Implementation of modern trends in ventilation support in the New Avenir-221R mechanical lung ventilation apparatus

Relevance: with the increasing incidence of COVID-19, it is clear that early detection of the risk of death in patients on mechanical lung ventilation can help ensure proper treatment planning and optimize health resources.Objectives of our study was to identify predictors of the risk of death in patients with COVID-19 who required mechanical ventilation.Material and methods: research design – retrospective, observational, multicenter. Inclusion criteria: clinical, laboratory, and radiological criteria for severe viral pneumonia. Exclusion criteria: death in the first 12 hours of hospitalization. End points: need for mechanical ventilation and death. One hundred and sixty-eight patients met the inclusion criteria. The number of patients who were given a ventilator was 69 (41,1%), 47 (68,1%) of them died. Risk factors were determined by calculating the odds ratio with a 95% confidence interval. The discriminative ability of factors was evaluated using ROC analysis with the calculation of the area under the curve (AUC ROC).Results: the most significant risk factors for require of mechanical ventilation in patients with COVID-19 were a large extent of changes in the lung parenchyma, more than 5 points of the SOFA scale and blood D-dimers >3000 ng/ml. Deceased patients were more likely to be men and initially had statistically significantly higher points of the SOFA scale, neutrophil-to-lymphocyte ratio, and blood interleukin 6 (IL-6) count >186 ng/ml. However, the discriminative ability of these risk factors was moderate (AUC ROC from 0.69 to 0.76). In deceased patients, there were no changes in the PaO2/FiO2 ratio, blood D-dimer count, and SOFA severity assessment in the first three days of intensive care.Conclusion: Predictors of the development of an unfavorable outcome of the disease with moderate discriminative ability in patients with severe COVID-19 on mechanical ventilation are an increased score on the SOFA scale, an increase of the neutrophil-lymphocyte ratio, high levels of D-dimers and IL-6 in the blood.

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Ventilator-Induced Diaphragm Dysfunction (Review)

General Reanimatology ◽

10.15360/1813-9779-2018-3-82-103 ◽

2018 ◽

Vol 14 (3) ◽

pp. 82-103

Author(s):

M. A. Babaev ◽

D. B. Bykov ◽

Т. M. Birg ◽

M. А. Vyzhigina ◽

A. A. Eremenko

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Contractile Function ◽

Clinical Manifestations ◽

Lung Ventilation ◽

Respiratory Support ◽

Diaphragm Dysfunction ◽

Mechanical Lung ◽

Mechanical Lung Ventilation ◽

Ventilation Modes

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy.

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