Background. In recent decades, respiratory therapy radically changed and continues to change approaches to the treatment of many diseases that are accompanied by the development of respiratory failure. An important issue of intensive care is timeliness of early respiratory support. In this article, we have tried to describe the causes of respiratory failure, the beginning and features of mechanical ventilation in group of patients with intra-abdominal hypertension caused by acute severe pancreatitis. Materials and methods. In this study, we have analyzed the group of 10 patients who had been suffering from acute severe pancreatitis complicated by the acute respiratory failure. Intra-abdominal pressure was measured to all patients using intra-vesical route. The measurement of intra-abdominal pressure (IAP) was performed when patients entered intensive care unit (ICU), before and after intubation (Kron, Iberti technique). Results. Seven patients needed artificial lung ventilation within first 2–3 days of staying in the ICU. They all had intra-abdominal hypertension (World Society of the Abdominal Compartment Syndrome grades 2–4). IAP increased from 5 to 22 % after the beginning of artificial lung ventilation. Conclusions. The development of respiratory failure in patients with severe acute pancreatitis correlates with the increase of intra-abdominal hypertension. The presence of intra-abdominal hypertension is a pathophysiological component of acute respiratory failure and can be one of the criteria of early respiratory support. Invasive mechanical ventilation increases IAP, but which parameter has got the most significant influence on these changes requires further research. Timeliness of early respiratory therapy in patients with acute severe pancreatitis is without doubt one of the main priorities of fighting mortality, but the presence of intra-abdominal hypertension greatly complicates its implementation and definitely requires further researches of ways of optimization.
respiratory therapy; intra-abdominal hypertension; mechanical ventilation; acute severe pancreatitis; acute respiratory distress syndrome
Pelosi P., Vargas M. Mechanical ventilation and intra-abdominal hypertension: Beyond Good and Evil // Critical Care. — 2012. — 16. — 187. doi: 10.1186/cc11874.
Maltseva L.O., Mosentsev M.F., Bazylenko D.V., Bilan O.M., Kunik L.V. Respiratory Distress Syndrome: Current Issues of Definitions, Clinical Presentation, Diagnostic Algorithm // Emergency Medicine. — 2016. — № 4(75). — P. 108-110. doi: 10.22141/2224-0522.214.171.1246.75827.
Raniery V.M., Rubenfeld D. еt al. Acute respiratory distress-syndrome: Berlin definition // JAMA. — 2012. — № 307(23). — P. 2526-2533. doi: 10.1001/jama.2012.5669.
Santos C.L., Moraes L., Santos R.S., Oliveira M.G., Silva J.D., Maron-Gutierrez T., Ornellas D.S., Morales M.M., Capelozzi V.L., Jamel N., Pelosi P., Rocco P.R., Garcia C.S. Effects of different tidal volume in pulmonary and extrapulmonary lung injury with or without intrabdominal hypertension // Intensive Care Med. — 2012. — 38. — 499-508. 10.1007/s00134-011-2451-6.
Dean R., Hess Ph.D. RRT FAARC. Respiratory Mechanics in Mechanically Ventilated Patients // Respir. Care. — 2014. — 59(11). — 1773-1794. doi: 10.4187/respcare.03410.
Satishur O. Mechanical lung ventilation. — Minsk, 2006.
Goriachev A., Savin I. Essentials of artificial lung ventilation. — Moscow, 2009.