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AUTHORIZATION

№3, 2012 (Volume VIII)

ACUTE RESPIRATORY DISTRESS SYNDROME

Optimization of Positive End Expiratory Pressure in Patients with Acute Respiratory Distress Syndrome Caused by Direct and Indirect Damaging Factors Abstract

V. V. Moroz ¹ , A.V. Vlasenko ^1,2 , V. N. Yakovlev ² , V. G. Alekseyev ²
V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, Moscow
² S. P. Botkin City Clinical Hospital, Moscow
^{Correspondence to:}
^{Vlasenko A. V.}
^{E-mail:

[email protected]}

^.

^{Objective: to study the clinical efficiency of undifferentiated and differentiated use of escalation and de-escalation procedures for optimizing positive endexpiratory pressure (PEEP) during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) resulting from direct and indirect damaging factors. Subjects and methods. During a prospective study, 24 examined patients (16 men, 8 women; their age was 22 to 65 years) with ARDS of different genesis were divided into 2 groups. Group A (n=11; 7 men, 4 women) and Group B (n=13; 9 men, 4 women) included patients with ARDS arising from both direct (gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia) and indirect (abdominal sepsis, severe nonthoracic injury, and acute massive blood loss) damaging factors. The results of treatment via differentiated or undifferentiated, according to the cause of ARDS, use of escalation and deescalation procedures for PEEP optimization were assessed in Groups A and B patients. Results. The differentiated, according to the cause of ARDS, use of escalation and deescalation procedures for PEEP optimization makes it possible to more effectively improve the parameters of pulmonary gas exchange and biomechanics and to reduce the length of respiratory support and stay in the intensive care unit, the incidence of ventilatorassociated pneumonia, and mortality rates in patients with ARDS resulting from direct and indirect damaging factors. Conclusion. It is advisable to apply the differ entiated, according to the cause of ARDS, approach to choosing escalation or deescalation procedures to optimize PEEP in patients with ARDS of different genesis. Key words: acute respiratory distress syndrome, direct damaging factors, indirect damaging factors, mechanical ventilation, positive endexpiratory pressure, escalation PEEP optimization procedure, deescalation PEEP optimization procedure, lung opening manoeuver.}

INJURY

Systemic Hemodynamic and Myocardial Contractile and Metabolic Impairments in Severe Thermal Injury in the Experiment and Their Correction Abstract

CRITICAL CONDITIONS IN PEDIATRICS

Placental Inflammatory Changes and Bacterial Infection in Premature Neonates with Respiratory Failure Abstract

GUIDELINES FOR THE PRACTITIONER

Early Diagnosis of Critical Postperfusion Circulatory Disorders Abstract

Prognostic Value of Scales for Patients with Different Level Abstract

Prognostic Value of Scales for Patients with Different Level of Constant Potential in Acute Colonic Ileus Abstract

Optimization of Treatment Policy for Acute Carbon Monoxide Poisoning Abstract

Use of Intravenous Immunoglobulins in Intensive Therapy Abstract

REVIEWS

Pharmacological Preconditioning: Role of Opioid Peptides Abstract

Sedation in Intensive Care: A review of the State-of-the-Art Abstract

HISTORY OF MEDICINE

Russian History of Cardiac Defibrillation Abstract

Chronicles

Anniversary

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