[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome]. / Primenenie neinvazivnoi masochnoi vspomogatel'noi ventiliatsii legkikh pri ostrom respiratornom distress-sindrome u kardiokhirurgicheskikh bol'nykh.

Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. The indications for extubation of patients were as follows: PaO2/FiO2 of 200 and more mm Hg, respiratory rate (RR) of less than 30 per min, respiratory volume of more than 6 ml/kg with pressure support at inspiration of less than 5 cm H2O and with the total pressure at the exhalation end of no more than 3 cm H2O. Mask ventilation sessions were started in a growing dyspnea of more than 26 per min, a decreased content of oxyhemoglobin in arterial blood (below 95% at oxygen inhalation of 10-15 l/min), involvement of auxiliary muscles in breathing and at subjective complaints of patients related with complicated breathing and with being short of air. The mask SIMV ventilation with a preset apparatus-aided rate of inhales of 2-6/min, with Bi-PAP and PSV inhale pressure of 15 cm/ H2O and with PEEP of 3-5 cm/ H2O was made by 40-120 min sessions; the number of IFMLV sessions ranged from 6 to 22/patient, mean - 11 +/- 1.1 h. The total IFMLV duration was 10.7 +/- 1.1 h. The need for respiratory support persisted for 4-6 days after extubation. In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.

[Postoperative period in early activated patients after myocardial revascularization]. / Osobennosti posleoperatsionnogo perioda pri rannei aktivatsii bol'nykh posle operatsii revaskuliarizatsii miokarda.

The specific features of an early postoperative period were studied in 115 patients undergone myocardial revascularization who were divided into 3 groups according to the time of postoperative activation. Group 1 comprised 35 patients in whom tracheal extubation was made in the operating room 30-60 min after the end of the operation. Group 2 included 32 patients extubated 2-8 hours after admission to the resuscitation and intensive care unit (RICU); Group 3 consisted of 48 patients undergone tracheal intubation for more than 8 hours. The patients of this group received traditional anesthesia using ketamine, benzodiazepines, and large-dose fentanyl. The developed combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics, such as isoflurane, diprivan, tracrium, was used in 60.3% of the patients in Groups 1 and 2. The developed type of anesthesia using a high thoracic (T2-T4) epidural blockade as a basic component of anesthesiological maintenance was studied. In Group 2, the preextubation time was twice less than that in a control group (5.2 +/- 0.3 and 10.8 +/- 0.4 hours, respectively, p < 0.05). In groups with early extubation, the incidence of clinically significant cardiovascular disorders was less than that in the controls, which is indicative of better performance of the cardiovascular system. In Group 1, the frequency of reintubations for arterial hypoxemias was 2.8% and that of pneumonias and pulmonary microatelectasis was 2.5 times less as that in Group 3 (9%, p < 0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p < 0.05). A programme on early activation after aortocoronary bypass surgery could reduce the patients' stay at the RICU on an average by 24 hours without increasing the risk for postoperative complications.

[Noninvasive mask ventilation of the lungs in the treatment of acute respiratory insufficiency in heart surgery patients in the postoperative period]. / Neinvazivnaia masochnaia ventiliatsiia legkikh pri lechenii ostroi dykhatel'noi nedostatochnosti v posleoperatsionnom periode u kardiokhirurgicheskikh bol'nykh.

Noninvasive ventilation of the lungs using a mask (NIVLM) was used in 54 patients with hypercapnic (n = 14) and hypoxemic (n = 40) respiratory failure. Respironics (USA) nasal and facial masks were applied. Ventilation regimens were selected individually. Trigger monitored ventilation, intermittent forced ventilation of the lungs, and assisted ventilation with positive expiratory pressure, biphasic positive pressure in the airways, and constant positive pressure in the respiratory contour were used. The efficacy of NIVLM in patients with hypercapnic respiratory failure was 100%. The pCO2 and ETCO2 normalized in all patients both during and after discontinuation of NIVLM. Despite a relatively long period of ventilation (229 +/- 72 min), the patients did not complain of discomfort during the procedure; no complications or individual intolerance of nasal or facial masks were observed. In patients with hypoxemic respiratory failure NIVLM resulted in a decrease of dyspnea, increase of respiratory volume, etc. The detected changes did not disappear after NIVLM was discontinued. Individual tolerance of nasal and facial masks was somewhat worse in this group: patients complained of stuffiness, lack of air, difficult respiration. Six patients (18.2%) developed episodes of psychomotor excitation which required sedative and analgesic therapy. In general, the efficacy of NIVLM was 91%, but resolution of respiratory failure without repeated intubation of the trachea was attained in only 33 patients (87%) with the hypoxemic condition. The mean duration of NIVLM in this group was 464 +/- 47 min. Hence, NIVLM is an effective method for respiratory support in patients with both hypoxemic and hypercapnic respiratory failure, which helps decrease the duration of forced ventilation of the lungs or do without repeated intubation of the trachea.