RU2223769C1 - Method for treating acute stenosing laryngotracheobronchitis in children - Google Patents

Abstract

FIELD: medicine, otolaryngology. SUBSTANCE: at the background of medicinal therapy, tracheal intubation and physiotherapy it is necessary to make an impact upon affected parts of laryngeal mucosa behind the walls of intubation tube with air-gaseous flow containing 2000 - 2500 mg/cu. m nitrogen monoxide for 30-90 sec daily, at 3-8 seances/course. The present innovation decreases terms of intubation, prevents complications in the form of scar laryngeal and tracheal stenosis due to permeability of air-gaseous flow of nitrogen monoxide between the walls of intubation tube and mucosa and direct impact upon affected parts of mucosa that, in its turn, leads to stimulation of epithelization, improved circulation, decreased mucosal edema, activation of fibroblasts. EFFECT: higher efficiency in preventing infection of affected mucosa. 2 ex

Description

 The invention relates to medicine, namely to otorhinolaryngology, and can be used in the treatment of pathological changes in the larynx and trachea during prolonged intubation in acute stenotic laryngotracheobronchitis.

 Acute stenosing laryngotracheobronchitis (OSL) most often occurs in children against the background of acute respiratory viral infection (ARVI) in the presence of a weakened premorbital condition, exudative diathesis, prior allergization. Especially often, OSL develops in children in the first three years of life. In cases where OSL leads to the development of stenosis of the larynx of the II-III stage, it is necessary to proceed to the immediate restoration of patency of the larynx, i.e. to intubation of the trachea (insertion of a special tube into the lumen of the larynx and trachea), and if the latter is ineffective, to conduct a tracheotomy. The use of prolonged tracheal intubation reduced mortality from OSL during ARVI and led to a distinct reduction in the number of tracheotomies.

 But after prolonged intubation, the number of children with cicatricial laryngeal stenosis (RSH) increased in the post-intubation period. The main reasons for this complication of prolonged intubation may be: trauma to the laryngeal mucosa as a result of using tubes larger in diameter than the lumen of the baby's larynx; non-compliance with asepsis rules; non-observance of the terms of peri-intubation, etc. Thus, the prevention and treatment of OSL are the most important link in the prevention of RSH, which, in turn, is one of the most severe disabling diseases.

 There is also a method for the complex treatment of exacerbations of chronic inflammation in the tracheobronchial tree using inhalation of the NO-containing gas stream of the Plazon apparatus ("NO-therapy: theoretical aspects, clinical experience and problems of using exogenous nitric oxide in medicine", edited by Grachev S. V., Shekhtera A.B., Kozlova N.P. "Publishing House" Russian Doctor "," 2001, p.119-120). Inhalations were carried out by inhalation of a cooled gas stream through the mouth, daily, in courses of 6-8 days. The data obtained showed that the use of inhaled air-plasma NO-therapy contributed to a reduction in the duration of clinical recovery by 3-5 days compared with the control group. Against the background of NO-therapy, the relief of cough accelerated, the purulent character of sputum changed, and the respiratory function improved faster.

 However, inhalation of a NO-containing gas stream is ineffective in the treatment of OSL in intubated patients, because pathologically altered mucous membrane of the larynx and trachea in this case is not directly affected by nitric oxide due to the fact that it is located behind the wall of the endotracheal tube.

 Currently, one of the most well-known and frequently used methods of treating OSL in children is a method that includes complex drug therapy, tracheal intubation, endotracheal tube inhalation, and physiotherapy. A pre-intubated patient is kept in a specialized or adapted vapor-oxygen chamber with periodic use of drug aerosol-oxygen inhalations. This method requires compliance with the following sequence of manipulations: inhalation of bronchodilators and desensitizing drugs; inhalation of mucolytics; postural drainage and lavage of the tracheobronchial tree; inhalation of antibiotics (E.V. Melnikova, M.A. Schuster, etc. "Acute stenotic laryngotracheobronchitis in acute respiratory viral infections in children. Inf. letter for doctors. M., published by MONIKI, 1985, p.6 prototype).

 The disadvantage of this method is that in an intubated patient, a pathologically altered mucous membrane of the larynx itself is not exposed to drugs used in inhalation, because it is located behind the endotracheal tube wall.

 The task posed by the authors is to eliminate these shortcomings by directly affecting the affected areas, increase the effectiveness of treatment, reduce the time of intubation, and prevent complications in the form of cicatricial stenosis of the larynx and trachea.

To this end, in a method of treating acute stenosing laryngotracheobronchitis in children, including complex drug therapy, tracheal intubation, physiotherapy, it is proposed to additionally affect the affected areas of the larynx mucosa behind the walls of the endotracheal tube with an air-gas stream containing 2000-2500 mg / m ³ of nitrogen monoxide within 30-90 s, daily, for a course of 3-8 sessions (exposure time and number of sessions are determined by individual indications).

 The proposed effect in these modes allows the air-gas flow to penetrate between the walls of the endotracheal tube and the mucous membrane, directly reaching the affected areas of the mucosa, stimulating epithelization, improving blood circulation, reducing swelling of the mucous membrane, activating fibroblasts, and preventing infection of the affected mucous membrane.

 The method is as follows.

 The patient is intubated with a trachea and complex drug therapy is prescribed depending on the severity of the condition, including antibacterial and antiviral drugs, immunocorrectors, and drugs that support homeostasis. Physiotherapy (UV, UHF), inhalation through an endotracheal tube and NO-therapy are performed.

An air-gas stream containing nitric oxide (NO-therapy) is brought into the larynxopharynx via a catheter made of hypoallergenic plastic. Such a flow is generated by a stimulator-manipulator operating at maximum air flow. A 1.5 m long silicone tube with a metal tip mounted at its end with an outlet of 0.7 mm is attached to the manipulator. A catheter is attached to the tip, which, in turn, is carried out into the larynxopharynx to the level of the glottis. Previously, the larynxopharynx is cleared of sputum and saliva using an aspirator. A gas stream containing nitric oxide diffusely penetrates between the wall of the endotracheal tube and the mucous membrane of the larynx, exerting a direct effect on pathologically altered tissues. The content of NO in the gas stream 2000-2500 mg / m ³ . The temperature of the gas stream is about 20-25 ^o C (room temperature). The exposure time is selected empirically, depending on the age of the child and the severity of the condition and ranges from 30 to 90 seconds. The session is held 1 time per day. The course of treatment consists of 3-8 sessions.

 The experience of the treatment is 26 patients aged 7 days to 7 years. None of the children who were on prolonged intubation, against the background of the conducted NO-therapy, had inflammatory and purulent complications in the area of the mouth, larynx, pharynx, and trachea. All children were extubated. Subsequently, their condition did not require repeated intubation.

Example 1
Patient U., 8.5 months., Was admitted to the children's intensive care unit (DRO) with a diagnosis of Acute respiratory viral infection. Stenosing laryngotracheobronchitis. Laryngeal stenosis, II-III art. Bilateral bacterial pneumonia. From the anamnesis: I became ill acutely a week before, when a barking cough appeared, an increase in body temperature up to 38 ^o C. I entered the intensive care unit at the place of residence with the phenomena of stenosis of the I-II stage, received conservative therapy, due to respiratory failure was intubated . For further treatment was transferred to a central clinic.

 The condition at admission is serious. The skin is pale pink, the lips are covered with crusts. Breathing through the nasotracheal tube, respiratory rate 44-46 per minute. Auscultatory: hard breathing, carried out in all departments, wire rales are heard.

The child received conservative therapy, which includes antibacterial, anti-inflammatory, antispasmodic, detoxification, desensitizing therapy, vitamin therapy, physiotherapeutic therapy - UHF on the larynx and chest, inhalation of mucalytics and antibiotics. Against the background of conventional therapy, 3 sessions of NO-therapy were carried out: the gas flow was directed along the catheter into the lumen of the larynxopharynx, previously purified from sputum and saliva using an aspirator. The NO content in the gas stream 2000 mg / m ³ , exposure 30 s, was carried out for 1 session per day. Five days after admission to the hospital, the child is extubated. Upon further observation, the child breathed through the natural ways, there were no phenomena of laryngeal stenosis. After 7 days, he was transferred for aftercare to the hospital at the place of residence.

Example 2
Patient N., 1.5 years old, was admitted to the intensive care unit with a diagnosis of acute respiratory viral infection. Stenosing laryngotracheobronchitis. Stenosis of the larynx III tbsp. Bilateral bacterial pneumonia. From the anamnesis it is known that he is sick for 6 days, when a cough, hoarseness appeared. From the 2nd day of the disease, he was hospitalized in DRO at the place of residence, and received conservative therapy. On the third day of the disease, due to respiratory failure, he was intubated and transferred to artificial lung ventilation. Later, an attempt was made to extubate, but after several hours of independent breathing, stenosis of the larynx developed, and therefore was re-intubated. On the fourth day - worsening condition - convulsions, cardiac arrhythmia appeared, transferred to the central clinic.

 The condition is serious, the skin is pale pink. Herpetic lesions of the lips. Free breathing through the orotracheal endotracheal tube. Auscultatory breathing is carried out in all departments, rales of various sizes are heard. On the day of admission, direct laryngoscopy and tracheobronchoscopy were performed, in which edema of the mucous membrane of the larynx and trachea was revealed. The baby is intubated through the nose.

The child received conservative therapy, including antibacterial, antiviral, anti-inflammatory, antispasmodic, detoxification, desensitizing therapies, vitamin therapy, physiotherapeutic therapy - UHF on the larynx and chest, aerosol therapy. Against the background of conventional therapy, 4 sessions of NO-therapy were carried out: the gas flow was directed along the catheter into the lumen of the larynxopharynx, previously purified from saliva and sputum using an aspirator. The content of NO in the gas stream is 2500 mg / m ³ . An exposure of 60 s was carried out for 1 session per day. After 4 sessions, a voice appeared, in addition to the endotracheal tube, which was not previously observed. On the same day, the child is extubated. Upon further observation, the child breathed through the natural ways, there were no phenomena of laryngeal stenosis.

 The proposed method allows to reduce the time of intubation, the duration of hospitalization, significantly reduce the cost of drug therapy, reduce the risk of death, prevent complications in the form of cicatricial stenosis of the larynx and trachea.

Claims (1)

A method of treating acute stenosing laryngotracheobronchitis in children, including complex drug therapy, tracheal intubation, physiotherapy, characterized in that they additionally affect the affected areas of the larynx mucosa behind the walls of the endotracheal tube with an air-gas stream containing 2000-2500 mg / m ³ of nitrogen monoxide for 30-90 s daily, for a course of 3-8 sessions.