Aim. To study death risk factors in patients with community-acquired pneumonia in municipal hospitals in Samara. Methods. 75 cases of deaths of patients hospitalized because of community-acquired pneumonia were studied (study group), 300 convalescent patients with community-acquired pneumonia discharged from the hospital were included in the control group. The retrospective comparative «case control» study was performed. Results. Mean age of the patients who died was 47.4±2.2 years; men were more prevalent (70.6%), time since admission date till death was 6.5±2.5 days, more than a third (36.0%) died before 24 hours after admission. The study group contained significantly higher number of unemployed (72.0%) and intravenous drugs users (16.0%). HIV infection was found in 37.3% of the patients who died, compared to 19.6% prevalence in control group. Multifactorial logistic regression of clinical signs revealed the following death risk factors in patients with community-acquired pneumonia: infiltrates on X-ray involving more than one lung lobe, arterial hypotension (systolic blood pressure ≤100 mm Hg, diastolic blood pressure ≤60 mm Hg), tachypnea (breath rate over 25 per minute). Conclusion. Factors having the highest positive prognostic value for a lethal outcome at patients with community-acquired pneumonia are: late admission, multilobar pneumonia; arterial hypotension; tachypnea; HIV infection, social unemployment and male gender.
ОРИгИ НаЛьНЫЕ ИССЛЕДОВаНИя Metelica VI. Spravochnik po klinicheskoj farmakologii 3. serdechno-sosudistyh sredstv [Reference book on clinical pharmacology of cardiovascular medicines]. M : Medpraktika. 1996: 784 р. Okorokov AN. Lechenie boleznej vnutrennih organov 4. [Treatment of diseases of internals]. Lechenie zabolevanij serdechno-sosudistoj sistemy [Treatment of diseases of cardiovascular system]. Mn: Vysh shk. 1997; 3 (1): 464 р. Chuchalina AG, Belousova JuB, Jasnecova VV editors. 5. Federal'noe rukovodstvo po ispol'zovaniju lekarstvennyh sredstv (formuljarnaja sistema) [Federal operating instructions of medicines (official system)]. 2nd ed. M.:
The aim of the study was to evaluate the efficacy of the new approach to the selection of respiratory support methods based on the analysis of arterial blood acid-base balance and gas composition in treatment of severe community-acquired pneumonia complicated by acute respiratory failure.Materials and Methods. Conventional pulse oximetry (SрО 2 ) was used (G40 Patient Monitor), arterial blood acid-base balance and gas composition were analyzed (EasyStat device) to detect hypoxemia. Respiratory support of three types was carried out: 1) oxygen therapy (О 2 -therapy) with the use of oral nasal oxygen masks; 2) non-invasive lung ventilation (VENTIlogic 2 and BiPAP Vision devices); 3) artificial lung ventilation (Engström Carestation device).The work was carried out in two sequential stages. At the first stage, a respiratory support method was selected according to the results of pulse oximetry (SрО 2 ). At the second stage, a respiratory support method was selected on the basis of arterial blood acid-base balance and gas composition indices (рО 2 , pH, рCО 2 ). Recovery of pulse oximetry indices, arterial blood acid-base balance, and gas composition indices as well as presence of positive clinical dynamics were considered to be criteria of treatment efficacy.Results. Comparative analysis of the results of the used methods has provided the possibility to develop the algorithm of choosing the respiratory support method in severe community-acquired pneumonia on the basis of arterial blood acid-base balance and gas composition with pulse oximetry indices equalling 91.0±0.8%. On admission of a patient to the intensive care unit, oxygen therapy is administered at рН≥7.3; рO 2 >60 mm Hg; рСО 2 ≤45 mm Hg; non-invasive lung ventilation -at pH<7.3; рO 2 ≤60 mm Hg; рСО 2 ≤45 mm Hg; artificial lung ventilation -at pH<7.3; рO 2 <60 mm Hg; рСО 2 >45 mm Hg. Selection of respiratory support based on blood acid-base balance and gas composition indices without taking into account pulse oximetry indices allows us to increase treatment efficacy, reduce the period of stay in the intensive care unit by 1.5 times, mortality -by 4.3 times.
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