INFLUENCE OF RESPIRATORY SYSTEM PROTECTION ON THE TREATMENT OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

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Introduction. Craniocerebral trauma (CCT) results in disorders of pharyngeal reflex, deglutition, breathing rhythm and frequency. All the mentioned conditions cause the development of respiratory complications. Whereas they become independent factors of negative therapeutic consequences in such category of patients.
 Aim of a paper. The research aims at evaluating protection/treatment possibilities of the respiratory system concerning the course of craniocerebral trauma in injured patients.
 Materials and methods. We examined 237 patients with CCT who underwent urgent surgical interventions in the form of a decompressive cranial trepanation and the removal of both subdural and epidural hematomata. All patients required prolonged mechanical ventilation of the lungs. The patients were retrospectively divided into two groups, namely: the first group (132 patients) – the patients with tracheostomy on the 5th-6th days of admission to the clinics of anesthesiology and intensive care; the second group (105 patients) – the patients with tracheostomy on the 1st-2nd days of hospitalization. Patients of both groups were not differentiated by gender, the severity of CCT and general condition. In addition to general clinical and biochemical blood markers, culturing of the secretion in the tracheostomy tube (at the moment of tracheostomy and further every 3-4 days), blood and urine were performed in all patients. Simultaneously we controlled the leucocyte count in the peripheral blood, number of immature forms, levels of CRP and procalcitonin. The evaluation of a neurological status of patients was carried out by the Glasgow and Richmond Agitation-Sedation Scale (RASS). The severity of CCT was visualized with the help of CT.
 Research results. Even at the moment of tracheostomy the frequency of colonization of tracheobronchial tree was significantly higher in the first group of patients compared to the second one. Such tendency was monitored in further stages as well. The phenomena of tracheobronchitis and pneumonia were detected more frequently in the group of patients with tracheostomy on the 5th-6th days of postoperative period in contrast to the patients with tracheostomy on the 1st-2nd days of postoperative period. Microorganisms of Enterobacteriaceae with the extended spectrum of ß-lactamase and non-fermenting Gram-negative bacteria were detected more frequently in the first group.
 Conclusion. Early tracheostomy in patients with CCT results in both the decrease in the frequency of positive culturing of secretions from the tracheobronchial tree and the reduction in a detection frequency of nosocomial pneumonia.