INTENSIVE THERAPY OF SHOCK LUNG IN PATIENTS WITH MASSIVE HEMORRHAGE

Abstract

Objective: Presentation of the schemes of prophylaxis and intensive therapy of shock lung (SL), proceeding from the pathogenesis and stage of process development. Methods: The analysis of results of treatment of 42 patients with the phenomena of the shock of II-IV stages upon receipt. In 30 (71.4%) cases, the cause of the shock was massive hemorrhage caused by multiple fractures of limbs and pelvic bones, in 12 (21.6%) – massive gastrointestinal bleeding. All patients assessed: mean arterial pressure (MAP), heart rate (HR), acid-base balance (ABB), K+ and Na+ concentration in blood plasma, total peripheral vascular resistance (TPVR), hemoglobin (Hb), hematocrit (Ht), urea level, shock index (SI). Results: In patients with multiple fractures, the first signs of SL in 60% of cases appeared on 3-5 days, whereas in patients with gastrointestinal bleeding – by the end of first day. Patients with multiple fractures took place: compensated metabolic acidosis, hypoxemia, hypercapnia, hypokalemia, hypernatremia, increased TPVR, decreased Hb and Ht, decreased MAP, tachycardia, SI was 2.3±0.2. Out of 30 patients with fractures, 6 (20%) were transferred to artificial lung ventilation; died 4 (13.3%). The above parameters in patients with gastrointestinal bleeding were worse than in patients with multiple fractures. Conclusion: Proceeding from the complications of the pathogenesis of SL, important correction and preventive measures are the correction of hypovolemia and hypotension, definitive hemorrhage control, adequate immobilization of fractures, improvement of microcirculation, restriction of massive blood transfusion and timely transfer of patients to artificial lung ventilation.

Keywords

• shock lung
• intensive therapy
• massive hemorrhage
• multiple fractures.