Prolonged mechanical ventilation via tracheostomy in patients with abdominal sepsis: 616.381:616.94-07-08:616.24-008.4:615.816.2:616.231-089.85

Abstract

Summary. Introduction. Abdominal sepsis (АS) is diagnosed in the treatment of acute abdominal diseases in an average of 30.4–40.3% cases. Prolonged mechanical ventilation (pМV) via tracheostomy in patients with AS requires systematization and clinical evaluation. Аim: to evaluate PМV via tracheostomy in patients with АS. Materials and Methods. From 2021 to 2023 we conducted a prospective non-randomized observational study and studied treatment outcomes of 18 patients with АS and septic shock — 13 (72.22%) men and 5 (27.78%) women, aged from 32 to 85 years. The causes of АS included purulent-inflammatory complications, foci of infection and peritonitis after surgical treatment of various acute abdominal diseases: 11 (61.11%) cases of pancreatic necrosis, 2 (11.11%) cases of appendicitis, 2 (11.11%) cases of type 3 unformed intestinal fistulas, 1 (5.55%) case of acute intestinal obstruction, 1 (5.55%) case of perforated duodenal ulcer, 1 (5.55%) case of mesenteric intestinal thrombosis. Diagnosis and treatment were carried out in accordance with clinical recommendations for sepsis treatment; the treatment strategy employed the “Damage control” concept with relaparotomies performed on request or as part of the program. The condition severity and the prognosis of treatment were assessed using Simplified Acute Physiology Scale (SAPS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scale, and the Severity Rating Scale (2019). All the patients underwent pМV via tracheostomy according to the open method proposed by the authors; 4 (22.22%) patients underwent hemodiafiltration. Results. Gram-negative bacteria were detected in 4 (22.22%) patients and gram-positive bacteria — in 6 (33.33%) patients; no bacteria were detected in the blood of 8 (44.44%) patients. Of 18 patients with AS 9 (50%) survived, which suggests a positive outcome of the proposed treatment regimen for abdominal septic shock, with a mortality rate reaching 70–80%. Conclusion. The SAPS, APACHE II scales, and the Severity Rating Scale (2019) allow to adequately monitor the changes in the condition over time and the treatment prognosis of patients with АS and septic shock. The mortality rate was 50%, and complications of
tracheostomy were 9%.

For citation: Izmailov E.P., Tkebuchava I.V., Katkov S.S., Saifullin R.R. Prolonged mechanical ventilation via tracheostomy in patients with abdominal sepsis. Tromboz, gemostaz i reologiya. 2025;(2):75–82. (In Russ.).

References

1. Clinical guidelines. Sepsis (in adults). Moscow: Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2022. 157 pp. (In Russ.).
2. Sepsis: classification, clinical diagnostic concept and treatment. Ed. B.R. Gelfand. Moscow: MIA, 2017. 213 pр. (In Russ.).
3. RhodesА., Evans L.E., Alhazzani W. et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77. DOI: 10.1007/s00134‑017‑4683‑6.
4. Eskesen T.G., Wetterslev M., Perner A. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med. 2016;42(3):324–32. DOI: 10.1007/s00134‑015‑4168‑4.
5. Kirov M.Yu., Kuzkov V.V., Protsenko D.N. et al. Septic shock in adults: guidelines of the All- Russian public organization “Federation of Anesthesiologists and Reanimatologists”. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2023;(4):7–42. (In Russ.). DOI: 10.21320/1818‑474X‑2023‑4‑7‑42
6. Singer M., Deutschman C.S., Seymour C.W. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‑3). JAMA. 2016;315(8):801–10. DOI: 10.1001/jama.2016.0287.
7. Benz D., Balogh Z.J. Damage control surgery: current state and future directions. Curr Opin Crit Care. 2017;23(6):491–7. DOI: 10.1097/MCC.0000000000000465.
8. Kim M., Cho H. Damage control strategy in bleeding trauma patients. Acute Crit Care. 2020;35(4):237–41. DOI: 10.4266/acc.2020.00941.
9. Izmailov E.P., Trukhanova I.G., Izotov A.Yu. Assessment of the severity of the condition of patients in the provision of emergency therapeutic and surgical care at the inpatient stage: study aid for residents of the specialty 31.08.02 “Anesthesiology-Reanimatology”. Moscow: Aj Pi Ar Media, 2023. 198 pp. (In Russ.).
10. Belokonev V.I., Izmailov E.P. Diagnosis and treatment ofgastrointestinal fistulas: a monograph. Samara: Perspektiva, 2005. 240 pр. (In Russ.).
11. Izmailov E.P., Trukhanova I.G. Severity rating scale for patients and victims. Medicinskij alfavit. 2022;(23):42. (In Russ.).
12. Izmailov E.P., Tikholoz Yu.L., Nagoga A.G., Zhadyaev N.A. Aperture of anterior wall of trachea. Рatent RF No. 2409326 C2 dated of 20.01.2011. Bull. No. 2. 5 рp. (In Russ.). Available at: https://patents.s3.yandex.net/RU2409326C2_20110120.pdf. [Accessed: 20.05.2024].
13. Izmailov E.P., Trukhanova I.G., Saifullin R.R. et al. Method of forming a tracheostoma in coagulopathy. RF Patent No. 2815285 C1 dated of 13.03.2024. Bull. No. 8. 9 pр. (In Russ.). Available at: https://patentimages.storage.googleapis.com/d5/4f/9d/ea644bbb2982f5/RU2815285C1.pdf. [Accessed: 20.05.2024].
14. Bryusov P.G., Urazovsky N.Yu., Kuritsyn A.N., Tariverdiev M.L. Possibilities of using fast-track surgery (FTS) in field surgery. Al’manah Instituta hirurgii imeni A.V.Vishnevskogo. 2017;(1):1248–9. (In Russ.).
15. Zatevakhin I.I., Pasechnik I.N., Gubaidullin R.R. et al. Accelerated postoperative rehabilitation: multidisciplinary issue. Part 1. Hirurgiya. Zhurnal imeni N.I. Pirogova. 2015;(9):4–8. (In Russ.).
16. Esakov Yu.S., Raevskaya M.B., Sizov V.A. et al. The philosophy of rapid rehabilitation in thoracoabdominal surgery. Hirurgiya. Zhurnal imeni N.I. Pirogova. 2016;(11):88–92. (In Russ.). DOI: 10.17116/hirurgia20161188‑92.