CLINICAL AND ECONOMIC SIGNIFICANCE OF MONITORING THE STATE OF THE RESPIRATORY SYSTEM WITH ACTIVE TREATMENT TACTICS FOR PATIENTS WITH SEVERE CHEST TRAUMA
DOI: 10.22138/2500-0918-2018-15-5-658-667
N.S. Davydova1, L.A. Skorokhodova3, S.Yu. Lukin2, E.A. Besedina2, Т.V. Smelyaya4, P.G. Boltaev2
1 Ural State Medical University, Yekaterinburg, Russian Federation;
2 Central City Hospital №36, Yekaterinburg, Russian Federation;
3 Ural Law Institute of the Ministry of Internal Affairs of Russia, Yekaterinburg, Russian Federation;
4 V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russian Federation
Abstract. Aims. The goal based on monitoring the parameters of respiratory biomechanics, such as Pes (intrasophageal pressure), Ptp (transpulmonary pressure), compliance (Cstat), elasticity of the lungs (Clang), and chest (Ccw), minute volume of carbon dioxide (VCO2), the work spent on breathing by the patient (WOBp), to analyze the results of active surgical treatment tactics on the outcomes of treatment of patients with blunt chest trauma, to evaluate the effect of complex treatment of patients of this group on the duration of stay in the intensive care unit, the duration of mechanical ventilation in the study group, the number of infectious complications in the group, the need for antimicrobial agents, and the cost-effectiveness of the technique used. Material and methods. From 2003 to 2018, a multicentre, open, controlled retrospective and prospective study was conducted at the following bases: the clinical hospital of the Central City Hospital No. 36, Yekaterinburg and the Main Military Clinical Hospital of the Russian National Guard, Balashikha. During the study, 2 groups of patients were formed: the control group and the main one. Conclusions: Absence of statistically significant Pes change, Ptp median in the postoperative period, growth of PaO2/FiO2 and significant changes in VCO2 indices confirm the necessity and safety of conducting active surgical tactics in the group of victims with TTGC and increases the sensitivity of the CPIS scale. The significant decrease in the duration of stay in the intensive care unit and the duration of mechanical ventilation in the study group can significantly reduce the number of infectious complications in the group, reduce the need for antimicrobial drugs, which significantly affects the economic effectiveness of integrated treatment.
Keywords: Severe chest trauma, surgical fixation, artificial ventilation, intestinal and median transpulmonary pressure
There is no conflict of interest.
Contact information of the author responsible for correspondence:
Nadezhda S. Davydova
davidovaeka@mail.ru
Received 19.10.2018
For citation:
Davydova N.S., Skorokhodova L.A., Lukin S.Yu., Besedina E.A., Smelyaya Т.V., Boltaev P.G. Clinical and economic significance of monitoring the state of the respiratory system with active treatment tactics for patients with severe chest trauma. Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2018, Vol. 15, no. 5, pp. 658–667. DOI: 10.22138/2500-0918-2018-15-5-658-667 (In Russ)
REFERENCES
1. Khmara AD, Norkin IA, Khmara TG. Tactics of treatment for combined chest trauma and limb segments. Saratov Journal of Medical Scientific Research, 2012, vol. 8, No. 4. from. 982 — 988 (In Russ)
2. Chen R., Gabler H.C. Risk of thoracic injury from direct steering wheel impact in frontal crashes. J Trauma Acute Care Surg 2014; 76: 1441.
3. Unsworth A., Curtis K., Asha S.E. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015, 23:17
4. Yih-Wen Tarng, Yuan-Yuarn Liu, Fong-Dee Huang, Hsing-Lin Lin, Tzu-Chin Wu and Yi-Pin Chou. The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure. Surg Endosc. 2016; 30: 388-395.
5. Sung Kwang Lee and Do Kyun Kang. Nuss procedure for surgical stabilization of flail with horizontal sternal body fracture and multiple bilateral rib fractures. J Thorac Dis. 2016 Jun; 8 (6): E390-E392.
6. Shen N.P., Davydova NS, Boltaev PG, Lukin S.Yu., Ushakov SA, Skorokhodova LA, Mukhacheva S.Yu., Vasilenko P.B. Comparative study of the tactics of surgical fixation with closed chest trauma: the view of the resuscitator, economic aspects. Anesthesiology and Reanimatology. 6. 2015. P.54-58 (In Russ)
7. Danielyan Sh.N., Abakumov MM, Saprin AA, Chernenkaya TV / Treatment of pulmonary hemorrhages and their complications with closed trauma of the chest. Surgery, 2012. №5. P.37-41 (In Russ)
8. Diagnosis and intensive treatment of acute respiratory distress syndrome. Clinical recommendations of the PHAR on October 4, 2015 (In Russ)
9. Vlasenko AV, Moroz VV, Yakovlev VN, Alekseev VG, Bulatov NN. Choice of the method for optimization of PEEP in patients with acute respiratory distress syndrome. General resuscitation. Volume VIII. №1. 2012. P.13-21 (In Russ)
10. Voskresensky OV, Trofimova E.Yu., Radchenko Yu.A., Abakumov MM. The role of ultrasound in the selection of surgical tactics for wounds of the chest. Surgery, 2011. №12. C.10-15 (In Russ)
11. Abakumov MM, Sharifullin FA, Pinchuk TP, Danielyan Sh.N., Popova IE, Kvardakova OV, Saprin AA Diagnosis and treatment of pulmonary hemorrhage at closed trauma of the chest. Surgery, 2011. № 4. P.17-24 (In Russ)
12. Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma 2002; 52: 727-732.
13. Davydova NS, Skorokhodova LA, Boltaev PG, Besedina EA, Shen N.P., Mukhacheva S.Yu. Prognostic significance of monitoring respiratory biomechanics in differentiated therapy of ventilator-associated pulmonary complications in patients with severe combined trauma with lesion of chest organs Medical Science and Education of the Urals. 2016. V.17. No. 2. P.17-22 (In Russ)
14. 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): 583-587.
15. París E., Tarazona V., Blasco E., Cantó A., Casillas M., Pastor J., París M and Montero R. Surgical stabilization of traumatic flail chest. Thorax. 1975 Oct; 30 (5): 521-527.
16. 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 Jun; 103 (2): 120-125. Epub 2014 Apr 29.
17. Simon B., Ebert J., Bokhari F., Capella J., Emhoff T., Hayward T. 3rd, Rodriguez A., Smith L.; Eastern Association for the Surgery of Trauma. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov; 73 (5 Suppl 4): S351-61.
18. Yaroshetsky AI, Protsenko DN, Rezepov NA, Gelfand BR. Adjusting the positive end-expiratory pressure in parenchymal ventilation: Static loop «pressure volume» or transpulmonary pressure? Anesthesiology and Reanimatology. 2014. No, 4. pp. 53-59 (In Russ)
19. Mietto C., Pincirroli R., Patel N., Berra L. Ventilator Associated Pneumonia: Evolving definitions and preventive strategies. Resp. Care, June, 2013, Vol. 58, No. 6, pp. 990-1008.
20. Shabanov AK, Khubutia M.Sh., Bulava GV, Beloborodova NV. Dynamics of the level of procalcitonin in the development of nosocomial pneumonia in patients with severe combined trauma. General resuscitation. 2013. IX. 5. P.11-17 (In Russ)
21. Mardganieva EA, Mironov PI, Rudnov VA Diagnosis and treatment of ventilator-associated pneumonias in children. Anesthesiology and resuscitation. 2006. No. 1. pp. 34-38 (In Russ)
22. Gelfand BR, Yaroshetsky AI, Protsenko DN, Ignatenko OV, Lapshina I.Yu., Gelfand EB. Parenchymal respiratory failure in patients in critical states: is this always respiratory distress syndrome? Bulletin of Intensive Therapy. 2014. No. 4. pp. 3-9 (In Russ)
23. Shabalin A.Yu. Treatment of the wounded with combat with fighting chest damage in local armed conflicts: dissertations (In Russ)
24. Benyan A.S., Korymasov A.E., Pushkin S.Yu., Kameev I.R. Justification of the expansion of indications for osteosynthesis of the ribs with a closed chest injury Analogs of surgery. 2015. No. 4. pp. 27-33. (In Russ)
Authors
Nadezhda S. Davydova
Ural State Medical University
Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation, Vice-Rector for Academic Affairs of the Ural State Medical University
Russian Federation, 620028, Yekaterinburg, 3 Repin str.
davidovaeka@mail.ru
Larisa A. Skorokhodova
Ural Law Institute of the Ministry of Internal Affairs of Russia
Cand.Sci. (Economic), Associate Professor of the Department of Social and Economic Disciplines
Russian Federation, 620057, Yekaterinburg, ul. Corepin 66
larissa.15@me.com
Stanislav Yu. Lukin
City Hospital №36 «Traumatology»
Cand. Sci. (Med.), Honored Doctor of Russia, Chief Doctor
Russian Federation, 620007, Yekaterinburg, st. Central 2
lukin-s.u@mail.ru
Ekaterina A. Besedina
City Hospital №36 «Traumatology»
Department of Anesthesiology and Resuscitation, doctor
Russian Federation, 620007, Yekaterinburg, st. Central 2
besedina_ekateri@mail.ru
Pavel G. Boltaev
City Hospital №36 «Traumatology»
Cand. Sci. (Med.), Head of Anesthesiology and Resuscitation
Russian Federation, 620007, Yekaterinburg, st. Central 2
dr.boltaev@mail.ru
Tamara V. Smelaya
V.A. Negovsky Research Institute of General Reanimatology
Dr. Sci. (Med.), Associate Professor, Professor of the Department of Anesthesiology-Resuscitation
Russian Federtion, 107031 Moscow, st. Petrovka 25
tamara_smelaya@mail.ru