[Criteria for adequate respiratory support during transfer of patients to spontaneous respiration]. / Kriterii adekvatnosti respiratornoi podderzhki pri perevode bol'nykh na samostoiatel'noe dykhanie.

Time course of circulation, oxygen transport and consumption parameters were studied in patients with parenchymatous pulmonary diseases during their transfer to spontaneous respiration under conditions of pressure support ventilation after long forced ventilation of the lungs. The oxygen cost of respiration can serve as a reliable criterion of respiratory support adequacy when the use of a respirator is discontinued. With oxygen cost of respiration at least 14%, a decrease of respiratory support is hardly possible without decompensation of the respiration system and circulation, which dictates monitoring of this parameter during transfer of patients to spontaneous respiration.

[Postural therapy during mechanical pulmonary ventilation with PEEP in patients with unilateral lung damage]. / Pozitsionnaia terapiia pri mekhanicheskoi ventiliatsii legkikh s PDKV u bol'nykh s odnostoronnim povrezhdeniem legkikh.

Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP.

[Optimization of artificial respiration parameters in patients with acute pulmonary parenchymal damage syndrome]. / Optimizatsiia parametrov IVL u bol'nykh s sindromom ostrogo parenkhimatozhnogo povrezhedeniia legkikh.

The relationship between the mean pressure in the trachea, generated in mechanical ventilation of the lungs (Ptr.m), and normal arterial oxygenation is linear in ventilated patients with severe bilateral acute parenchymatous damage to the lungs. Under conditions of mechanical ventilation of the lungs (MVL) with regulated volume, constant end-expiratory pressure (PEEP) and inspiratory pause (eIP) are effective methods for regulating Ptr.m. However, the efficacy of regulating Ptr.m by PEEP and IF for each clinical case is different. The algorithm of using PEEP and IF for optimizing the respiratory pattern in this category of patients is not clear, too. The results indicate that optimization of MVL with controlled volume should be started with selecting the optimal level of PEEP for each patient. The level of Ptr.m should not be increased immediately at by of prolonging eIP, because the probability of compromising the hemodynamics is higher in such a case than the probability of improving blood oxygenation. Only after selecting the optimal PEEP is it permissible to try to improve arterial oxygenation by prolonging xx, because under such conditions the efficacy of prolonged inspiration is notably increased. Our data indicate that eIP no higher than 30% of the respiratory cycle (inspiration/expiration = 1.5/1) is the optimal. A further increase of eIP gives rise to a tendency towards decrease of arterial oxygenation and oxygen transport to tissues.

[Occlusion pressure in the first 100 ms of inspiration (P0.1) as an index of the possibility of decreasing respiratory support in acute respiratory failure]. / Okkliuzionnoe davlenie v pervye 100 ms (P0,1) vdokha kak pokazatel' vozmozhnosti snizheniia dykhatel'noi podderzhki pri ostroi dykhatel'noi nedostatochnposti.

The need in making the process of transfer of patients to spontaneous respiration using ventilation of the lungs with inspiratory pressure support (VLIPS) after prolonged mechanical ventilation of the lungs prompted the authors to analyze the prognostic value of criteria traditionally used by the physician to cease or decrease the respiratory support (vital capacity of the lungs, peak spontaneous flow, PaO2, etc.) and the P0.1 occlusion pressure in the airways at the end of the first 100 msec of inhalation. This latter value proved to be the most sensitive (88%), specific (86%), positive (95%) and negative (67%) prognostic value in predicting the results of decrease of respiratory support under conditions of VLIPS. The P0.1 value determining the result of decrease of respiratory support in patients with parenchymatous pulmonary diseases under conditions of VLIPS is 3.8 cm H2O.

[A comparative evaluation of the efficacy of the traditional combination of high-frequency and intermittent high-frequency artificial ventilation of the lungs in patients with parenchymatous acute respiratory insufficiency]. / Sravnitel'naia otsenka éffektivnosti traditsionnoi sochetannoi vysokochastotnoi i preryvistoi vysokochastotnoi iskusstvennoi ventiliatsii legkikh u bol'nykh s parenkhimatoznoi ostroi dykhatel'noi nedostatochnost'iu.

Conventional controlled lung ventilation (CLV) with positive end expiratory pressure (PEEP) (Con CLV), combined high-frequency CLV (Com HF CLV) and intermittent high-frequency CLV with PEEP (Int HF CLV) have been performed in 43 patients with parenchymatous acute respiratory failure (ARF). It has been established that Int HF CLV significantly increases PaO2 in patients with focal damages of the lung parenchyma and effective compliance (Ceff) > 0.033 l/cm H2O. Com HF CLV increases significantly PaO2 and lung compliance in patients with disseminated lung damages and Ceff < 0.030 l/cm H2O and has marked consequences. Different efficacy of various types of HF CLV under study may be to some extent accounted for by different intraalveolar maximum pressure, which (as it has been shown on the lung model) is higher in Com HF CLV and lower in Con CLV and Int HF CLV.

[Changes in hemodynamics during intermittent high-frequency ventilation of the lungs in patients with acute respiratory insufficiency]. / Izmeneniia gemodinamiki pri preryvistoi vysokochastotnoi ventiliatsii legkikh u bol'nykh s ostroi dykhatel'noi nedostatochnost'iu.

Hemodynamic changes have been studied in 19 patients (30 observations) with acute respiratory failure of various genesis during transition from conventional controlled lung ventilation, performed using PO-6 and Phase-3C devices, to intermittent high-frequency jet ventilation ("Spiron 601"). Impedance plethysmography and rheopulmonography have been used. It has been established that intermittent high-frequency jet ventilation during 1 hour can have both positive and negative effect on systemic and pulmonary hemodynamics in patients with lung damage. It has been demonstrated that the type of reaction depends on the initial values of stroke volume and cardiac output.