Continuous Flow Ventilatory Support (Clinical Experience)

Abstract

Background. The world literature contains no reports on the clinical application of continuous flow ventilatory support by an insufflation catheter. Despite the use of different forms of ventilatory support, disconnection of patients from artificial ventilation is unsuccessful in 10—30% of cases despite the fact that the clinical and biochemical criteria are met. Objective: to discuss the efficiency of the new ventilation regime — continuous flow ventilatory support in the clinical setting. Methods: continuous flow ventilatory support with an original licensed multi-jet insufflation catheter or a terminal one-orifice catheter nasally inserted into the trachea was applied to 70 patients. It was used in a subgroup of 64 patients with chronic obstructive lung disease (COLD) due to the occurrence of global respiratory insufficiency caused by infectious complications and in a group of 6 patients as a ventilatory regime for their disconnection from long-term artificial ventilation, whose disconnection other ventilatory regimens being used were unsuccessful. Results. None patient with COLD should be intubated, and just 30 minutes after the initiation of ventilatory support with a multi-jet catheter, there were decreases in the mean respiration rate from 33±2.8 to 27±2.5 cycles/min and in paCo 2 from 11.9±1.7 to 10.8±1.6 kPa and an increase in paCo 2 from 5.7±1.1 to 6.8±1.3 kPa at FiO 2 =0.3. Within 24 hours after the initiation of ventilatory support, blood gas levels changed in response to the values typical of partial respiratory insufficiency. The spontaneous ventilation rate decreased to 20±2.2, paCO 2 reduced to 6.4±1.2 kPa and pO 2 continuously increased up to the value 8.9±1.4 kPa (FiO 2 =0.3) at hour 24 of ventilatory support. Ventilatory support lasted an average of 5 days. Statistical comparison of the study parameters showed a significant improvement (p<0.05) just 6 hours after ventilatory support and a marked improvement of the parameters (p<0.01) following 72 hours. In the other group of patients, continuous flow ventilatory support was used due to failing disconnection of the patients from long-term artificial ventilation. After extubation and 30 minutes after the initiation of continuous flow ventilatory support, the ventilation rated decreased to 27±2.5 cycles/min, there was a continuous reduction in paCO 2 to 3.9±0.9 kPa as a manifestation of hyperventilation that had been likely to be induced by a continuous decrease of paCO 2 to 8.8±1.4 kPa. Only 60 minutes after the initiation of ventilatory support, with the equal ventilation rate, the values of blood gases (paO 2 =9.9±1.5 kPa, paCO 2 =5.2±1.1 kPa) increased, as did VT (0.38±0.30), which permitted one to proceed with continuous flow ventilatory support that could be interrupted following 48 hours. Conclusion. The findings lead to the conclusion that continuous flow ventilatory support is an effective ventilation regimen that is applicable to patients with chronic obstructive lung disease in global respiratory insufficiency and makes it possible to overcome the period of, for example, infectious complications without intubation and artificial ventilation. It may also be used as a non-invasive ventilation regime in the disconnection of patients from long-term artificial ventilation. Its application in acute respiratory failure (acute respiratory failure, acute respiratory distress syndrome) requires further prospective studies.