Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome

D.V. Gaigolnik1, K.Yu. Belyaev1, E.A. Gritsan2, A.I. Gritsan1,2

1 Krasnoyarsk Regional Clinical Hospital, Regional Public Health Institution, Krasnoyarsk

2 Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, Krasnoyarsk

For correspondence: Alexey I. Gritsan, Dr. Med. Sci., Professor, Chief of the Department of Anaesthesiology and Intensive Care Krasnoyarsk of the State Medical University named after Professor V.F. Voyno-Yasenetsky, Ministry of Health of the Russian Federation, Krasnoyarsk; e-mail: gritsan67@mail.ru

For citation: Gaigolnik DV, Belyaev KYu, Gritsan EA, Gritsan AI. Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome. Alexander Saltanov Intensive Care Herald. 2019;1:65–77.

DOI: 10.21320/1818-474X-2019-1-65-77


Objective. To compare the dynamics of ventilation parameters, mechanical properties of the lungs and gas exchange in the process of respiratory support in patients with a favorable and unfavorable outcome of intensive treatment of necrotic pancreatitis.

Methods. The work is based on the results of a single-center observational study. The results of treatment of 94 patients aged from 25 to 65 years with necrotic pancreatitis complicated by acute respiratory distress syndrome and sepsis are analyzed. All patients were divided into two groups: group 1 (68 patients with severe sepsis), group 2 (26 patients with severe sepsis complicated by septic shock). Within each group, patients were divided into two subgroups: the group of sepsis — patients with a favorable outcome (28 patients) and unfavorable outcome (40 patients), in the group of septic shock — patients with a favorable outcome (5 patients) and unfavorable outcome (21 patients). All patients were treated with complex therapy according to international and Russian guidelines for the treatment of pancreatic necrosis, sepsis, and acute respiratory distress syndrome. The evaluation of the mechanical properties of the lungs was performed in patients based on the parameters recorded in the IVL card: F, Vt, MV, PIP, PEEP, CPAP, Clt, Flow.

Dynamic assessment of gas exchange was carried out by continuous monitoring of SpO2, PetCO2, plethysmography and according to gas analysis. The data were recorded in the mechanical ventilation map with the subsequent calculation of some indicators: FiO2, PaO2, PaCO2, pH, AaDO2, PaO2/FiO2.

Results. Patients with necrotizing pancreatitis with a favorable outcome in the process of artificial ventilation of the lungs to ensure sufficient oxygenation during septic shock use significantly higher (by 16.0–18.3 %) levels of PIP and PEEP than in sepsis, as well as more significant disorders of gas exchange in the lungs (by AaDO2 and PaO2/FiO2) compared with sepsis. In sepsis and septic shock with an unfavorable outcome (in comparison with a favorable one), during respiratory support, more pronounced disorders of oxygen status are observed, which indicates the presence of a more severe acute respiratory distress syndrome. In sepsis with a favorable outcome, as opposed to unfavorable, there is a direct correlation between positive changes in oxygen status (PaO2/FiO2) and Vt, PIP, PEEP levels, whereas in septic shock there is no such relationship.

Conclusion. The obtained results allowed us to offer a starting regimen of respiratory support for ARDS in patients with necrotic pancreatitis.

Keywords: necrotic pancreatitis, sepsis, acute respiratory distress syndrome, respiratory support, respiratory biomechanics, gas exchange

Received: 05.11.2018


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Experience of Treatment of Seasonal Influenza, Complicated by Viral and Bacterial Pneumonia: a Multicenter Retrospective Study

D.L. Shukevich1, G.P. Plotnikov1, L.E. Shukevich3, S.V. Voevodin4, E.A. Kameneva2, R.A. Kornelyuk1, S.V. Vostrikov3, D.C. Peredelkin3, P.G. Sitnikov4, E.F. Malyugin5, E.I. Tutolmin5, V.E. Shipakov5, E.V. Grigorev1

1 FGBNU «Institute for Complex Problems of cardiovascular disease», Kemerovo

2 MBUZ «City Clinical Hospital № 3», Kemerovo

3 GAUZ «Kemerovo Regional Clinical Hospital», Kemerovo

4 MLPU «City Clinical Hospital № 1», Novokuznetsk

5 GAUS «Tomsk Regional Clinical Hospital», Tomsk

For citation: Shukevich DL, Plotnikov GP, Shukevich LE, Voevodin SV, Kameneva EA, Kornelyuk RA, Vostrikov SV, Peredelkin DC, Sitnikov PG, Malyugin EF, Tutolmin EI, Shipakov VE, Grigorev EV. Experience of Treatment of Seasonal Influenza, Complicated by Viral and Bacterial Pneumonia: a Multicenter  Retrospective Study. Intensive Care Herald. 2016;2:46–50.


Тhe aim of the study. To conduct a comparative analysis of the experience of intensive care of severe viral-bacterial pneumonia, complicated by ARDS. Materials and methods. We conducted a retrospective analysis of clinical, historical, laboratory and instrumental data which were done by comparing the array of indicators for the periods (1) 2009 and (2) 2015–2016. We used the standard methods of investigations, including clinical, instrumental and laboratory methods. Results. The period 2015–2016 was characterized by an early hospitalization of patients in the ICU, a quick decision to intubate the patients and the rejection of non-invasive respiratory support, the expansion of indications for extrapulmonary oxygenation procedures and for renal replacement therapy.

Conclusions

  1. Following the principles of intensive treatment of severe viral and bacterial pneumonia flu season A(H1N1) have improved outcomes in the studied group of patients.
  2. Initial experience of the extracorporeal membrane oxygenation (ECMO) demonstrated the perspective for achieving optimal oxygenation without the ventilator-associated lung injury. The criteria for the initiation of ECMO can be moved into the area of critical values decrease the oxygen fraction, plateau pressure and positive end-expiratory pressure.
  3. Methods of renal replacement therapy with the use of membranes with the function of cytokine adsorption can neutralize the systemic inflammatory response.

Keywords: seasonal flue, acute respiratory distress syndrome, intensive care

Received: 09.05.2016


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New in the Treatment of Acute Respiratory Distress Syndrome

A.V. Vlasenko1, 2, D.P. Pavlov2, V.V. Kochergina2, D.A. Shestakov2, A.K. Doloksaribu2

1 FGBOU VPO «Department of Anesthesiology and Intensive Care in FUV People’s Friendship University», Moscow

2 City Clinical Hospital n.a. S.P. Botkin, Moscow

For citation: Vlasenko AV, Pavlov DP, Kochergina VV, Shestakov DA, Doloksaribu AK. New in the Treatment of Acute Respiratory Distress Syndrome. Intensive Care Herald. 2016;2:37–45.


Тhe aim of the study. The study of clinical efficiency and of the not differentiated and differentiated use of respiratory, non-respiratory and pharmacological treatments in patients with acute respiratory distress syndrome of different genesis. Materials and methods. In the prospective study 63 examined patients (38 men, 25 women, aged 22 to 68 years) with acute respiratory distress syndrome were divided into 2 groups. Group A (n = 30, 18 men, 12 women) and group B (n = 33, 20 men, 13 women). All patients had acute respiratory distress syndrome as a result of direct and indirect damage factors: aspiration of gastric contents, blunt chest trauma with lung injury, acute bilateral pneumonia, abdominal sepsis, severe concomitant injury without lung injury, acute massive blood loss. In group A undifferentiated use respiratory, non-respiratory and pharmacological treatments for ARDS. In group B these methods applied differentiated depending of the causes of ARDS. We studied the clinical efficiency not differentiated and the differentiated application of escalation or de-escalation PEEP optimized methods, lung recruitment, prone-position, Surfactant BL, Perftoran and their combined use. Results. Depending of the ARDS reasons differentiated use of respiratory, non-respiratory and pharmacological methods can improve results and reduce mortality in patients with ARDS. Conclusions. It is advisable to use a differentiated respiratory, non-respiratory and pharmacological treatment in patients with ARDS depending of the reasons of its development.

Keywords: acute respiratory distress syndrome, direct damaging factors, not direct damaging factors, mechanical ventilation, positive end-expiratory pressure, lung recruitment, prone-position, Surfactant BL, Perftoran

Received: 14.04.2016 


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A single lung acute respiratory distress sindrome: case report

R.A. Ibadov, L.A. Nazirova, Sh. N. Khudaybergenov, H.K. Abrolov, A.Sh. Arifdjanov, N.A. Strijkov, N.R. Gizatulina, S.Kh. Ibragimov

Intensive care unit of AO Republican Specialized Surgery Center named after academician V. Vahidova, Uzbekistan

For citation: Ibadov RA, Nazirova LA, Khudaybergenov ShN et al. A single lung acute respiratory distress sindrome: a case report. Intensive Care Herald. 2016;1:57–60.


The paper presents a clinical case of acute respiratory distress syndrome (ARDS) in a patient with a single lung that developed on the 4th day after emergency pneumonectomy. Basic disease, hydatid lung, involves in the process the wall of aortic arch and forms an aortocystic fistula that caused a number of complications: pulmonary hemorrhage, hemothorax, hemorrhagic shock. The surgery was carried out under the conditions of the auxiliary artificial circulation. This case represented a serious clinical situation with the highest risk to life. The need for an immediate respiratory support was due to the development of severe respiratory failure, the presence of direct and indirect harmful factors of ARDS. The correct choice of modes and techniques of mechanical ventilation resulted in significant and sustained improvement in gas exchange parameters without hemodynamic disorders with a further favorable outcome.

Keywords: hydatid disease of lung, hemorrhagic shock, pneumonectomy, acute respiratory distress syndrome.


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