[Evaluating the effectiveness of "open lung" maneuvre]

The purpose of this study--a comparative evaluation of the treatment of postoperative acute respiratory insufficiency in cardio surgical patients with lung opening maneuver and conventional mechanical ventilation. The study included 81 patients operated on the heart and magistral vessels in which the immediate postoperative period was complicated by the development of acute lung injury. Patients were divided into 2 groups: 1 (main) group (48 patients), on which the open lung technique was used, 2 (control) group (33 patients) who underwent a standard respiratory support. The initial values of the partial oxygen pressure in arterial blood and the oxygenation index in patients of both groups were significantly reduced, and the fraction of intrapulmonary shunting - significantly increased. Starting with 1 day sharp increase in PaO2 and IE in patients with the first group was noticed, which coincides with the beginning of the opening of the alveoli. At the same time, the dynamics of these indicators in the second group had the reverse tendency. After the recruiting maneuver in all patients significant improvements in the mechanics of breathing were noticed. As a result of the recruiting maneuver in the first group sustained improvement of arterial oxygenation was achieved in 35 patients. In patients with acute postoperative respiratory failure recruiting maneuver led to a significant increase in arterial oxygenation and reduce the fraction of intrapulmonary shunt. Application of "open lung" maneuver leads to the resolution of respiratory failure, which greatly reduces the timing of mechanical ventilation and length of stay of patients in intensive care units in comparison with traditional methods of respiratory therapy.