Respiratory Therapy in Polytrauma
Background. State of polytrauma patients is usually complicated by the development of multiple organ dysfunction, one of the main components of which is the acute respiratory dysfunction (ARD). Respiratory distress syndrome is the cause of ARD. Mortality in patients with ARD reaches 27–45 %. The objective of this work is to discuss the indications for respiratory therapy, technology of its implementation in polytrauma patients and transferring patients to spontaneous breathing after prolonged mechanical ventilation (MV). Materials and methods. 32 polytrauma patients were admitted to two clinical bases of anesthesiology and intensive care department of Lviv National Medical University named after Danylo Halytskyi (Lviv municipal emergency clinical hospital and Lviv clinical hospital № 8) during 2015. The severity of trauma was assessed using ISS scale — 18 ± 1, the severity of patient’s condition was evaluated by APACHE scale — 21–23 points, and the severity of multiple organ dysfunction by SOFA scale — 5–7 points. Results. Determining the presence or absence of ARD was made using Berlin definitions (Тhe ARDS Definition Task Force, 2012). Therapy of respiratory dysfunction was performed using step by step method: O2 inhalation — noninvasive mechanical ventilation — invasive mechanical ventilation. Invasive MV was performed using pressure control ventilation (PCV) technology. We have discussed the tactics of correction of output MV parameters in case of poor blood oxygenation and the weaning tactics in patients with prolonged lung ventilation. All the weaning technologies were held using one of the forced-assisted regimes of ventilation: SIMV/PSV, PSIMV/PSV, BIPAP/PSV trying to transfer patients to assist regimes (PSV CPAP) and then to wean from the respirator. Conclusions. In our opinion, the most important parameter, which indicates the need for MV, is PaO2 ≤ 65–70 mmHg at FiO2 — 0.4–0.45. Therapy of respiratory dysfunction should be made using step by step method: O2 inhalation — noninvasive mechanical ventilation — invasive mechanical ventilation. Weaning in polytrauma patients should be performed using one of the forced-assisted regimes: SIMV/PSV, PSIMV/PSV, BIPAP/PSV trying to transfer patients to assist regimes (PSV CPAP) and then to spontaneous breathing, monitoring presence of patient’s «respiratory comfort» (Vt — 7–9 ml/kg, f = 12–15/min, SaO2 > 94 %, PaO2 ≤ 65–70 mmHg).
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