Comparative characteristic of impact of noninvasive and invasive pulmonary ventilation on the sepsis course

Abstract

Objective. To compare the impact of noninvasive and invasive pulmonary ventilation on the course of sepsis, caused by severe neurotrauma, complicated by an acute respiratory distress syndrome of light degree.
 Маterials and methods. In a randomized multicenter investigation 60 patients took part (all – the men) with diagnosis: an acute cranio–cerebral trauma, sepsis, an acute respiratory distress–syndrome of light degree. The patients’ average age was (43.8 ± 8.6) yr. Меthod of accidental distribution of patients was used to form two groups with 30 patients in every one. In the first group a regime of coerced invasive pulmonary ventilation with the volume control (Synchronized Intermittent Mandatory Ventilation – SIMV) was applied in the treatment. In the second group a regime of noninvasive pulmonary ventilation (Constant Positive Airway Pressure – СPAP) was applied. There were established the exclusion criteria for the investigation: disorder of cognition, unstable hemodynamics, presence of roentgenological signs of pneumonia. While conduction of ventilation in the SIMV regime a respiratory volume was established and calculated by 4 – 6 ml/kg of the patient’s body mass, the pressure plateau did not exceed 22.5 mm Hg, while end–expiratory positive pressure have constituted 6.0 mm Hg. While conduction of noninvasive pulmonary ventilation there was used the end–expiratory positive pressure 6.0 mm Hg value with supportive pressure up to 11.3 mm Hg, and maximal pressure did not exceeded 22.5 mm Hg.
 Results. Ventilation in the СРАР regime have predicted the positive end–respiratory pressure as opposite towards ventilation in the SIMV regime, and the sepsis course improvement, manifested by leukocytosis reduction in 1.3 times, procalcitonin content in the blood serum – in 2 times, occurrence of the ventilator–аssociated pneumonia – in 5 times and mortality index – in 3 times.
 Conclusion. The data obtained lead to conclusion, that application of noninvasive pulmonary ventilation in septic patients and acute respiratory distress–syndrome of light degree promotes lowering of the occurrence risk for a ventilator–associated pneumonia and mortality index.