Abstract
Objective: to study the clinical efficiency of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) resulting from direct and in indirect damaging factors. Subjects and methods. During a prospective study, 46 examined patients (30 men, 16 women; their age was 21 to 67 years) with ARDS of different genesis were divided into 2 groups: 1) 22 patients (14 men and 8 women) in whom the causes of ARDS were direct damaging factors: gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia; 2) 24 patients (16 men and 8 women) in whom the causes of ARDS were indirect damaging factors: abdominal sepsis, severe nonthoracic injury, and acute massive blood loss. In Groups 1 and 2, the efficiency of the escalation and de-escalation procedures for PEEP optimization was compared during controlled MV with a managed object. Results. In the patients with ARDS caused by direct damaging factors, the escalation procedure for PEEP optimization was more effective than the de-escalation one. In those with ARDS caused by indirect damaging factors, the de-escalation procedure for PEEP optimization was more effective than the escalation one. Conclusion. It is expedient to use a differential approach to choosing an escalation or de-escalation procedure for PEEP optimization in patients with ARDS induced by direct and indirect damaging factors. Key words: acute respiratory distress syndrome; direct and indirect damaging factors; mechanical ventilation; positive end-expiratory pressure; escalation procedure for PEEP optimization; de-escalation procedure for PEEP optimization; lung opening maneuver.
Highlights
Цель исследования — изучение клинической эффективности эскалационного и деэскалационного способов оптимиза ции положительного давления в конце выдоха в условиях искусственной вентиляции легких у больных с острым рес пираторным дистресс синдромом, развившимся вследствие воздействия прямых и непрямых повреждающих факто ров
46 examined patients (30 men, 16 women; their age was 21 to 67 years) with ARDS of different genesis were divided into 2 groups: 1) 22 patients (14 men and 8 women) in whom the causes of ARDS were direct damaging factors: gastric con tent aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia; 2) 24 patients (16 men and 8 women) in whom the causes of ARDS were indirect damaging factors: abdominal sepsis, severe nonthoracic injury, and acute massive blood loss
In the patients with ARDS caused by direct damaging factors, the escalation procedure for PEEP optimization was more effective than the de escalation one
Summary
ВЫБОР СПОСОБА ОПТИМИЗАЦИИ ПДКВ У БОЛЬНЫХ С ОСТРЫМ РЕСПИРАТОРНЫМ ДИСТРЕСС СИНДРОМОМ. А. У больных с ОРДС, развившимся вследствие воздействия прямых повреждающих факторов, более эффективным является эскалационный способ оптимизации ПДКВ, по сравнению с деэскалационным. У больных с ОРДС, развившимся вследствие воздействия непрямых повреждающих факторов, бо лее эффективным является деэскалационный способ оптимизации ПДКВ, по сравнению с эскалационным. Objective: to study the clinical efficiency of escalation and de escalation procedures for optimizing positive end expi ratory pressure (PEEP) during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) resulting from direct and in indirect damaging factors. It is expedient to use a differential approach to choos ing an escalation or de escalation procedure for PEEP optimization in patients with ARDS induced by direct and indirect damaging factors. Цель исследования — cравнение клинической эф фективности эскалационного и деэскалационного спо собов оптимизации ПДКВ в условиях ИВЛ у больных с ОРДС, развившимся вследствие воздействия прямых и непрямых повреждающих факторов
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