Общая реаниматология (Mar 2020)
Respiratory Support During Pulmonary Artery Thromboembolia (Review)
Abstract
Pulmonary artery thromboembolia (PATE) is not a clinical entity as such, but a complication of different diseases and conditions leading to deep thrombosis in the low tension circulation system, right cardiac chambers or causing local thrombosis in the pulmonary artery system. PATE is characterized by complex pathogenesis of respiratory failure of varying severity, which makes it difficult to choose a respiratory support technique.Purpose of the overview: to show advantages of different respiratory support techniques and prospects of high-flux oxygen therapy with regard to PATE pathophysiology.82 sources were selected based on the principle of combining clinical and experimental data from papers published over the recent 5 years and earlier that are still relevant for medical practice.The overview presents the structure of main causes and prevalence of PATE and considers thrombogenesis stages and predominant manifestations of respiratory failure during PATE occurring due to inconsistency between pulmonary ventilation and perfusion. Review discusses five methods of respiratory therapy in PATE patients: low-flux and high-flux oxygen therapy, non-invasive and invasive artificial lung ventilation, extracorporeal blood oxygenation. Finally, the paper shows the efficacy and limitations of these methods.Conclusion. High-flux oxygen therapy seems to be the most effective and promising technique in PATE patients thanks to absence of adverse cardiohemodynamic consequences, subjective comfort for patients, and relation to minimal risks of secondary infectious complications.Nevertheless, the clinical experience accumulated is insufficient to make an absolute choice of one particular technique for respiratory support during PATE. It is necessary to continue investigating the clinical efficacy of high-flux oxygen therapy in the specific population of patients who experienced PATE.
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