RU-2861508-C1 - METHOD FOR TREATING EROSIVE LARYNGITIS AND EROSIVE TRACHEITIS IN PATIENTS WITH SEVERE CRANIOFACIAL TRAUMA

RU2861508C1RU 2861508 C1RU2861508 C1RU 2861508C1RU-2861508-C1

Abstract

FIELD: medicine; anaesthesiology; resuscitation. SUBSTANCE: invention can be used in the treatment of erosive laryngitis and erosive tracheitis in patients with severe craniofacial trauma. The method includes stepwise implementation. At the first stage, during a puncture-dilatation tracheostomy, cleaning the subglottic space by introducing 20 ml of sterile 0.9% sodium chloride solution into the channel for supracuff aspiration of the tracheostomy tube, after removal of which, 20 ml of 0.01% miramistin antiseptic solution or 0.05% aqueous chlorhexidine bigluconate solution is introduced into the channel for supracuff aspiration of the tracheostomy tube, after a 10-minute exposure, the antiseptic solution is completely removed from the patient's larynx by active aspiration, 20 ml of an antibiotic solution of amikacin 500 mg or colistin 80 mg is introduced into the channel for supracuff aspiration of the tracheostomy tube, after a 30-minute exposure, the antibiotic solution is completely removed from the patient's larynx by active aspiration. At the second stage, during the entire period of controlled respiratory support, daily, 4 times a day, every 6 hours, washing the subglottic space through the channel for supracuff aspiration of the tracheostomy tube, for which 20 ml of sterile 0.9% sodium chloride solution is first introduced, complete aspiration is carried out from the supracuff space, 20 ml of 0.01% miramistin antiseptic solution or 0.05% aqueous chlorhexidine bigluconate solution is introduced into the channel for supracuff aspiration of the tracheostomy tube, after a 10-minute exposure, the antiseptic solution is completely removed from the patient's larynx by active aspiration. Additionally, 2 times a day, with a 12-hour interval, 20 ml of an antibiotic solution of amikacin 500 mg or colistin 80 mg is introduced into the channel for supracuff aspiration of the tracheostomy tube, after a 30-minute exposure, the antibiotic solution is completely removed from the patient's larynx by active aspiration. EFFECT: reducing mortality, improving treatment outcomes and reducing the percentage of persistent disability in convalescents. 1 cl, 1 ex

Inventors

Nazarenko Mikhail Borisovich
RODIONOV EVGENIJ PETROVICH
Vlasenko Aleksej Viktorovich
Shabunin Aleksej Vasilevich

Dates

Publication Date: 20260505
Application Date: 20250610

Claims (1)

A method for treating erosive laryngitis and erosive tracheitis in patients with severe craniofacial trauma, including a step-by-step implementation, at the first stage, when performing a puncture-dilation tracheostomy operation, the subglottic space is cleaned by introducing a sterile solution of 0.9% sodium chloride in a volume of 20 ml into the channel for supracuff aspiration of the tracheostomy tube, after removing which a solution of 0.01% miramistin antiseptic or an aqueous solution of 0.05% chlorhexidine biglucanate, in a volume of 20 ml, is introduced into the channel for supracuff aspiration of the tracheostomy tube, after 10 minutes of exposure, the antiseptic solution is completely removed from the patient's larynx by active aspiration, a solution of amikacin 500 mg or colistin 80 mg antibiotic in a volume of 20 ml is introduced into the channel for supracuff aspiration of the tracheostomy tube, through After 30 minutes of exposure, the antibiotic solution is completely removed from the patient's larynx by active aspiration. At the second stage, during the entire period of controlled respiratory support, daily, 4 times a day, every 6 hours, the subglottic space is washed through the channel for supracuff aspiration of the tracheostomy tube. For this purpose, a sterile solution of 0.9% sodium chloride in a volume of 20 ml is first introduced, complete aspiration is performed from the supracuff space, a 0.01% miramistin antiseptic solution or an aqueous solution of 0.05% chlorhexidine biglucanate in a volume of 20 ml is introduced into the channel for supracuff aspiration of the tracheostomy tube. After 10 minutes of exposure, the antiseptic solution is completely removed from the patient's larynx by active aspiration. Additionally, 2 times a day, at intervals of 12 hours, an amikacin antibiotic solution is introduced into the channel for supracuff aspiration of the tracheostomy tube. 500 mg or colistin 80 mg in a volume of 20 ml, after 30 minutes of exposure, the antibiotic solution is completely removed from the patient's larynx by active aspiration.

Description

The invention relates to the field of medicine, in particular to anesthesiology and resuscitation. Patients with severe craniofacial trauma (CFT) require respiratory support and prolonged mechanical ventilation (MV). Traditionally, during the first few days of illness, MV is administered through an orotracheal tube; however, tracheostomy is currently the preferred method for maintaining airway patency for prolonged MV [Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A: Early tracheostomy versus prolonged endotracheal intubation in severe head injury. The Journal of trauma 2004, 57(2):251–254]. Tracheostomy techniques can be either open surgical or percutaneous, using a technique known as puncture-dilation tracheostomy (PDT). PDT is performed most frequently, as it has a number of specific advantages over surgical tracheostomy, in particular, it does not require transporting the patient to the operating room and is performed directly at the patient’s bedside in the anesthesiology and intensive care unit (ARI) [Seder DB, Lee K, Rahman C, et al. Safety and feasibility of percutaneous tracheostomy performed by neurointensivists. Neurocrit Care 2009;10(03):264-268]. Regardless of the method of maintaining airway patency, standard nursing care of the oropharynx of a patient on mechanical ventilation includes brushing teeth, rinsing and rinsing the oral cavity, and regular sanitation of the liquid component with a sterile aspiration catheter through the natural passages (mouth and nasal passages). Additional measures for tracheostomy care include the use of humidified air breathing mixtures, regular sanitation of the tracheobronchial tree (TBT), care of the external skin of the anterior surface of the neck, monitoring of safe pressure in the tracheostomy tube cuff, and inhalation therapy [Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA 3rd, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg . 2013 Jan;148(1):6-20. doi: 10.1177/0194599812460376]. All of the above measures are technically effective only below the distal end of the tracheostomy tube, since access to the lower parts of the larynx, the subglottic space and the area above the inflated cuff in patients on mechanical ventilation is extremely difficult, and in certain circumstances completely impossible. As a result, despite the high-quality implementation of care measures, one of the most common long-term complications of long-term mechanical ventilation is the development of erosive laryngitis (EL) and/or erosive tracheitis (ET), which are acute or chronic inflammatory reaction of the mucous membrane and submucosal layer of the larynx and trachea of varying intensity, resulting from prolonged exposure to a physical and/or bacterial agent, and leading to persistent disturbances in the functioning of the larynx and TBD [Chernehovskaya N.E., Kirasirova E.A., Ekaterinchev V.A. On the diagnosis and treatment of erosive tracheitis. Medcovet 2013; 7: 54-55]. In particular, the erosive-ulcerative form of EL, affecting the patient's vocal cords and leading to their paresis and incomplete closure, makes timely decannulation impossible, which is a significant obstacle to the active rehabilitation of convalescents and causes persistent disability. Patients with severe CFT who have significant anatomical structural changes to the face and/or who have undergone reconstructive surgery on the facial skeleton and jaw bones are most susceptible to developing EL and ET. This is due to ongoing bleeding and/or increased secretion of fluid in the injured areas of the nose and oropharynx, as well as the technical impossibility of performing comprehensive standard oral hygiene procedures in these patients. Patients with severe CFT are particularly susceptible to the prolonged, persistent accumulation of fluid waste products (sputum, saliva, paranasal sinus secretions), which serve as a breeding ground for pathogenic microorganisms, in the lower part of the oropharynx and larynx, in the vocal cord area, and above the inflated cuff of the tracheostomy tube. For the complete prevention and treatment of EL and ET in such patients, in addition to effective systemic intensive and antimicrobial therapy, it is necessary to minimize the factors damaging the laryngeal epithelium and TBD. Standard nursing care measures do not fully achieve this; the use of special techniques is required [Moreira M, Ferreira PR, Sarmento A, Cardoso AL. Bacterial Tracheitis: A New Presentation of a Well-Known Disease. Cureus . 2024 Jul 2;16(7):e63697. doi: 10.7759/cureus.63697]. A known method for performing tracheofiberbronchoscopy (TFBS) involves inserting a special instrument—an endoscope—into the patient's tracheal canal through an existing orotracheal/tracheostomy tube. This instrument allows for the removal of liquid secretions and sputum from the trachea and main bronchi under direct vis