Method for treating the cases of acute respiratory insufficiency of cardiac genesis

FIELD: medicine.

SUBSTANCE: method involves introducing catheter via nasal passage into the rhinopharynx and fixed above the entrance to larynx and artificial high frequency jet ventilation is carried out with frequency of 140-150 cycles per min in three stages. Compressed gas working pressure is increased at the first stage to 2.0-2.5 kg of force/cm2 during 7-10 min. The compressed gas working pressure is supported at this level to the moment the clinic manifestations of pulmonary edema being removed and gas exchange normalization being achieved at the second stage. The working pressure is stepwise dropped during 1-2 h at the third stage hold during 10-15 min at each step.

EFFECT: enhanced effectiveness in normalizing hemodynamics.

 

The invention relates to medicine, namely to emergency cardiology, and may find application in the treatment of patients with acute respiratory failure on the background of left ventricular failure.

The most threatening complication of left ventricular failure is cardiogenic pulmonary edema, manifested in the form of alveolar or interstitial pulmonary edema (cardiac asthma).

There is a method of alveolar edema edema of the lungs by artificial lung ventilation (ALV) with positive pressure at the end of the expiratory (peep) (Kassil V.L. mechanical ventilation in the intensive care unit. - M.: Medicine, 1987, s-206).

The disadvantage of this method are the need for intubation of the trachea, the problem of choosing an optimal level of peep, possible complications in the form of oppression of Central hemodynamics or barotrauma of the lungs due to the formation of high airway pressure, the need to ensure complete adaptation of the patient to a respirator.

There is a method of treatment of acute respiratory failure cardiac dysfunction by conducting rescattering inkjet VCELL (Gologorsky VA and other high-Frequency jet ventilation in the intensive therapy of cardiogenic shock and pulmonary edema in patients with myocardial infarction. EN is thesiology and resuscitation 1993, No. 6, pp.42-46). This method involves percutaneous transtracheal catheterization trachea and conducting rescattering inkjet high-frequency mechanical ventilation (VCELL).

The disadvantage of this method is its invasiveness, need puncture catheterization of the trachea, the possibility of complications such as bleeding or subcutaneous emphysema, the possibility of injury posterior wall of the trachea and esophagus, which significantly limits or excludes the possibility of applying this method in acute respiratory failure developing in the conditions of interstitial pulmonary edema (cardiac asthma) or starting alveolar OL.

In accordance with this task, aimed at eliminating these disadvantages and creating an effective, low-impact method of treatment of acute respiratory failure in patients with interstitial or starting alveolar pulmonary edema.

To solve this problem in the treatment of acute respiratory failure cardiac dysfunction by conducting rescattering inkjet VCELL catheter is inserted through the nasal passage into the oropharynx to a depth of 14 to 17 cm and is mounted above the entrance to the larynx, and inkjet VCELL carried out with a frequency of 140 to 150 cycles per minute in three stages, the first stage working pressure of compressed ha is and speed increase to 2.0-2.5 kgf/cm 2within 7-10 minutes, the second stage working pressure of compressed gas is maintained at this level to reduce clinical manifestations of pulmonary edema and normalization of gas exchange, and at the third stage working pressure reduce speed within 1-2 hours of exposure at each stage for 10-15 minutes.

This method was used in 2 groups of patients: 17 patients with heart disease and / or cardiac arrhythmias without the original myocardial ischemia and in 19 patients with acute myocardial infarction or progressive angina without arterial hypotension. It was found that the use of known high flux of oxygen therapy for the treatment of these patients was accompanied by slight changes in the blood oxygenation with preservation of dyspnea, hypercapnia and clinical manifestations of cardiac asthma, and when using inkjet rescattering VCELL was quickly corrected hypoxemia, hypercapnia, dyspnea and cardiac clinic asthma.

Respiratory support was carried out on the background of standard therapy hemodynamic disturbances. Therefore, the observed results were as a result of using the proposed method, since the stabilization of hemodynamics was observed after full correction of respiratory insufficiency and gas exchange because of the way the Chennai actions of pharmacological preparations.

The implementation of the method is illustrated with specific examples.

Example 1.

Patient B. 64 years, and/b 2/5534, received 03.09.99, complaining of feeling disruptions in heart rhythm, chest congestion, shortness of breath. From the anamnesis it is known: 3 days ago felt a disruption of the heart rhythm condition progressively worsened, increased shortness of breath, the last night of "sleep" sitting. In 1997, he suffered acute anterior THEM, the last 15 years, suffering from hypertension disease (AD working 170-180/95-100 mm Hg). After transferred several times there were paroxysmal atrial fibrillation. He entered the BOC with a diagnosis of coronary artery disease, myocardial infarction anterior wall, the paroxysm of atrial fibrillation. Hypertensive heart disease. Pulmonary edema. Diabetes mellitus (type 2).

Admission: forced position orthopnea, total cyanosis of skin and mucous membranes, respiratory rate (NPV) 42 in a minute, indrawing compliant seats, moist rales are heard in the distance, auscultatory a large number of different crackles at the lung. The heart rate of 140 per minute, heart rate of 106 beats per minute, full (pulse deficit 34 shots in a minute). AD 200 /100 mm Hg, saturation 81-82%. When entering the BOC initiated oxygenotherapy through facial mask with flow 14 l/min (Marked by a moderate rise in the saturation up to 87% for 3 minutes, without far is our growth. The patient is excited, there is a shortness of breath, NPV 42 min tearing off the mask, says that he is suffocating. Transferred to the auxiliary krasnaselio transcatheter VCELL mode rrab. 1 kgf/cm2the ratio of inhalation/exhalation is 1:1, frequency 140 cycles per minute After 5 minutes, the resulting increase in saturation to 91-92%. Over the next 3 minutes made a gradual transition to the rrab. up to 2.5 kgf/cm2in still other options. In this case the patient calmed down, subjectively, to "breathe easier", the NPV 26 min, saturation 97-98%, auscultatory - no krupnobyudzhetnyh wheeze, reducing the total amount of moist rales. Hemodynamic parameters without the expressed dynamics. Initiated conventional pharmacotherapy, including continuous infusion polarizing mixture, bolus/introduction lasixa 60 mg, heparin 5 t units, mikrostruyno procainamide hydrochloride 1 g Over 10 minutes at a stable indicators of adequate oxygenation (Cat. 98-99%) and NPV reduction to 22 min was a decrease HELL to 180/100 mm Hg and pulse deficit, (HR 128, pulse 110 beats per minute). Appeared diuresis in the amount of 600 ml.

Then there was a gradual stepwise reduction of the rrab. Every 10 min 0.5 kgf/cm2no signs of recurrence OL. After 60 min at a relatively stable hemodynamics (HR-118, a pulse rate of 108 beats per minute, BP 170/90 mm Hg) and the moustache is oicheva high oxygenation (Hbo 2- 97 - 98%, Rho2- 129 mm Hg, RNO2- 39 mm Hg) patient transferred to independent breathing flow through the previously installed catheter oxygen flow of 6 l/min After 2 hours on the background of therapy registered restoring sinus rhythm with a heart rate of 78 beats per minutes no Complaints, subjectively feels OK. Transferred to the cardiology Department.

Example 2.

Patient Century, 75 years old, he enrolled in the BSC 07.06.97, and/b 2/3388 with a diagnosis of CHD post-mi Rupniecibas infarction of the anterior wall (re-NAMED 1994, 1996), progressive angina. Cardiac asthma.

Upon receipt of a complaint on swelling pain zagrudinnoe, shortness of breath, feeling of shortage of air. Objectively, the patient is excited, sitting, acrocyanosis. Shortness of breath with NPV 26 min KHS and gas composition of the blood testified to the presence of hypoxemia (Rho2- 55 mm Hg, NVO2- 86%), hypercapnia (RNO2- 48 mm Hg) and respiratory acidosis (pH of 7.23, BE - 7,6), auscultative in the lungs breathing hard, multiple dry single wet fine basal crackles on both sides. Heart tones are muffled, rhythmic, heart rate 88 beats per minute, pulse 88 ADV min, full, BP 130/70 mm Hg Initiated the oxygen therapy via nasal cannula flow 12 l/min Condition has not changed, remained odes is ka (NPV - 28 min), NVO2- 88%, HR 92 min Started krasnoselka, frescatistory inkjet VCELL with the rrab. of 1.3 kgf/cm2and a frequency of 150 cycles per minute Via a 7 minutes on the background of a gradual increase in the rrab. up to 2 kgf/cm2with the same parameters, an increase in the saturation of 97%, dyspnea reduction to 22 min and tachycardia to 84 beats per minutes Attempting to reduce the rrab. up to 1 kgf/cm2was accompanied by a rapid within 2 minutes by reducing saturation to 92-93%. VCELL resumed with the rrab. 2 kgf/cm2. Parallel to the patient is established on/in infusion of nitroglycerin at a speed of 6 mg/min. Oral aspirin 125 mg, atenolol 20 mg After 20 minutes the resulting diuresis 600 ml. Patient calm, subjectively feels much better, NPV - 20 min, HR - 80 beats./min, BP 110/65 mm Hg, saturation is 98%, Rho2- 118 mm Hg, RNO2- 41 mm RT. Art., against this background, started a stepped reduction of the rrab. 0.5 ATM every 15 minutes. After 1 hour, the total urine output was 800 ml, with stable hemodynamic parameters (heart rate of 74 beats/ min, BP 105/65 mm Hg) and the absence of signs ONE (NPV - 16 min, saturation is 98%) the patient was transferred to the oxygen flow of 6 l/min ECG without evidence of repeated THEM a day later transferred to the cardiology Department.

Using this method will provide an effective, low-impact treatment of acute respiratory is nedostatocnosti in patients with interstitial or starting alveolar pulmonary edema.

A method of treating acute respiratory failure cardiac dysfunction by conducting rescattering inkjet high-frequency mechanical ventilation, characterized in that the catheter is inserted through the nasal passage into the oropharynx to the depth 14-17 cm, set above the entrance to the larynx, and high-frequency jet ventilation of lungs is carried out with a frequency of 140 to 150 cycles per minute in three phases, with the first stage operating pressure of the compressed gas increases up to 2.0 - 2.5 kgf/cm2within 7-10 min; at the second stage working pressure of compressed gas is maintained at this level to reduce clinical manifestations of pulmonary edema and normalization of gas exchange, and at the third stage working pressure reduce speed for 1-2 h with exposure at each stage within 10-15 minutes



 

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