Pathophysiological mechanisms of chronic critical conditions in patients in the neuroresuscitation department

Purpose of the work. To determine the existing pathophysiological mechanisms in patients with critical conditions and, in particular, in patients with stroke during the period of chronicization of processes on the part of the respiratory tract and aspects of the work of doctors - endoscopists, as part of the multidisciplinary team involved in the treatment of this group of patients. Materials and methods. In accordance with the set goal, an analysis of the world literature was performed using the TripDataBase search system, which allowed to study and structure the main pathophysiological mechanisms observed in patients with “chronic critical conditions”. The obtained data were implemented in the work of the endoscopic department of the Federal State Budgetary Institution Federal Center for Medical and Biological Affairs of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of the Russian Federation. Results. According to the analysis of the world literature, the most important factors in patients with chronic critical conditions who are in the departments of anesthesiology and resuscitation are respiratory distress syndrome and comorbidity. According to the results of practical work, the features of the endoscopic picture in this group of patients, based on our endoscopic observations, were as follows: erosive and ulcerative changes in the mucous membrane and tracheobronchial dyskinesia of stage II. As a result of the study, an endoscopic algorithm for managing this group of patients was presented, which demonstrated its clinical effectiveness and the results of its application will be presented in the following publications Conclusion. Rehabilitation for stroke during the period of chronicization of processes is carried out by a multidisciplinary team, in which the role of endoscopic methods of treatment has been proven by the clinical experience of using the developed algorithm.

acute cerebrovascular accident, endobronchitis, mucociliary clearance, tracheobronchial dyskinesia, endoscopy, rehabilitation

1. Golubev A. M. Personalized Critical Care Medicine (Review). General Reanimatology. 2022;18(4):45-54. doi: 10.15360/1813-9779-2022-4-45-54.@@ Голубев А. М. Персонализированная медицина критических состояний (обзор). Общая реаниматология. 2022;18(4):45-54. doi: 10.15360/1813-9779-2022-4-45-54.

2. Gaba D. M., Fish K. J., Hauard S. K. Crisis Management in Anesthesia logy. Transl, Eng. Moscow. Medicine Publ. 2000, 440 P (in Russ.)@@ Габа Д. М., Фиш К.Дж., Хауард С. К. Критические ситуации в анестезиологии: Пер. с англ. - М.: Медицина, 2000-440 с.: ил.

3. Order of Ministry of Health of the Russian Federation. No. 796n of December 2, 2014 “On approval of the Regulation on the organization of the provision of specialized, including high -tech medical care”, was registered in the Ministry of Justice of Russia on February 2, 2015. No. 35821.Russia. (editorial office of 08.27.2015-applies from 09/22/2015).@@ Министерство здравоохранения Российской Федерации. Приказ от 2 декабря 2014 г. № 796н «Об утверждении Положения об организации оказания специализированной, в том числе высокотехнологичной медицинской помощи», зарегистировано в МинЮсте России 2 февраля 2015 г. № 35821 (редакция от 27.08.2015-действует с 22.09.2015).

4. Dechert R. E. The pathophysiology of acute respiratory distress syndrome. Respir Care Clin N Am. 2003 Sep;9(3):283-96, vii-viii. doi: 10.1016/s1078-5337(03)00031-5.

5. Lazabnik L. B. [Age and polymorbidity]. Medicine and pharmacy news. 2007; (1):205. (in Russ.)@@ Лазебник Л. Б. Старение и полиморбидность. Новости медицины и фармации. 2007; (1):205.

6. Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970 Dec;23(7):455-68. doi: 10.1016/0021-9681(70)90054-8.

7. Fortin M., Lapointe L., Hudon C., Vanasse A. Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician. 2005 Feb;51(2):244-5. PMID: 16926936.

8. Chuchalin A. G. [Chronic obstructive lung disease and concomitant diseases. Chronic obstructive lung disease]. Moscow. 2011, pp. 448-455. (in Russ.)@@ Чучалин А. Г. Хроническая обструктивная болезнь легких и сопутствующие заболевания // Хроническая обструктивная болезнь легких. - М., 2011. - С. 448-455.

9. Dvoretski L. I. Mucolytic and mucoregulatory drugs in the treatment of chronic bronchitis. RMZ. 2005;13(15):1012. (in Russ.)@@ Дворецкий Л. И. Муколитические и мукорегуляторные препараты в лечении хронического бронхита. РМЖ. 2005;13(15):1012.

10. Braiman A., Priel Z. Efficient mucociliary transport relies on efficient regulation of ciliary beating. Respir Physiol Neurobiol. 2008;163(1-3):202-207. doi: 10.1016/j.resp.2008.05.010.

11. Bustamante-Marin X. M., Ostrowski L. E. Cilia and Mucociliary Clearance. Cold Spring Harb Perspect Biol. 2017;9(4): a028241. doi: 10.1101/cshperspect.a028241.

12. Clary-Meinesz C., Mouroux J., Huitorel P. Ciliary beat frequency in human bronchi and bronchioles. Chest. 1997 Mar;111(3):692-7. doi: 10.1378/chest.111.3.692.

13. Kopieva T. N., Barmina G. V., Grobova O. M., Voronin L. M. [Local protection mechanisms for chronic inflammation in the lungs]. Archive of pathology. 1992;(9):5-12. (in Russ.)@@ Копьева Т. Н., Бармина Г. В., Гробова О. М., Воронина Л. М. Местные механизмы защиты при хроническом воспалении в легких. Архив патологии. - 1992. - № 9. - С. 5-12.

14. Rubin B. K. Physiology of Airway Mucus Clearance. Respir. Care. 2001; 47(7): 761-768.

15. Knowles M. R. Boucher R. C. Mucus clearance as a primary innate defense mechanism for mammalian airways. J Clin Invest. 2002 Mar;109(5):571-7. doi: 10.1172/JCI15217.

16. Chuchalin A. G. [Cough (pathophysiology, clinical interpretation, treatment)] // eds. A. G. Chuchalin, V. N. Abrosimov. Ryazan. LLC Bureau of Advertising «Mila» Publ., 2000. 104 p. (in Russ.)@@ Чучалин А. Г. Кашель (патофизиология, клиническая интерпретация, лечение) / А. Г. Чучалин, В. Н. Абросимов. - Рязань: ООО Бюро рекламы «Мила», 2000. - 104 с.

17. Boucher R. C. Relationship of airway epithelial ion transport to chronic bronchitis. Proc Am Thorac Soc. 2004;1(1):66-70. doi: 10.1513/pats.2306018.

18. Sethi S. Bacterial infection and the pathogenesis of COPD. Chest. 2000 May;117(5 Suppl 1):286S-91S. doi: 10.1378/chest.117.5_suppl_1.286s.

19. Ma J., Rubin B. K., Voynow J. A. Mucins, Mucus, and Goblet Cells. Chest. 2018 Jul;154(1):169-176. doi: 10.1016/j.chest.2017.11.008.

20. Kuchmaeva T. B. [The role of the expiratory stenosis of the trachea and the main bronchi in the development of respiratory failure in patients with non -differentiated connective tissue dysplasia syndrome]. Diss… med. science. Moscow. 2008, 22P. (in Russ.)@@ Кучмаева Т. Б. Роль экспираторного стеноза трахеи и главных бронхов в развитии дыхательной недостаточности у больных с синдромом недифференцированной дисплазии соединительной ткани. Автореферат диссертации. - 2008, 22с.

21. Brodskaya O. A. [Expiratory collapse of the trachea and large bronchi]. Practical pulmonology. 2013;(4):8-11. (in Russ.)@@ Бродская О. А. Экспираторный коллапс трахеи и крупных бронхов. Практическая пульмонология - 2013 - № 4, с. 8-11.

22. Serebryakov D.Yu. [The therapeutic approach to the diagnosis and treatment of patients with tracheobronchial dyskinesia]. Diss… med. sciense. Moscow. 2004, 25P. (in Russ.)@@ Серебряков Д. Ю. Терапевтический подход к диагностике и лечению больных с трахеобронхиальной дискинезией. Автореферат диссертации. - 2004, 25с.

23. Mora R., Arold S., Marzan Y., Suki B., Ingenito E. P. Determinants of surfactant function in acute lung injury and early recovery. Am J Physiol Lung Cell Mol Physiol. 2000 Aug;279(2): L342-9. doi: 10.1152/ajplung.2000.279.2.L342.

24. Haitsma J. J., Lachmann R. A., Lachmann B. Lung protective ventilation in ARDS: role of mediators, PEEP and surfactant. Monaldi Arch Chest Dis. 2003 Apr-Jun;59(2):108-18. PMID: 14635498.

25. Nakos G., Kitsiouli E. I., Lekka M. E. Bronchoalveolar lavage alterations in pulmonary embolism. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1504-10. doi: 10.1164/ajrccm.

26. Nakos G., Tsangaris H., Liokatis S., Kitsiouli E., Lekka M. E. Ventilator-associated pneumonia and atelectasis: evaluation through bronchoalveolar lavage fluid analysis.Intensive Care Med. 2003 Apr;29(4):555-63. doi: 10.1007/s00134-003-1680-8.

27. Ivanova G. E. [We must do our best to help people who have undergone a stroke return to a normal life.Interview]. Effective pharmacotherapy. Neurology and psychiatry. 2011;(4):4-6. (in Russ.)@@ Иванова Г. Е. Мы должны сделать все возможное, чтобы помочь людям, перенесшим инсульт, вернуться к нормальной жизни. Интервью. Эффективная фармакотерапия. Неврология и психиатрия. 2011. -№ 4. - С. 4-6.