Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector10890110.17816/medjrf108901Clinical medicineКлиническая медицинаResearch ArticleHigh-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantagesВысокопоточная назальная оксигенотерапия у пациентов после вмешательств на пищеводе — преимущества и недостаткиhttps://orcid.org/0000-0002-7145-8516GeyzeAnton V.ГейзеАнтон Викторович
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

antongeyze@mail.ruhttps://orcid.org/0000-0002-9354-0828KorolevaIuliia V.КоролеваЮлия Владимировна
Russian Federation
ykoroleva@med-rf.ruhttps://orcid.org/0000-0002-4291-3380PlotnikovGeorgy P.ПлотниковГеоргий Павлович
Russian Federation

MD, Dr. Sci. (Med.)

д.м.н.

georgpp@mail.ruhttps://orcid.org/0000-0002-6951-1816KovalerovaNatalya B.КовалероваНаталья Борисовна
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

kovalerova.nat@gmail.comhttps://orcid.org/0000-0002-8776-1368ManevskiyAndrey A.МаневскийАндрей Александрович
Russian Federation

MD, Cand. Sci. (Med.), assistant

к.м.н., ассистент

a_manevskiy@mail.ruA.V. Vishnevski National Medical Research Center of SurgeryНациональный медицинский исследовательский центр хирургии им. А.В. ВишневскогоNational Medical Research Center «Treatment and Rehabilitation Center»Национальный медицинский исследовательский центр «Лечебно-реабилитационный центр»Pirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова2607202228137452106202222062022Copyright ©; 2022, Eco-VectorCopyright ©; 2022, ООО "Эко-Вектор"2022Eco-VectorООО "Эко-Вектор"https://medjrf.com/0869-2106/article/view/108901

BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.

AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.

MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patient’s tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.

RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.

CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patient’s condition and ventilation requirement.

Обоснование. Легочные осложнения у пациентов после эзофагэктомии с одномоментной пластикой пищевода являются частой причиной смертности в реанимации (ОРИТ). В то же время применение неинвазивной вентиляции легких (НИВЛ) у таких пациентов не показано из-за развития несостоятельности эзофагогастроанастомоза. В сравнении с НИВЛ и стандартной оксигенотерапией, высокопоточная оксигенотерапия (ВПО) уменьшает частоту перевода пациента на искусственную вентиляцию легких (ИВЛ) при острой дыхательной недостаточности (ОДН).

Цель исследования — оценка клинических преимуществ и недостатков ВПО у пациентов с дыхательной недостаточностью после эзофагэктомии.

Материалы и методы. Обследованы 90 пациентов с эзофагэктомией. Путем рандомизации сформированы 2 группы: 1-я (n=45) со стандартной респираторной терапией (СРТ), побудительная спирометрия, назальная оксигенотерапия с сеансами НИВЛ с незначительным давлением в конце выдоха (до 6 мм рт. ст.; 2-я (n=45) — с ВПО. Параметры терапии подбирали по индексу оксигенации (PaO2/FiО2), сатурации (SaО2). Анализировали изменения параметров, длительность сеанса, переносимость пациентом методов респираторной терапии (от 1 до 10 баллов), динамику рентгенологической картины органов грудной клетки, продолжительность лечения в реанимации.

Результаты. Показаны преимущества ВПО: пациенты не испытывали дискомфорта в течение сеанса; возможность снижать поток О2, необходимый для адекватного уровня оксигенации; высокий поток с управляемой фракций О2 позволяет достигать целевых значений индекса оксигенации; снижение частоты перевода пациентов на ИВЛ; времени нахождения в ОРИТ.

Заключение. Применение ВПО оправдано в составе комплексной респираторной терапии у пациентов с дыхательной недостаточностью средней степени. У пациентов с тяжелой дыхательной недостаточностью ВПО является альтернативой другим методам с высоким потоком и НИВЛ. Выбор между этими методами должен быть индивидуализирован и зависит от состояния пациента, потребности в вентиляции легких.

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