medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-6-39-49medalphabet-3103Research ArticleСтатьиВысокопоточная оксигенотерапия при отлучении от респиратора пациентов-канюленосителейHigh-flow oxygen therapy for ventilator weaning patients with tracheostomy cannulahttps://orcid.org/0000-0002-5477-4242КорякинА. Г.KoryakinA. G.

Корякин Альберт Геннадьевич

Москва

Koryakin Albert G.

Moscow

koriakinalbert@gmail.comhttps://orcid.org/0000-0003-4535-2563ВласенкоА. В.VlasenkoA. V.

Власенко Алексей Викторович

Москва

Vlasenko Alexey V.

Moscow

dr.vlasenko67@mail.ruЕвдокимовЕ. А.EvdokimovE. A.

Евдокимов Евгений Александрович

SCOPUS: 33156677

Москва

Evdokimov Evgeny A.

Moscow

ea_evdokimov@mail.ruhttps://orcid.org/0000-0002-7263-0058МаковейВ. И.MakoveiV. I.

Москва

Moscow

nica-m-med@yandex.ruhttps://orcid.org/0000-0002-7320-3322ЕрофеевВ. В.ErofeevV. V.

Москва

Moscow

erofeevvv@rmapo.ruОсиповС. А.OsipovS. A.

Москва

Moscow

serosip@mail.ruhttps://orcid.org/0000-0002-3852-8877РодионовЕ. П.RodionovE. P.

Родионов Евгений Петрович

Москва

Rodionov Evgeny P.

Moscow

dr.rodionov@gmail.comСластниковЕ. Д.SlastnikovE. D.

Москва

Moscow

КлюевИ. С.KlyuevI. S.

Москва

Moscow

ГБУЗ г. Москвы «Городская клиническая больница имени С.П. Боткина Департамента здравоохранения Москвы»РоссияCity Clinical Hospital n.a. S.P. BotkinRussian FederationГБУЗ г. Москвы «Городская клиническая больница имени С.П. Боткина Департамента здравоохранения Москвы»; Кафедра анестезиологии и неотложной медицины ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияCity Clinical Hospital n.a. S.P. Botkin; Russian Medical Academy for Continuing Professional EducationRussian FederationКафедра анестезиологии и неотложной медицины ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian Federation20230806202306Кардиология. Неотложная медицина» (1)3949Copyright © Корякин А.Г., Власенко А.В., Евдокимов Е.А., Маковей В.И., Ерофеев В.В., Осипов С.А., Родионов Е.П., Сластников Е.Д., Клюев И.С., 20232023Корякин А.Г., Власенко А.В., Евдокимов Е.А., Маковей В.И., Ерофеев В.В., Осипов С.А., Родионов Е.П., Сластников Е.Д., Клюев И.С.Koryakin A.G., Vlasenko A.V., Evdokimov E.A., Makovei V.I., Erofeev V.V., Osipov S.A., Rodionov E.P., Slastnikov E.D., Klyuev I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3103Актуальность

Актуальность. На сегодняшний день информация о применении высокопоточной оксигенотерапии (ВПО) у пациентов-канюленосителей носит ограниченный характер. Можно предположить, что использование ВПО у данного контингента пациентов на этапе отлучения от респиратора может улучшить результаты лечения.

Цель исследования

Цель исследования. Улучшение результатов лечения пациентов-канюленосителей с паренхиматозной ОДН различного генеза посредством использования ВПО на этапе отлучения от респиратора после длительной ИВЛ.

Материалы и методы

Материалы и методы. В проспективное открытое когортное исследование включены 50 пациентов в возрасте 45 (от 37 до 57) лет, продолжительность инвазивной ИВЛ – 8,68 ± 3,83 суток. Пациенты рандомизированы на две группы: в группе А отлучение от респиратора проводили посредством сочетания традиционной низкопоточной оксигенотерапии (НПО) и сеансов вспомогательной вентиляции легких (ВВЛ); в группе В – посредством сочетания ВПО и сеансов ВВЛ. В группах сравнивали показатели газообмена, продолжительность отлучения от респиратора, частоту развития осложнений (легочных и внелегочных), продолжительность лечения, летальность в отделении реанимации (ОР) и в стационаре. У всех пациентов анализировали наиболее значимые предикторы внутрибольничной летальности.

Результаты

Результаты. Применение ВПО у пациентов в группе В выявило значимые преимущества по изучаемым показателям на ранних и поздних этапах исследования. Летальность в группах не различалась. Наиболее значимые факторы риска внутрибольничной летальности: возраст более 53 лет (AUC ROC0,856, р < 0,001), реинтубация на ранних стадиях лечения ОДН (ОШ = 9,667; 95% ДИ: 2,414–38,713), канюленосительство после перевода из ОР (р = 0,001).

Выводы

Выводы. Использование ВПО у пациентов-канюленосителей на этапе отлучения от респиратора клинически более эффективно по сравнению с НПО. Оценка факторов риска у каждого пациента позволит оптимально применять ВПО.

Introduction

Introduction. To date, information of the use of high-flow oxygen therapy (HFOT) in patients with tracheostomy cannulas is limited. The use of HFOT in this group of patients at the ventilator weaning may improve outcomes.

Objective

Objective. Improving results of treatment of patients with tracheostomy cannulas with hypoxemic ARF of various origin through the use of HFOT at the ventilator weaning after prolonged mechanical ventilation (MV).

Materials and methods

Materials and methods. The prospective open cohort study included 50 patients aged 45 (from 37 to 57) years, the duration of invasive mechanical ventilation was 8.68 ± 3.83 days. Patients were randomized into two groups: in group A, weaning from the respirator was performed through a combination of traditional low-flow oxygen therapy (LFO) and assisted modes of MV; in group B – through a combination of HFOT and assisted modes of MV. The groups compared gas exchange rates, the duration of weaning from the respirator, the incidence of complications (pulmonary and extrapulmonary), the duration of treatment, mortality in the ICU and in the hospital. In all patients, the most significant predictors of in-hospital mortality were analyzed.

Results

Results. The use of HFOT in patients in group B revealed significant benefits in terms of the studied parameters in the early and late stages of the study. Mortality in the groups did not differ. The most significant risk factors for in-hospital mortality were cannulation after transfer from the OR (OR = 9,667; 95% CI: 2.414–38,713; p = 0,001).

Conclusions

Conclusions. The use of HFOT in patients with tracheostomy cannulas is more clinically effective than COT. Risk factors assessment in every patient will allow optimal use HFOT.

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The authors declare that there are no conflicts of interest present.