Method for transferring patients from artificial lung ventilation to self-standing breathing

FIELD: medicine.

SUBSTANCE: method involves applying dosed load to cardiac respiration system due to compressed gas working pressure being reduced by 0.4 kg/m2 keeping it constant during 5-20 min. Then, the working pressure is reduced depending on patient state starting with a rate of 0.02-0.08 kg/m2/min. Gas exchange and hemodynamic parameters being in norm, the selected rate is increased. The parameters deviating from a norm, the selected rate is adjusted by increasing working pressure to reach their normal values. Optimum gas flow rate is determined and the working pressure is reduced at this rate, continuing to adjust its value under unchanged gas exchange and hemodynamic parameter values or their deviation from norm.

EFFECT: accelerated treatment course.

2 cl

 

The invention relates to medicine and can be used in resuscitation and intensive care patients with acute respiratory failure in the process of termination of long-term artificial lung ventilation (ALV).

There is a method of transferring patients with artificial lung ventilation on spontaneous breathing by reducing the operating pressure of the compressed gas with constant control parameters of gas exchange and hemodynamics (RF patent No. 1572511, class. And 61 In 5/08, 1993). This method is carried out using high-frequency jet ventilation (VCELL), the decline of respiratory support is carried out by stepwise reduction of the operating pressure of the compressed gas (Rslave.with the stay of the patient at each intermediate stage within a certain time (texp).

The disadvantage of this method is that the selected Rslave.and texp.at every level are empirically established, averages, which may not correspond to the specific needs of the patient, which will lead to the development of severe decompensation cardiorespiratory system and return to the previous stage or illegal will increase the period of stay of the patient at the hardware breath.

In accordance with this task, aimed at improving the efficiency of power is a patient with an artificial self breath by eliminating the development of decompensation from cardiorespiratory system and reducing the time of termination of prolonged mechanical ventilation due to the approaching speed reduction Pslaveit is optimal for each particular patient.

This task is achieved in that in the method of transfer of patients from mechanical ventilation to spontaneous breathing by reducing the operating pressure of the compressed gas with constant control parameters of gas exchange and hemodynamics, pre-dosed exercise stress on the cardiorespiratory system and reduce operating pressure of compressed gas is 0.4 kg/m2and incubated for 5-20 min, then depending on the condition of the patient begin reducing the working pressure with a rate of 0.02 to 0.08 kg/m2/min, and in the presence of normal parameters of gas exchange and hemodynamics in the process of transition to spontaneous breathing, the selected speed is gradually increased, and when the deviation parameters of gas exchange and hemodynamics from the norm are selected adjustment speed, which increase the operating pressure to the normalization of parameters of gas exchange and hemodynamics, determine the optimal speed and carry out the reduction of the operating pressure with this speed, constantly adjusting its value at constant parameters of gas exchange and hemodynamics or their deviation from the norm.

In this case, the optimal speed adjustment is carried out by its increase at constant parameters of gas exchange and hemo is inimici or decrease in the deviation of parameters of gas exchange and hemodynamics from the norm.

Implementation of the proposed method in 10 patients confirmed that the termination of long-term mechanical ventilation is carried out in the absence of decompensation from cardiorespiratory system and the necessity of returning to controlled mechanical ventilation with a decrease in the duration of this process compared to option stepdown Pslave.with fixed values of the step reduction Pslave.and the exposure time at each intermediate stage.

Implementation of the proposed method is illustrated with specific examples.

Example 1

Patient R., and b/W No. 238, entered the RO MONICA with a diagnosis of Severe concomitant injury. Closed traumatic brain injury is a concussion. Fracture of the left shoulder. Bruised belly. Multiple organ failure. Bilateral pneumonia. The state of admission was extremely heavy, the mind confused. Skin moist, cyanosis of the lips. In connection with respiratory distress transferred on a ventilator. In the lungs breathing weakened in the lower divisions, to listen to a large number of moist rales. The radiological examination confirmed the presence of bilateral pneumonia. Hemodynamic parameters with a tendency to hypotension HELL 90/50 mm RT. Art.; HR 100-120 1 min Severity of the condition was further aggravated by paresis of the intestine. On the 5th day was imposed tracheostomy with C is poured improve the sanitation of the LDP.

In the future, against the background of the events were observed improvement in General condition, presence of positive dynamics of the flow of pneumonia, which allowed 10 days to start translating the SD.

In the beginning VCELL parameters of gas exchange and hemodynamics were: Pslaveto 2.1 kgf/cm2f 120; TI/te1:2, while RAO2was 110 mm RT. Art.; Paco2- 32 mm RT. Art.; SaO2- 99%; AD - 124/75 mm RT. Art.; HR - 84 in 1 minute After 5 minutes after the decrease of Pslave.0.4 kgf/cm2HELL remained at the same numbers, heart rate increased slightly to 88 per minute, BH - 5-6 per minute, SaO2- 90%. In accordance with the relatively stable condition of the patient initiated the process of translation on CD by reducing the Pslave.with velocity Vselect=0,02 kg/cm2/min. While physiological measures of cardio-respiratory status remained almost stable. Against this background, the speed reduction Pslave.changed to a faster V1=0,07 kg/cm2/minutes At this speed on the 8th minute was observed a tendency to increase the blood pressure to 128/92 mm RT. Art., a fast heart rate up to 90 per minute, BH up to 20 per minute, while SaO2declined to 93-94%, i.e. has been growing signs of decompensation systems of breathing and circulation.

Further tactic was to adjust V1. Dlaczego P slave.increased by 0.2 kgf/cm2and reduced V1to V2. This V2. amounted to 0.04 kgf/cm2. This rate continued to decrease Pslaveand against the background of steady state cardio-respiratory system increased the speed to V3to 0.45 kgf/cm2/min, then after the appearance of the first signs of decompensation systems of breathing and circulation V4was 0,035 kg/cm2/min, while maintaining that when stable parameters of gas exchange and hemodynamics continued and completed the process of termination of long-term mechanical ventilation.

Estimated time of termination IVL constant initial speed would be around 105 minutes, the actual time of transition from mechanical ventilation to independent breathing - 60 min, i.e. about 40% less,

Example 2

Patient R., 38 years old, and a/b No. 17916 operated on for reconstructive surgery on the biliary tract result in iatrogenic damage to the choledochus.

In the postoperative period was on prolonged mechanical ventilation respirator RO-9 within 5 days with the following parameters: UP to 0,700 l/min; inspiratory/expiratory 1:2; Fi270%, which resulted in stabilization of gas exchange and hemodynamic parameters: RW290 mm Hg, PaCO232 mm RT. Art., pH 7,39, BE 1.5 mEq/l, SaO294%, HELL 128/75 mm RT. art, heart rate 80 / min; ISO 4,72 l/min; CSS 61,35 ml UD-1. Started the translation of the DM with what omashu VCELL with parameters: R slave.1.7 kgf/cm2, f 120, Tl/Te 1:2. When this pre-created metered load on the cardiorespiratory system by reducing the operating pressure of the compressed gas is 0.4 kg/m2. Exposure was carried out for 15 minutes While the patient was observed moderate response rate of 84 per minute, HELL has not changed with the occurrence of a single respiratory attempts, SaO296%. Starting to decrease Pslave.with a speed of 0.05 kgf/cm2/min. In the process of transferring the patient to the Board of Directors, there was a gradual increase in BH, HR, AD, a tendency to decrease SaO2there were growing signs of respiratory insufficiency and 24 minutes from the beginning of the cessation of mechanical ventilation were noted: increased heart rate to 97 per minute, raising HELL to 135/87 mm RT. Art., reducing SaO2up to 90% on the background 26-28 breaths per minute, the patient noted the anxiety and the beginning of decompensation. In this regard, R slave was increased by 0.4 kgf/cm2after which the decrease in Pslaveresumed with a speed of 0.03 kgf/cm2/min And after 24 minutes reclassified by the Board of Directors with satisfactory indices of gas exchange and hemodynamics without obvious signs of decompensation of cattle.

Using this method will allow to increase the efficiency of the transition of the patient with an artificial self breath by eliminating the development of decompensation from cardiorespiratory what istemi and reduction of the time of termination of prolonged mechanical ventilation due to the approaching speed reduction P slaveit is optimal for each particular patient.

1. The method of transfer of patients from mechanical ventilation to spontaneous breathing by reducing the operating pressure of the compressed gas with constant control parameters of gas exchange and hemodynamics, wherein the pre-dosed exercise stress on the cardiorespiratory system and reduce operating pressure of compressed gas is 0.4 kg/m2and incubated for 5-20 min, then depending on the condition of the patient begin reducing the working pressure with a rate of 0.02 to 0.08 kg/m2/min, and in the presence of normal parameters of gas exchange and hemodynamics in the process of transition to spontaneous breathing, the selected speed is gradually increased, and when the deviation parameters of gas exchange and hemodynamics from the norm are selected adjustment speed, which increase the operating pressure to the normalization of parameters of gas exchange and hemodynamics, determine the optimal speed and carry out the reduction of the operating pressure with this speed, constantly adjusting its value at constant parameters of gas exchange and hemodynamics or their deviation from the norm.

2. The method according to claim 1, characterized in that the adjustment of the optimal speed is carried out by its increase at constant parameters of gas exchange and hemodynamics or decrease in the deviation of parameters of gas exchange and hemodynamics from the norm.



 

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