Tactics of preventive correction of critical respiratory failure in patients with resectable forms of lung cancer in combination with chronic obstructive pulmonary disease

The article describes clinical examples of the effectiveness of preventive puncture-dilatation tracheostomy (PDT) in preventing critical respiratory complications and improving the immediate results of radical surgical treatment of patients with severe manifestations of chronic obstructive pulmonary disease (COPD) and resectable forms of lung cancer (LC). According to the generalized literature data, the incidence of LC and COPD is 72.8 % among the male population and 52.5 % among women. The combination of LC and COPD causes a significant decrease in respiratory reserves in cancer patients, which leads to an increase in the frequency of complications and an increased risk of death during their treatment. For resectable forms, LC surgical treatment involves removal or resection of the lung, which reduces the total area of the respiratory surface of the lung tissue and oxygen supply to the lungs. These changes are accompanied by a critical violation of the ventilation-perfusion ratio, i.e. alveolar ventilation and cardiac output with an aggravation of hypoxia. This situation is most dangerous for patients with COPD, who after radical surgery have an aggravation of obstructive manifestations in the lungs with an already initially altered gas exchange. As a result, insufficient oxygen enrichment of the organs leads to a cascade of uncontrolled reactions with an intensification of lipid peroxidation and an imbalance in the antioxidant system with fatal consequences for the patient. These clinical examples demonstrate the obvious advantage of preventive PDT, which allows timely changes in the tactics of respiratory support in the early postoperative period and treatment in general (clinical example 1). Routine PDT allows avoiding emergency measures to replace the respiratory function with reintubation, and the use of adapted intelligent artificial lung ventilation modes eliminates additional sedation, muscle relaxation and analgesia in patients LC with severe forms of COPD. Clinical case 2 shows that emergency replacement of the patient's respiratory function has significant difficulties in terms of treatment and prognosis of the course of the disease, and increases the duration of his stay in the intensive care unit.