Comparative characteristic of impact of noninvasive and invasive pulmonary ventilation on the sepsis course
Objective. To compare the impact of noninvasive and invasive pulmonary ventilation on the course of sepsis, caused by severe neurotrauma, complicated by an acute respiratory distress syndrome of light degree.
Маterials and methods. In a randomized multicenter investigation 60 patients took part (all – the men) with diagnosis: an acute cranio–cerebral trauma, sepsis, an acute respiratory distress–syndrome of light degree. The patients’ average age was (43.8 ± 8.6) yr. Меthod of accidental distribution of patients was used to form two groups with 30 patients in every one. In the first group a regime of coerced invasive pulmonary ventilation with the volume control (Synchronized Intermittent Mandatory Ventilation – SIMV) was applied in the treatment. In the second group a regime of noninvasive pulmonary ventilation (Constant Positive Airway Pressure – СPAP) was applied. There were established the exclusion criteria for the investigation: disorder of cognition, unstable hemodynamics, presence of roentgenological signs of pneumonia. While conduction of ventilation in the SIMV regime a respiratory volume was established and calculated by 4 – 6 ml/kg of the patient’s body mass, the pressure plateau did not exceed 22.5 mm Hg, while end–expiratory positive pressure have constituted 6.0 mm Hg. While conduction of noninvasive pulmonary ventilation there was used the end–expiratory positive pressure 6.0 mm Hg value with supportive pressure up to 11.3 mm Hg, and maximal pressure did not exceeded 22.5 mm Hg.
Results. Ventilation in the СРАР regime have predicted the positive end–respiratory pressure as opposite towards ventilation in the SIMV regime, and the sepsis course improvement, manifested by leukocytosis reduction in 1.3 times, procalcitonin content in the blood serum – in 2 times, occurrence of the ventilator–аssociated pneumonia – in 5 times and mortality index – in 3 times.
Conclusion. The data obtained lead to conclusion, that application of noninvasive pulmonary ventilation in septic patients and acute respiratory distress–syndrome of light degree promotes lowering of the occurrence risk for a ventilator–associated pneumonia and mortality index.
Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China. PLoS One. 2014;9(9): e107181-96. doi: 10.1371/journal.pone.0107181.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2013;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.
Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, et al. Mechanical Ventilation Strategies for Intensive Care Unit Patients Without Acute Lung Injury or Acute Respiratory Distress Syndrome: A Systematic Review and Network Meta-Analysis. Crit Care. 2016;20(1): 226-34. doi: 10.1186/s13054-016-1396-0.
Philippart F, Bouroche G, Timsit JF, Garrouste-Orgeas M, Azoulay E, Darmon M, et al. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection. PLoS One. 2015;10(9): e0137262. doi: 10.1371/journal.pone.
Hodgson C, Cooper DJ, Arabi Y, Bennett V, Bersten A, Brickell K, et al. Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure (PHARLAP): A Protocol for a Phase 2 Trial in Patients With Acute Respiratory Distress Syndrome. Crit Care Resusc. 2018;20 (2):139-149. doi: 10.1164/rccm.201901-0109OC.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287.
Walkey AJ, Goligher EC, Del Sorbo L, Hodgson CL, Adhikari NK, Wunsch H, et al. Low Tidal Volume Versus Non-Volume-Limited Strategies for Patients With Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc. 2017;4(4): 271-79. doi: 10.1513/AnnalsATS.201704-337OT.
Wang X, Xu S, Liu G, Caikai S. Study of timing of invasive and noninvasive sequential ventilation in patients with acute respiratory distress syndrome. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26(5):330-4. doi: 10.3760/cma.j.issn.2095-4352.2014.05.009.
Wu D, Wu C, Zhang S, Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front Pharmacol. 2019; 10:482-9. doi: 10.3389/fphar.2019.00482.
Spalding MC, Cripps MW, Minshall C. Ventilator-Associated Pneumonia: New Definitions. Crit Care Clin. 2017; 33(2):277-92. doi: 10.1016/j.ccc.2016.12.009.
Sevransky JE, Levy MM, Marini JJ. Mechanical Ventilation in Sepsis-Induced Acute Lung Injury/Acute Respiratory Distress Syndrome: An Evidence-Based Review. Crit Care Med. 2004;32 (11):548-53. doi: 10.1097/01.ccm.0000145947.19077.25
Agarwal R, Reddy C, Aggarwal A. Gupta D. Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med. 2006;100(12):2235-8. doi: 10.1016/j.rmed.2006.03.018
Nava S, Schreiber A, Domenighetti G. Noninvasive ventilation for patients with acute lung injury or acute respiratory distress syndrome. Respir Care. 2011;56(10):1583-8. doi: 10.4187/respcare.01209.
Bello G, De Pascale G, Antonelli M. Noninvasive ventilation for the immunocompromised patient: always appropriate? Curr Opin Crit Care. 2012;18(1):54-60. doi: 10.1097/MCC.0b013e32834e7c21.
Tucci MR, Costa EL, Nakamura M, Morais CA. Noninvasive Ventilation for Acute Respiratory Distress Syndrome: The Importance of Ventilator Settings. J Thorac Dis. 2016;8(9): 982-6. doi: 10.21037/jtd.2016.09.29
Luo J, Wang MY, Zhu H, Liang BM, Liu D, Peng XY, et al. Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis. Respirology. 2014;19(8):1149-57. doi: 10.1111/resp.12383.
Grassi A, Foti G, Laffey JG, Bellani G. Noninvasive mechanical ventilation in early acute respiratory distress syndrome. Pol Arch Intern Med. 2017;127(9):614-620. doi: 10.20452/pamw.4088.
This work is licensed under a Creative Commons Attribution 4.0 International License.