maggart M., Stewart S. The mechanisms and management of non-cardiogenic pulmonary edema following cardiopulmonary bypass. Ann. Thorac. Surg. 1987; 43: 231.
10. Lloyd J., Newman J., Brigham K. Permeability pulmonary edema: diagnosis and management. Arch. Intern. Med. 1984; 144: 143.
11. Oster J. B., Sladen R. N., Berkowitz D. E. Cardiopulmonary bypass and the lung, in Gravlee GP, Davis RF, Kurusz M, Utley JR (eds): Cardiopulmonary Bypass: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins; 2000. 367.
12. Magnusson L., Zemgulis V., Tenling A. et al. Use of a vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass: an experimental study. Anesthesiology 1998; 88: 134.
13. Власенко А. В., Закс И. О., Мороз В. В. Прошлое и будущее определения понятий острого повреждения легких и респираторного дистресс-синдрома и их лечения (обзор зарубежной литературы. Реаниматология и интенсивная терапия. Анестезиология 2000; 3: 2—13.
14. Sirivella A., Gielchinsky I., Parsonnet V. Management of catheterinduced pulmonary artery perforation: a rare complication in cardiovascular operations. Ann. Thorac. Surg. 2001; 72: 2056.
15. Boldt J., Bormann B. V., Scheild H. H. et al. The influence of extracorporeal circulation on extravascular lung water in coronary surgery patients. J. Thorac. Cardiovasc. Surg. 1986; 34: 110—115.
16. Katz M., Mack M., Kugelmas A. et al. Clinical outcomes among patients with left main disease undergoing coronary artery bypass graft surgery in community hospitals. Emory University, Atlanta, GA, Cardiac Data Solutions, Inc., Atlanta, GA; 2003. Abstract 147.
17. Mishra Y., Wasir H., Kohli V. et al. Beating heart versus conventional reoperative coronary artery bypass surgery. Indian Heart J. 2002; 54: 159—163.
18. Brown P., Mack М., Katz М. et al. Predictors of adult respiratory distress syndrome in coronary artery bypass graft surger; Emory University, Atlanta, GA, HCA, Inc., Nashville, TN, Cardiac Data Solutions , Inc., Atlanta, GA; 2003. Abstract 67.
19. Еременко А. А., Левиков Д. И., Егоров В. М. и др. Применение неинвазивной масочной вспомогательной вентиляции легких при остром респираторном дистресс-синдроме у кардиохирургических больных. Анестезиология и реаниматология 2004; 5: 14—17.
Review
For citations:
Zagorodnyaya T.V., Korniyenko A.N., Ketskalo M.V. Respiratory Therapy for Acute Respiratory Distress Syndrome in Cardiosurgical Patients. General Reanimatology. 2005;1(5):65-68. (In Russ.) https://doi.org/10.15360/1813-9779-2005-5-65-68
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