FEATURES OF INTENSIVE TREATMENT IN PATIENTS AFTER TRACHEOSTOMY

E A Kirasirova,E A Kuzina,R F Mamedov,O K Piminidi,N V Lafutkina

doi:10.15360/1813-9779-2015-6-69-78

Abstract

Objective: to enhance the efficiency of medical rehabilitation in patients who have undergone mechanical ventilation (MV) and tracheostomy in an intensive care unit through dynamic clinical, laboratory, endoscopic control and adequate therapy for detected pathology. A total of 120 intensive care unit patients who had undergone tracheostomy in different MV periods were examined. Subjects and methods. A total of 120 patients (76 men and 44 women) aged 15 to 78 years were examined in different MV periods. All the patients were operated on in intensive care units. The surgical techniques of tracheostomy were described; the clinical and endoscopic pattern of the laryngeal and tracheal mucosa in patients on MV was presented. The bacteria isolated from the patients on MV were typed; the cartilages of the anterior tracheal wall were pathomorphologically studied in different MV periods. Results. Microbiological examination indicated the predominance of the mixed microflora: Staphylococcus, Pseudomonas aeruginosa and Proteus. Intraoperative postmortem examination of the cartilages of the anterior tracheal wall was made in 30 patients in different MV periods who were noted to develop pathological changes in the laryngeal and tracheal mucosa and destructive and dystrophic alterations in the tracheal cartilage even if their intubation lasted as long as 3 days. Morphological examination of tracheal cartilages in patients who were on MV for 4 to 7 days revealed progressive destructive and dystrophic processes in peretracheal connective tissue, leukocyte accumulation, and focal bleeding. During intubation for more 7 days, there was partial death of the cartilage, its replacement by granulation tissue, and appearance of regions of sequestration of the dead cartilage. Endoscopic examination showed varying degrees of postintubation laryngeal and tracheal changes in all (n=120) the examinees. Conclusion. The performed treatment permitted decannulation of 111 patients; 16 patients underwent endoscopic intervention into the larynx and trachea; reconstructive operations followed by decannulaton were performed in 4 patients with postintubation laryngeal and tracheal stenosis; 5 patients with severe comorbidity remained to be chronic cannula carriers.

Highlights

В настоящее время в результате автокатастроф, техногенных аварий, военных конфликтов отмечен рост числа больных, нуждающихся в проведении реанимационных мероприятий, включающих интубацию трахеи, искусственную вентиляцию легких и трахеостомию
Microbiological examination indicated the predominance of the mixed microflora: Staphylococcus, Pseudomonas aeruginosa and Proteus
Intraoperative postmortem examination of the cartilages of the anterior tracheal wall was made in 30 patients in different mechanical ventilation (MV) periods who were noted to develop pathological changes in the laryngeal and tracheal mucosa and destructive and dystrophic alterations in the tracheal cartilage even if their intubation lasted as long as 3 days

Summary

Introduction

В настоящее время в результате автокатастроф, техногенных аварий, военных конфликтов отмечен рост числа больных, нуждающихся в проведении реанимационных мероприятий, включающих интубацию трахеи, искусственную вентиляцию легких и трахеостомию. Стало возможным выполнение хирургических операций на сердце, крупных сосудах, головном мозге у исходно тяжелой категории больных, что в послеоперационном периоде часто требует проведения длительной ИВЛ и трахеостомии [1—8]. Установлено, что даже непродолжительная по времени ИВЛ, погрешности в технике трахеостомии оказывают отрицательное воздействие на состояние слизистой оболочки гортани и трахеи, способствуют образованию эрозий и формированию в последующем стеноза различной степени выраженности [9—13]. В литературе малочисленны сведения о клинико-эндоскопической картине состояния слизистой оболочки гортани и трахеи у больных, получающих ИВЛ, трактовке этих данных и их влиянии на развитие постинтубационных повреждений верхних дыхательных путей. Остаются дискутабельными вопросы о сроках проведения трахеостомии при ИВЛ, способе подбора необходимых трахеостомических трубок и тактики ведения больных после трахеостомии [14, 15].

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