Abstract
BACKGROUND: Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units.
 AIMS: The analysis of the predictors of the success of disconnection from mechanical ventilation on the basis of clinical and diagnostic criteria in patients with brain damage of various etiologies.
 METHODS: The study included 53 patients (husband ― 28, women ― 25; cf. age 53.69 2.34) who are in 2019 with the consequences of traumatic brain injury (TBI) (n = 18; 33.9%); consequences of acute cerebrovascular accident (n = 24; 45.3%); the effects of anoxic brain damage (n = 3; 5.7%); consequences of subarachnoid hemorrhage (n = 8; 15.1%).
 RESULTS: The statistically significant predictor of recovery of spontaneous breathing in the 1st and 2nd groups of patients were preserved chemoreflex sensitivity (IPCS), the sensitivity and specificity of IPCS was 78.57% [95 % DI 49.295.26] and 83.3 % [95 % CI 62.695.26]. The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] [Vt(e) / Vt(i)] [VE(e) / VE(i)] [Vt(e) VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO2 in the range of 9080 %.
 CONCLUSIONS: The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator.
Highlights
Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units
The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] × [Vt(e) / Vt(i)] × [VE(e) / VE(i)] × [Vt(e) × VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO2 in the range of 90−80 %
The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator
Summary
Федеральный научный клинический центр реаниматологии и реабилитологии, Москва, Российская Федерация. Восстановление самостоятельного дыхания является важнейшей задачей интенсивной терапии и реабилитации пациентов с зависимостью от искусственной вентиляции легких (ИВЛ) при черепно-мозговой травме, нарушении мозгового кровообращения, аноксии головного мозга. Цель исследования ― провести сравнительный анализ эффективности прогноза восстановления самостоятельного дыхания на основе клинико-диагностических критериев у пациентов с повреждением головного мозга различной этиологии. Изучено прогностическое значение важнейших паттернов, от которых зависят успех или неудача восстановления самостоятельного дыхания у пациентов с повреждением головного мозга различной этиологии, а именно: физиологических показателей функции легких, данных томографического импеданса легких, показателей хеморефлекторной чувствительности, клинических данных уровня сознания, тяжести состояния пациентов, коморбидности. Восстановление самостоятельного дыхания является важнейшей задачей интенсивной терапии и реабилитации пациентов с зависимостью от искусственной вентиляции легких (ИВЛ) после окончания острого и острейшего периодов черепно-мозговой травмы, нарушения мозгового кровообращения, аноксии головного мозга. Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation
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