Effectiveness of Alveolar Opening in Patients with Acute Lung Injury and Concomitant Pneumothorax
https://doi.org/10.15360/1813-9779-2009-2-17
Abstract
Objective: to study the efficiency of a lung opening maneuver in patients with acute lung injury (ALI) and concomitant pneumothorax, who were on biphasic positive airway pressure ventilation (BIPAP) and synchronized intermittent mandatory ventilation. Subject and methods. Seventy-three patients with acute lung injury and concomitant pneumoth-orax resulting from blunt chest trauma were examined. Their condition was an APACHE II of 18—24 scores. After elimination of pneumothorax, an open lung maneuver was made using different modes of lung support 3—5 times daily. Results. The study has shown that BIPAP used in patients with ALI and concomitant pneumothorax reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be applied earlier. The employment of the latter in patients with ALI and pneumothorax permits a prompter recovery of lung function during different types of respiratory support, which is attended by reductions in the number of complications, artificial ventilation, and mortality. When the lung opening maneuver is combined with BIPAP, its efficiency considerably increases. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.
References
1. Кассиль В. Л., Золотокрылина Е. С.
2. Haas C. F.Lung protective mechanical ventilation in acute respiratory distress syndrome. Respir. Care Clin. N. Am. 2003; 9 (3): 363—396.
3. Gammon R. B, Shin M. S., Groves R. H.Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am. J. Respir. Crit. Care Med. 1995; 152(4 Pt 1): 1235—1240.
4. Kacharek R. M., Schwartz D. R.Lung recruitment. Respir. Care Clin. N. Am. 2000; 6 (4): 597—623.
5. Мороз В. В., Голубев А. М., Чурляев Ю. А. и соавт.Транспульмональ-ная термодилюция в диагностике ранних проявлений острого повреждения легких. Методические рекомендации ГУ НИИ ОР РАМН для врачей. М.: Изд-во РАМН; 2008.
6. Lachman B.Open lung in ARDS. Minerva Anestesiol. 2002; 68 (9): 637—642.
7. 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 (10): 601—610.
8. Lachman B.Open up the lung and keep the lung open. Intensive Care Med. 1992; 18: 319—321.
9. Blanch I., Fernandez R, Benito S. 6tаі.Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient. Chest 1987; 92: 451—454.
10. Bellone A., Barbieri A., Ricci C.Acute effects of non-invasive ventilato-ry support on functional mitral regurgitation in patients with exacerbation of congestive heart failure. Care Med. 2002; 28 (9): 1348—1350.
11. Calzia E., Lindner K.H., Witt S. et al.Pressure-time product and work of breathing during biphasic continous positive airway pressure and
12. assisted spontaneous breathing. Am. Respir. Crit. Care Med. 1994; 150 (4): 904—910.
13. Beydon L., Uttman L., Rawal R., Jonson B.Effects of positive end-expiratory pressure on dead space and its partitions in acute lung injury. Intensive Care Med. 2002; 28 (9): 1239—1245.
14. Foti G., Cereda M., Banfi G. et al.Simple estimate of patient inspiratory effort at different levels of pressure support. Abstr. Am. Rev. Respir. Dis. 1993; 147: A876.
15. Naureckas E. T., Dawson C. A., Gerber B. S. et al.Airway reopening pressure in isolated rat lungs. J. Appl. Physiol. 1994; 76 (3): 1372—1377.
16. 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. Anaesth. 1997; 14 (6): 576—582.
17. Froese A. B., Bryan A. C.Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 1974; 41 (3): 242—255.
18. Putensen C., Rasanen J., Lopez F. A.Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injuri. Am. J. Respir. Crit. Care Med. 1994; 150(1): 101—108.
19. HormanС., Baum M., Putensen C. 6t al.Bifasic positive airway pressure (BIPAP) — a neu mode of ventilatori support. Eur. J. Anasth. 1994; 11 (1): 37—42.
20. Stock M.C., Perel A.Mechanikal ventilatory support. Baltimore: Williams and Wilkins; 1994. 277—286.
Review
For citations:
Marchenkov Yu.V., Izmailov V.V., Kozlova Ye.M., Bogomolov P.V. Effectiveness of Alveolar Opening in Patients with Acute Lung Injury and Concomitant Pneumothorax . General Reanimatology. 2009;5(2):17. (In Russ.) https://doi.org/10.15360/1813-9779-2009-2-17
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