[Recruiting maneuver used in the treatment of respiratory heart failure in cardiosurgical patients].

The possibility of performing the recruiting artificial ventilation technique with a high plateau and positive end-expiratory pressure was studied in 32 cardiosurgical patients, including those with cardiovascular insufficiency. The lung opening maneuver, by using the artificial ventilation adjustable by pressure and the monitoring peak pressure, PDKV, tidal volume, and dynamic compliance, by accurately determining the points of opening and closure is the method of choice in alveolar recruitment. This method permits a significant improvement of arterial oxygenation and dynamic compliance of the lung in patients with acute respiratory failure. This maneuver using the high airway pressures adversely affects hemodynamics particularly in patients with lowered reserves of the cardiovascular system. In this connection, a careful monitoring of hemodynamic parameters is required for the timely provision of cardiotonic and vasopressor support.

[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome]. / Primenenie neinvazivnoi masochnoi vspomogatel'noi ventiliatsii legkikh pri ostrom respiratornom distress-sindrome u kardiokhirurgicheskikh bol'nykh.

Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. The indications for extubation of patients were as follows: PaO2/FiO2 of 200 and more mm Hg, respiratory rate (RR) of less than 30 per min, respiratory volume of more than 6 ml/kg with pressure support at inspiration of less than 5 cm H2O and with the total pressure at the exhalation end of no more than 3 cm H2O. Mask ventilation sessions were started in a growing dyspnea of more than 26 per min, a decreased content of oxyhemoglobin in arterial blood (below 95% at oxygen inhalation of 10-15 l/min), involvement of auxiliary muscles in breathing and at subjective complaints of patients related with complicated breathing and with being short of air. The mask SIMV ventilation with a preset apparatus-aided rate of inhales of 2-6/min, with Bi-PAP and PSV inhale pressure of 15 cm/ H2O and with PEEP of 3-5 cm/ H2O was made by 40-120 min sessions; the number of IFMLV sessions ranged from 6 to 22/patient, mean - 11 +/- 1.1 h. The total IFMLV duration was 10.7 +/- 1.1 h. The need for respiratory support persisted for 4-6 days after extubation. In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.