Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome

Abstract

Objective. To compare the dynamics of ventilation parameters, mechanical properties of the lungs and gas exchange in the process of respiratory support in patients with a favorable and unfavorable outcome of intensive treatment of necrotic pancreatitis. Methods. The work is based on the results of a single-center observational study. The results of treatment of 94 patients aged from 25 to 65 years with necrotic pancreatitis complicated by acute respiratory distress syndrome and sepsis are analyzed. All patients were divided into two groups: group 1 (68 patients with severe sepsis), group 2 (26 patients with severe sepsis complicated by septic shock). Within each group, patients were divided into two subgroups: the group of sepsis - patients with a favorable outcome (28 patients) and unfavorable outcome (40 patients), in the group of septic shock - patients with a favorable outcome (5 patients) and unfavorable outcome (21 patients). All patients were treated with complex therapy according to international and Russian guidelines for the treatment of pancreatic necrosis, sepsis, and acute respiratory distress syndrome. The evaluation of the mechanical properties of the lungs was performed in patients based on the parameters recorded in the IVL card: F, Vt, MV, PIP, PEEP, CPAP, Clt, Flow. Dynamic assessment of gas exchange was carried out by continuous monitoring of SpO₂, PetCO₂, plethysmography and according to gas analysis. The data were recorded in the mechanical ventilation map with the subsequent calculation of some indicators: FiO₂, PaO₂, PaCO₂, pH, AaDO₂, PaO₂/FiO₂. Results. Patients with necrotizing pancreatitis with a favorable outcome in the process of artificial ventilation of the lungs to ensure sufficient oxygenation during septic shock use significantly higher (by 16.0-18.3 %) levels of PIP and PEEP than in sepsis, as well as more significant disorders of gas exchange in the lungs (by AaDO₂ and PaO₂/FiO₂) compared with sepsis. In sepsis and septic shock with an unfavorable outcome (in comparison with a favorable one), during respiratory support, more pronounced disorders of oxygen status are observed, which indicates the presence of a more severe acute respiratory distress syndrome. In sepsis with a favorable outcome, as opposed to unfavorable, there is a direct correlation between positive changes in oxygen status (PaO₂/ FiO₂) and Vt, PIP, PEEP levels, whereas in septic shock there is no such relationship. Conclusion. The obtained results allowed us to offer a starting regimen of respiratory support for ARDS in patients with necrotic pancreatitis.