3 research outputs found
ΠΠ°Π²Π»Π΅Π½ΠΈΠ΅ Π² Π»ΡΠΊΠΎΠ²ΠΈΡΠ΅ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ ΠΏΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΡΠΈΠ΄Ρ
Background. The pressure in brain sinuses (BSP) is used to monitor the effectiveness of various methods of prevention and treatment of venous air embolism (VAE) during surgeries in patients in the sitting position. A simpler and more approachable way is to measure the pressure in the superior bulb of the jugular vein (JBP), which accurately reflects the BSP. The dependence of the frequency and severity of VAE in JBP, however, has not been investigated, and the data on the effect of various methods of prevention and treatment of VAE on JBP are either insufficient or contradictory. The study was aimed to determine the dynamics of the JBP when bringing the patient to a sitting position, its relation with the severity of the VAE and to assess the effect of right atrium pressure (RAP), positive end expiratory pressure (PEEP) and decreased minute pulmonary ventilation (MPV) on it.Material and methods. The prospective study included 66 people who underwent intracranial surgery in a sitting position. In addition to the standard monitoring under general anesthesia with artificial lung ventilation, the superior bulb of the jugular vein and the right atrium were catheterized, and the esophagus was intubated with transesophageal echocardiography sensor. JBP was measured in a supine and sitting position and examined in relationship to RAP. In patients with JBP<0 mm Hg, its dynamics was evaluated at PEEP<0 cm H20 and MPV with end-tidal carbon dioxide (etCO2)=44 mm Hg, PEEP=15 cm H20 and MPV with etCO2=36 mm Hg. The Tuebingen scale (Tuebingen VAE) was used to determine the severity of VAE.Results. After bringing the patient to the sitting position the JBP significantly (W=2137.5; p<0.001) decreased by an average of 8 mm Hg, while in 11 (16.7%; 95% CI: 8.6-27, 8) cases it remained positive. No correlation was found between the RAP and JBP in the supine position (Z =-0.08225; p=0.9344) and in the sitting position (Z=1.2272, p=0.2198). The VAE frequency was 51% (95% CI 38.8-64). In patients with JBP <0 mm Hg, the frequency and severity of VAE was significantly higher than with JBPβ₯1 mm Hg (chi-square=4.37; df=1; p=0.036 and Z=2.47, p=0.015, respectively). Significant changes of JBP when PEEP 15 cm H2O and MPV with etCO2=36 mm Hg were not found (Z = -0.9784, p=0.3964 and Z=-1.3324, p=0.2305 respectively).Conclusion. 1. The negative JBP after bringing the patient to the sitting position is accompanied by an increase in the frequency and severity of VAE. 2. In patients in a sitting position, the correlation between RAP and JBP was not found. 3. Isolated PEEP and changes in ventilation do not lead to an increase in JBP.Β ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π‘ ΡΠ΅Π»ΡΡ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ Π²ΠΎΠ·Π΄ΡΡΠ½ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ (ΠΠΠ) ΠΏΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΡ
Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΡΠΈΠ΄Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΡΡ ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΡΠΈΠ½ΡΡΠ°Ρ
Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° (Π²Π½ΡΡΡΠΈΡΠΈΠ½ΡΡΠ½ΠΎΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ - ΠΠ‘Π). ΠΠΎΠ»Π΅Π΅ ΠΏΡΠΎΡΡΡΠΌ ΠΈ Π΄ΠΎΡΡΡΠΏΠ½ΡΠΌ ΡΠΏΠΎΡΠΎΠ±ΠΎΠΌ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π²Π΅ΡΡ
Π½Π΅ΠΉ Π»ΡΠΊΠΎΠ²ΠΈΡΠ΅ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ (ΠΠΠ―Π), ΠΊΠΎΡΠΎΡΠΎΠ΅ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΡΠΎΡΠ½ΠΎ ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΠΠ‘Π. ΠΠ°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ ΡΠ°ΡΡΠΎΡΡ ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΠΠ ΠΎΡ ΠΠΠ―Π, ΡΠ΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅, Π½Π΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π°, Π° Π΄Π°Π½Π½ΡΠ΅ ΠΎ Π²Π»ΠΈΡΠ½ΠΈΠΈ Π½Π° Π½Π΅Π³ΠΎ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ Π½ΠΎΡΡΡ Π»ΠΈΠ±ΠΎ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΉ, Π»ΠΈΠ±ΠΎ ΠΏΡΠΎΡΠΈΠ²ΠΎΡΠ΅ΡΠΈΠ²ΡΠΉ Ρ
Π°ΡΠ°ΠΊΡΠ΅Ρ. Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠΎΡΠ»Π° Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΠΠΠ―Π ΠΏΡΠΈ ΠΏΡΠΈΠ²Π΅Π΄Π΅Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΠ΄Ρ, Π΅Π³ΠΎ ΡΠ²ΡΠ·ΠΈ Ρ ΡΡΠΆΠ΅ΡΡΡΡ ΠΠΠ ΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΠΏΡΠ°Π²ΠΎΠΌ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΈ (ΠΠΠ), ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΠΊΠΎΠ½ΡΠ΅ Π²ΡΠ΄ΠΎΡ
Π° (ΠΠΠΠ) ΠΈ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΠΌΠΈΠ½ΡΡΠ½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
(ΠΠΠ).ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ.Β Π ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 66 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΈΠ½ΡΡΠ°ΠΊΡΠ°Π½ΠΈΠ°Π»ΡΠ½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΡΠΈΠ΄Ρ. Π Π΄ΠΎΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΊ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΌΡ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Ρ ΠΈΠΌ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΎΠ±ΡΠ΅ΠΉ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΈ Ρ ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠ΅ΠΉ Π»Π΅Π³ΠΊΠΈΡ
ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·ΠΈΡΠΎΠ²Π°Π»ΠΈ Π²Π΅ΡΡ
Π½ΡΡ Π»ΡΠΊΠΎΠ²ΠΈΡΡ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ, ΠΏΡΠ°Π²ΠΎΠ΅ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠ΅, ΠΈΠ½ΡΡΠ±ΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΏΠΈΡΠ΅Π²ΠΎΠ΄ Π΄Π°ΡΡΠΈΠΊΠΎΠΌ Π΄Π»Ρ ΡΡΠ΅ΡΠΏΠΈΡΠ΅Π²ΠΎΠ΄Π½ΠΎΠΉ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ. ΠΠ·ΠΌΠ΅ΡΡΠ»ΠΈ ΠΠΠ―Π Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ Π»Π΅ΠΆΠ° ΠΈ ΡΠΈΠ΄Ρ, ΠΈΠ·ΡΡΠ°Π»ΠΈ Π΅Π³ΠΎ ΡΠ²ΡΠ·Ρ Ρ ΠΠΠ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ―Π, Π½Π΅ Π±ΠΎΠ»Π΅Π΅ 0 ΠΌΠΌ ΡΡ.ΡΡ., ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π΅Π³ΠΎ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΠΏΡΠΈ ΠΠΠΠ=0 ΡΠΌ Π²ΠΎΠ΄.ΡΡ. ΠΈ ΠΠΠ Ρ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΡΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-Π²ΡΠ΄ΡΡ
Π°Π΅ΠΌΠΎΠ³ΠΎ ΡΠ³Π»Π΅ΠΊΠΈΡΠ»ΠΎΠ³ΠΎ Π³Π°Π·Π° (etCO2)=44 ΠΌΠΌ ΡΡ.ΡΡ., ΠΠΠΠ=15 ΡΠΌ Π²ΠΎΠ΄.ΡΡ. ΠΈ ΠΠΠ Ρ etCO2=36 ΠΌΠΌ ΡΡ.ΡΡ. ΠΠ»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠΆΠ΅ΡΡΠΈ ΠΠΠ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠΊΠ°Π»Ρ Π’ΡΠ±ΠΈΠ½Π³Π΅Π½ (Tubingen VAE).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΡΠ»Π΅ ΠΏΡΠΈΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΠ΄Ρ ΠΠΠ―Π ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ (W=2137,5; p<0,001) ΡΠ½ΠΈΠΆΠ°Π»ΠΎΡΡ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π½Π° 8 ΠΌΠΌ ΡΡ.ΡΡ., ΠΏΡΠΈ ΡΡΠΎΠΌ Ρ 11 (16,7%; 95%ΠΠ 8,6-27,8) Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΠ½ΠΎ ΠΎΡΡΠ°Π»ΠΎΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΌ. ΠΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ²ΡΠ·ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΠΠΠ ΠΈ ΠΠΠ―Π ΠΊΠ°ΠΊ Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ Π»Π΅ΠΆΠ° (Z=-0,08225; p=0,9344), ΡΠ°ΠΊ ΠΈ Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΡΠΈΠ΄Ρ (Z=1,2272, p=0,2198) Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π½Π΅ Π±ΡΠ»ΠΎ. Π§Π°ΡΡΠΎΡΠ° ΠΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 51% (95%ΠΠ 38,8-64). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ―Π, ΡΠ°Π²Π½ΡΠΌ 0 ΠΌΠΌ ΡΡ.ΡΡ. ΠΈΠ»ΠΈ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΡΠΌ, ΡΠ°ΡΡΠΎΡΠ° ΠΈ ΡΡΠΆΠ΅ΡΡΡ ΠΠΠ Π±ΡΠ»Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π±ΠΎΠ»ΡΡΠ΅, ΡΠ΅ΠΌ ΠΏΡΠΈ ΠΠΠ―Π, ΡΠ°Π²Π½ΠΎΠ³ΠΎ ΠΈΠ»ΠΈ Π±ΠΎΠ»ΡΡΠ΅Π³ΠΎ 1 ΠΌΠΌ ΡΡ.ΡΡ. (Ρ
ΠΈ-ΠΊΠ²Π°Π΄ΡΠ°Ρ=4,37; df=1; p=0,036 ΠΈ Z=2,47, Ρ=0,015 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΠΠ―Π ΠΏΡΠΈ ΠΠΠΠ 15 ΡΠΌ Π²ΠΎΠ΄.ΡΡ. ΠΈ ΠΠΠ Ρ etCO2=36 ΠΌΠΌ ΡΡ.ΡΡ. Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ (Z=-0,9784, p=0,3964 ΠΈ Z=-1,3324, p=0,2305 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ).ΠΡΠ²ΠΎΠ΄Ρ. 1. Π€ΠΎΡΠΌΠΈΡΡΡΡΠ΅Π΅ΡΡ ΠΏΡΠΈ ΠΏΠ΅ΡΠ΅Π²ΠΎΠ΄Π΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΠ΄Ρ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ Π² Π²Π΅ΡΡ
Π½Π΅ΠΉ Π»ΡΠΊΠΎΠ²ΠΈΡΠ΅ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π΅ΡΡΡ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ°ΡΡΠΎΡΡ ΠΈ ΡΡΠΆΠ΅ΡΡΠΈ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ Π²ΠΎΠ·Π΄ΡΡΠ½ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ.2.Β Β Β Β Β Β Β Β Β Β Β Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΈ ΡΠΈΠ΄Ρ ΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ Π² ΠΏΡΠ°Π²ΠΎΠΌ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΈ ΠΈ Π²Π΅ΡΡ
Π½Π΅ΠΉ Π»ΡΠΊΠΎΠ²ΠΈΡΠ΅ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ Π½Π΅ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π°.3.Β Β Β Β Β Β Β Β Β Β Β ΠΠ·ΠΎΠ»ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΠΊΠΎΠ½ΡΠ΅ Π²ΡΠ΄ΠΎΡ
Π° ΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π½Π΅ ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡ ΠΊ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π²Π΅ΡΡ
Π½Π΅ΠΉ Π»ΡΠΊΠΎΠ²ΠΈΡΠ΅ ΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²Π΅Π½Ρ
ΠΠ»ΠΈΡΠ½ΠΈΠ΅ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ Π½Π° ΡΠ°ΡΡΠΎΡΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ ΠΎΠ΄Π° Ρ Π²Π·ΡΠΎΡΠ»ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠΉ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ
The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to MayΒ 25,Β 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) ofΒ them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients β after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference inΒ the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid inΒ reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΎΡΠ΅Π½ΠΈΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π²ΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
Π½Π° ΡΠ°ΡΡΠΎΡΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° Ρ Π²Π·ΡΠΎΡΠ»ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π΄ΡΡ
Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠΉ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ, Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ ΠΠ’).ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΡΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠ΅ ΠΊΠ°ΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π½Π°Ρ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
ΡΡ Π½Π° Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π² ΠΠ ΠΠ’ Ρ 1 Π°ΠΏΡΠ΅Π»Ρ ΠΏΠΎ 25 ΠΌΠ°Ρ 2020 Π³. ΠΠ±ΡΠ΅Π΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΎΡΠΎΠ±ΡΠ°Π½Π½ΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΠΊΠ°ΡΡ ΡΠΎΡΡΠ°Π²Π»ΡΠ»ΠΎ 101, Π΄Π°Π»Π΅Π΅ ΠΎΠ½ΠΈ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ. Π Π³ΡΡΠΏΠΏΡ β 1 (n = 49) Π²ΠΊΠ»ΡΡΠ΅Π½Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ, ΠΊΠΎΡΠΎΡΡΠΌ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΠΈΠ½ΡΡΡΡΠ»ΡΡΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π°, Π° Π² ΡΠ»ΡΡΠ°Π΅ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ β ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΡ ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΡΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
. Π Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ Π½Π΅ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΡΡΠΏΠΏΡ β 2 (n = 52) ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ, Ρ ΠΊΠΎΡΠΎΡΡΡ
ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ Π²ΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΡΡ ΠΎΠΊΡΠΈΠ³Π΅Π½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΈ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
. ΠΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΉ ΡΠΎΡΠΊΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ Π²Π»ΠΈΡΠ½ΠΈΡ Π²ΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
ΡΡΠΈΡΠ°Π»ΠΈ ΡΠ°ΡΡΠΎΡΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° Π² ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΡ
Π³ΡΡΠΏΠΏΠ°Ρ
. ΠΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π»ΠΈ ΡΠ°ΠΊΠΆΠ΅ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ, ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Ρ ΠΊΠΎΡΠΎΡΡΡ
ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ, ΡΡΠΈΡΡΠ²Π°Π»ΠΈ ΡΠ°ΡΡΠΎΡΡ ΠΈΡ
Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ, ΡΠΈΡΠ»ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ ΠΈΠ½ΠΈΡΠΈΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΡΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² Π³ΡΡΠΏΠΏΠ΅ β 2 ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½Ρ Π² 31 (60%) ΡΠ»ΡΡΠ°Π΅. ΠΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΡΡ ΠΎΠΊΡΠΈΠ³Π΅Π½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ Ρ 19 (36%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠ· Π½ΠΈΡ
; Π² 13 ΡΠ»ΡΡΠ°ΡΡ
ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΠΎΡΠ»ΡΡΠΈΡΡ ΠΎΡ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΏΠΎΡΠΎΠΊΠ°. ΠΠ΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½Π°Ρ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½Π° Π² 18 ΡΠ»ΡΡΠ°ΡΡ
, Ρ 12 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΅Π΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΏΡΠΈ Π½Π°ΡΠ°ΡΡΠ°Π½ΠΈΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π΄ΡΡ
Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ Π½Π° ΡΠΎΠ½Π΅ ΠΈΠ½ΡΡΡΡΠ»ΡΡΠΈΠΈ ΡΠ²Π»Π°ΠΆΠ½Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π°, Ρ 6 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² β ΠΏΠΎΡΠ»Π΅ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π²ΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΠ½ΡΡΠ±Π°ΡΠΈΡ ΡΡΠ°Ρ
Π΅ΠΈ ΠΈ ΠΏΠ΅ΡΠ΅Π²ΠΎΠ΄ Π½Π° ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΡΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
Π²ΡΠΏΠΎΠ»Π½Π΅Π½Ρ Ρ 25 (51%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π³ΡΡΠΏΠΏΡ β 1, 10 (19,2%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π³ΡΡΠΏΠΏΡ β 2. ΠΠ΅ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈΡΡ
ΠΎΠ΄ Π² Π³ΡΡΠΏΠΏΠ΅ β 1 Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ Π² 23 (47%) ΡΠ»ΡΡΠ°ΡΡ
, Π² Π³ΡΡΠΏΠΏΠ΅ β 2 β Π² 10 (19,2%) (p = 0,004). ΠΠ½Π°Π»ΠΈΠ· ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΡ
Π³ΡΡΠΏΠΏΠ°Ρ
ΠΏΠΎΠΊΠ°Π·Π°Π» ΡΠ°Π·Π»ΠΈΡΠΈΠ΅ Π² Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΠΎΠ³ΠΈΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΡ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»Π° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± + Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄ Π² ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠΈ ΡΠ°ΡΡΠΎΡΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° (p = 0,001).ΠΡΠ²ΠΎΠ΄. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ Ρ Π²Π·ΡΠΎΡΠ»ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ Π΄ΡΡ
Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠΉ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ, Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠ΅ΠΉ Π² ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± + Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ½ΠΈΠ·ΠΈΡΡ ΡΠ°ΡΡΠΎΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π°
Jugular Bulb Pressure in Surgery of Patients in Sitting Position
Background. The pressure in brain sinuses (BSP) is used to monitor the effectiveness of various methods of prevention and treatment of venous air embolism (VAE) during surgeries in patients in the sitting position. A simpler and more approachable way is to measure the pressure in the superior bulb of the jugular vein (JBP), which accurately reflects the BSP. The dependence of the frequency and severity of VAE in JBP, however, has not been investigated, and the data on the effect of various methods of prevention and treatment of VAE on JBP are either insufficient or contradictory. The study was aimed to determine the dynamics of the JBP when bringing the patient to a sitting position, its relation with the severity of the VAE and to assess the effect of right atrium pressure (RAP), positive end expiratory pressure (PEEP) and decreased minute pulmonary ventilation (MPV) on it.Material and methods. The prospective study included 66 people who underwent intracranial surgery in a sitting position. In addition to the standard monitoring under general anesthesia with artificial lung ventilation, the superior bulb of the jugular vein and the right atrium were catheterized, and the esophagus was intubated with transesophageal echocardiography sensor. JBP was measured in a supine and sitting position and examined in relationship to RAP. In patients with JBP<0 mm Hg, its dynamics was evaluated at PEEP<0 cm H20 and MPV with end-tidal carbon dioxide (etCO2)=44 mm Hg, PEEP=15 cm H20 and MPV with etCO2=36 mm Hg. The Tuebingen scale (Tuebingen VAE) was used to determine the severity of VAE.Results. After bringing the patient to the sitting position the JBP significantly (W=2137.5; p<0.001) decreased by an average of 8 mm Hg, while in 11 (16.7%; 95% CI: 8.6-27, 8) cases it remained positive. No correlation was found between the RAP and JBP in the supine position (Z =-0.08225; p=0.9344) and in the sitting position (Z=1.2272, p=0.2198). The VAE frequency was 51% (95% CI 38.8-64). In patients with JBP <0 mm Hg, the frequency and severity of VAE was significantly higher than with JBPβ₯1 mm Hg (chi-square=4.37; df=1; p=0.036 and Z=2.47, p=0.015, respectively). Significant changes of JBP when PEEP 15 cm H2O and MPV with etCO2=36 mm Hg were not found (Z = -0.9784, p=0.3964 and Z=-1.3324, p=0.2305 respectively).Conclusion. 1. The negative JBP after bringing the patient to the sitting position is accompanied by an increase in the frequency and severity of VAE. 2. In patients in a sitting position, the correlation between RAP and JBP was not found. 3. Isolated PEEP and changes in ventilation do not lead to an increase in JBP