CLINICAL AND ECONOMIC SIGNIFICANCE OF RESPIRATORY BIOMECHANICS ADVANCED CONTROL WHEN PERFORMING PROLONGED ARTIFICIAL PULMONARY VENTILATION IN PATIENTS WITH SEVERE BLUNT CHEST TRAUMA AFTER METAL STRUCTURES INTERSTITIAL RIB STABILIZATION
Background. According to authors’ majority blunt chest trauma belongs within 3 most common causes of death in patients with multisystem trauma. In native and foreign authors’ study designs there are no references to biomechanics aspiration control and analysis before or after chest carcass stabilization while it appears crucial to us. Literature data analysis shows aspiration biomechanics research necessity in pre and post operation period in surgical rib fixation within patients’ group given and these indicators’ management. Purposes of the study: to evaluate prognostic significance of esophageal pressure (Pes), aspiration biomechanics, CO2 transportation changes in pre and post operation period within incipient surgical rib stabilization control, based upon received data to appraise significance of these indicators management when performing artificial pulmonary ventilation for severe blunt chest trauma incomes. Material and Methods. Open-label, retrospective and prospective controlled study of prolonged artificial pulmonary ventilation clinical and economic significance over 76 patients with severe blunt chest trauma. 3 groups of patients are created: the first control group K ′ - on the basis of retrospective data (2003-2012 yy) victims with chest trauma. The second control group K ″-on the basis of the analysis of clinical records of patients about chest trauma, treatment., it was carried out conservatively (2013-2017yy), and control of PEEP was exercised on the basis of monitoring of Pes and a median of Ptp. The main group included patients at whom surgical stabilization of edges was carried out by submersible and nakostny metal designs. Management of size PEEP, Pes based on measurements and a median of Ptp was an indispensable condition of inclusion in group. Indicators of biomechanics of breath of Cstat, Clang, Ccw, WOBp, Vti, EtCO2, VCO2, VtCO2 fixed each hour for the first 12 hours and then each 12 hours when carrying out IVL. Results of research were analyzed in three time intervals: before operation, in 3 hours and later 24 after operation. Results. Dynamic surgical approach (ribs’ synthesis) along with PEEP-value setting and management based esophageal (Pes) and trancepulmonic media line pressures (Ptp) improves aspiration biomechanics state along with pulmonic interstitium leading to statistically significant PaO2/FiO2 on 34%. Mechanical ventilation with PEEP resting on the basis of Pes control over patients with severe blunt chest trauma allows to improve results of high-level treatment stage through reduction of hospitalization period in Department of anesthesia and reanimation 23,1 for 10,9 days (p < 0,05) and artificial pulmonary ventilation duration regardless of surgical tactics (as in active chest carcass stabilization or during nonsurgical management), with 12,4 for 7,4 days (p < 0,05), to reduce treatment costs. Conclusion. Absence of statistically significant change in tidal volume (VTi = 0.44 ± 0.01 p < 0,05), esophageal pressure (Pes = 12,6 ± 2,1 р < 0,05) and CO2 partial pressure in nearest post operational period speaks for safety of dynamic surgical approach using ribs’ synthesis method in interstitial and extramedullary structures, while PEEP setting and management based on Pes and media line Ptp evaluation increases safety and economic efficiency of severe blunt chest trauma patients’ treatment.
About the authorsDavydova Nadezhda S.
Khmara A.D., Norkin I.A., Khmara T.G. Tactics of treatment for combined chest trauma and limb segments. Saratovskiy nauchno-meditsinskiy zhurnal. 2012; 8(4): 982-8. (in Russian)
Chen R., Gabler H.C. Risk of thoracic injury from direct steering wheel impact in frontal crashes. J. Trauma Acute Care Surg. 2014; 76(6): 1441-6.
Unsworth A., Curtis K., Asha S.E. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Review. Scand. J. Trauma Resusc. Emerg. Med. 2015; 23: 17.
Tarng Y.W., Liu Y.Y., Huang F.D., Lin H.L., Wu T.C., Chou Y.P. The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure. Surg. Endosc. 2016; 30(1): 388-95.
Lee S.K., Kang do K. Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures. J. Thorac. Dis. 2016; 8(6): E390-2.
Shen’ N.P., Davydova N.S., Boltaev P.G., Lukin S.Yu., Ushakov S.A., Skorokhodova L.A. et al. A comparative study of the tactics of surgical fixation with closed chest trauma: a view of the resuscitator, economic aspects. Anesteziologiya i reanimatologiya. 2015; 60(6): 54-8. (in Russian)
Danielyan Sh.N., Abakumov M.M., Saprin A.A., Chernen’kaya T.V. Treatment of pulmonary hemorrhages and their complications with closed chest trauma. Khirurgiya. 2012; (5): 37-41. (in Russian)
Gritsan A.I., Yaroshetskiy A.I., Vlasenko A.V., Gavrilin S.V., Gel’fand B.R., Zabolotskikh I.B. et al. Diagnosis and intensive therapy of acute respiratory distress syndrome. Clinical recommendations of PHARE. Anesteziologiya i reanimatologiya. 2016; 61(1): 62-70. (in Russian)
Vlasenko A.V., Moroz V.V., Yakovlev V.N., Alekseev V.G., Bulatov N.N. Choice of the method of optimization PEEP in patients with acute respiratory distress syndrome. Obshchaya reanimatologiya. 2012; 8(1): 13-21. (in Russian)
Voskresenskiy O.V., Trofimova E.Yu., Radchenko Yu.A., Abakumov M.M. The role of ultrasound in the selection of surgical tactics for chest injuries. Khirurgiya. 2011; (12): 10-5. (in Russian)
Abakumov M.M., Sharifullin F.A., Pinchuk T.P., Danielyan Sh.N., Popova I.E., Kvardakova O.V. et al. Diagnosis and treatment of pulmonary hemorrhages with closed chest trauma. Khirurgiya. 2011; (4): 17-24. (in Russian)
Tanaka H., Yukioka T., Yamaguti Y., Shimizu S., Goto H., Matsuda H. et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J. Trauma. 2002; 52: 727-32.
Davydova N.S., Skorokhodova L.A., Boltaev P.G., Besedina E.A., Shen’N.P., Mukhacheva S.Yu. Prognostic significance of monitoring respiratory biomechanics in differentiated therapy for ventilator-associated pulmonary complications in patients with severe combined trauma with lesion of the chest. Meditsinskaya nauka i obrazovanie Urala. 2016; 17(2): 17-22. (in Russian)
Andreas Granetzny, Mohamad Abd El-Aal, ElRady Emam, Alaa Shalaby, Ahmad Boseila. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact. Cardiovasc. Thorac. Surg. 2005; 4(6): 583-7.
París E., Tarazona V., Blasco E., Cantó A., Casillas M., Pastor J. et al. Surgical stabilization of traumatic flail chest. Thorax. 1975; 30(5): 521-7.
De Jong M.B., Kokke M.C., Hietbrink F., Leenen L.P. Surgical Management of Rib Fractures: Strategies and Literature Review. Scand. J. Surg. 2014; 103(2): 120-5.
Simon B., Ebert J., Bokhari F., Capella J., Emhoff T., Hayward T. et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73(5, Suppl. 4): S351-61.
Yaroshetskiy A.I., Protsenko D.N., Rezepov N.A., Gel’fand B.R. Setting the positive end-expiratory pressure for parenchymal ventilation: Static loop «pressure volume» or transpulmonary pressure? Anesteziologiya i reanimatologiya. 2014; 59(4): 53-9. (in Russian)
Mietto C., Pincirroli R., Patel N., Berra L. Ventilator Associated Pneumonia: Evolving definitions and preventive strategies. Resp. Care. 2013; 58(6): 990-1008.
Shabanov A.K., Khubutiya M.Sh., Bulava G.V., Beloborodova N.V. Dynamics of the level of procalcitonin in the development of nosocomial pneumonia in patients with severe combined trauma. Obshchaya reanimatologiya. 2013; 9(5): 11-7. (in Russian)
Mardganieva E.A., Mironov P.I., Rudnov V.A. Diagnosis and treatment of ventilator-associated pneumonias in children. Anesteziologiya i reanimatologiya. 2006; 51(1): 34-8. (in Russian)
Talmor D., Sarge T., Malhotra A., O’Donnell C.R., Ritz R., Lisbon A. et al. Mechanical ventilation guided by esophageal pressure in lung injury. N. Engl. J. Med. 2008; 359: 2095-104.
Gel’fand B.R., Yaroshetskiy A.I., Protsenko D.N., Ignatenko O.V., Lapshina I.Yu., Gel’fand E.B. Parenchymal respiratory failure in patients in critical conditions: is it always a respiratory distress syndrome? Vestnik intensivnoy terapii. 2014; (4): 3-9. (in Russian)
Для цитирования: Давыдова Н.С., Шень Н.П., Скороходова Л.А., Болтаев П.Г., Лукин С.Ю., Беседина Е.А., Никольский А.В. Клиническая и экономическая значимость расширенного мониторинга респираторной биомеханики при продлённой искусственной вентиляции лёгких у пациентов с тяжёлой травмой грудной клетки. Анестезиология и реаниматология. 2017; 62(6): 412-418. DOI: http://dx.doi.org/10.18821/0201-7563-2017-62-6-412-418
For citation: Davydova N.S., Shen’ N.P., Skorokhodova L.A., Boltaeva P.G., Lukin S.Yu., Besedina E.A. Nikol’sky A.V. Clinical and economic significance of respiratory biomechanics advanced control when performing prolonged artificial pulmonary ventilation in patients with severe blunt chest trauma after metal structures interstitial rib stabilization. Anesteziologiya I reanimatologiya (Russian Journal of Anaesthesiology and Reanimatology). 2017; 62(6): 412-418. (In Russ.). DOI: http://dx.doi.org/10.18821/0201-7563-2017-62-6-412-418
- Refbacks are not listed
Контент доступен под лицензией Creative Commons Attribution 3.0 License.
ISSN: 0201-7563 (Print)