Active management of patients with severe chest injury: clinico-economic significance and predictors of mortality (multiple-center study)

Shen N.P.

Federal State Budgetary Educational Institution of Higher Education 'Tyumen State Medical University' of the Ministry of Healthcare of the Russian Federation, Russia, 625023, Tyumen, 625023, ul. Odesskaya, 54

Davydova N.S.

Ural State Medical University under the Ministry of Health of the Russia, Yekaterinburg, Russia, 620028

Smelaya T.V.

Negovskiy Research Institute of General Intensive Care, Moscow, Russia

Lukin S.Yu.

Ilizarov Russian Scientific Center, 640014, Kurgan, Russia;
Tyumen State Medical University, 625023, Tyumen, Russia

Besedina E.A.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Stolbikov S.A.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Skorokhodova L.A.

Ural State Medical University, Ekaterinburg, Russia

Boltaev P.G.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Panov I.D.

Tyumen State Medical University, Tyumen, Russia;
Tyumen Regional Clinical Hospital 2, Tyumen, Russia

Mukhacheva S.Yu.

Tyumen State Medical University of the Ministry of healthcare of the Russia, Tyumen, Russia

Active management of patients with severe chest injury: clinico-economic significance and predictors of mortality (multiple-center study)

Authors:

Shen N.P., Davydova N.S., Smelaya T.V., Lukin S.Yu., Besedina E.A., Stolbikov S.A., Skorokhodova L.A., Boltaev P.G., Panov I.D., Mukhacheva S.Yu.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2020;(2): 40‑47

DOI: 10.17116/anaesthesiology202002140

Downloaded: 131

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To cite this article:

Shen NP, Davydova NS, Smelaya TV, et al. . Active management of patients with severe chest injury: clinico-economic significance and predictors of mortality (multiple-center study). Russian Journal of Anesthesiology and Reanimatology. 2020;(2):40‑47. (In Russ.)
https://doi.org/10.17116/anaesthesiology202002140

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Objective. To analyze active management of patients with severe chest injury using early rib stabilization based on respiration biomechanics monitoring and reveal the predictors of mortality. Material and the methods. A retrospective and prospective study was performed in 2 groups of patients. The control group (n=70) retrospectively included the victims who underwent pleural drainage and sedation if it was necessary. In the main group (n=37), active surgical approach with early rib stabilization was applied. Results. Analysis of active management of patients with severe chest injury including early rib stabilization and respiration biomechanics monitoring revealed the predictors of unfavorable outcomes. The absence of significant changes of respiration biomechanics in postoperative period and increased oxygenation index (PaO2/FiO2) confirm advisability and safety of active surgical approach. The authors found reduced ICU-stay, duration of ventilation, number of infectious complications and need for antimicrobial drugs. These aspects have essential effect on the economic effectiveness of complex treatment.

Keywords:

severe chest injury

active management

mechanical ventilation

intraesophageal pressure

median transpulmonary pressure

Authors:

Shen N.P.

Davydova N.S.

Ural State Medical University under the Ministry of Health of the Russia, Yekaterinburg, Russia, 620028

Smelaya T.V.

Negovskiy Research Institute of General Intensive Care, Moscow, Russia

Lukin S.Yu.

Ilizarov Russian Scientific Center, 640014, Kurgan, Russia;
Tyumen State Medical University, 625023, Tyumen, Russia

Besedina E.A.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Stolbikov S.A.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Skorokhodova L.A.

Ural State Medical University, Ekaterinburg, Russia

Boltaev P.G.

Municipal Traumatological Hospital No. 36, Ekaterinburg, Russia

Panov I.D.

Tyumen State Medical University, Tyumen, Russia;
Tyumen Regional Clinical Hospital 2, Tyumen, Russia

Mukhacheva S.Yu.

Tyumen State Medical University of the Ministry of healthcare of the Russia, Tyumen, Russia

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