Non-invasive mechanical ventilation for reperfusion myocardial injury prevention after endovascular surgeries in patients with ST-elevation myocardial infarction (STEMI)
- Authors: Neimark MI1, Zayashnikov SV2, Kalugina OA2, Berestennikova LN2
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Affiliations:
- Altay State Medical University, Barnaul, Russia
- Altay Regional Dispensary of Cardiology, Barnaul, Russia
- Issue: Vol 94, No 1 (2013)
- Pages: 50-54
- Section: Theoretical and clinical medicine
- URL: https://bakhtiniada.ru/kazanmedj/article/view/1769
- DOI: https://doi.org/10.17816/KMJ1769
- ID: 1769
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Abstract
Aim. To determine the need for pressure controlled non-invasive mechanical ventilation for reperfusion myocardial injury prevention in patients with ST-elevation myocardial infarction (STEMI). Methods. The study enrolled 61 patients admitted to the intensive care unit within 6 hours from the debut of chest pain, ST-segment elevation on electrocardiogram and oxygen saturation less than 90%. A percutaneous coronary intervention on an affected coronary artery was performed in all patients 30-90 minutes from admission. Non-invasive mechanical ventilation using the «MAQUET Servo-s» machine was started in patients of the first group (31 patients, mean age 66.3±10.7 years, males - 19, females - 12) with positive end expiratory pressure of 2-6 cm H2O, pressure support of 6-10 cm H2O, 40-60% O2 gas mix. Patients of the second group (comparison group, 30 patients, mean age 63.5±9.8 years, males - 16, females - 14) were offered a conventional treatment of ST-elevation myocardial infarction, including inhalations of humidified oxygen (6-8 liters per minute) using a nasal cannula. Results. Systolic, diastolic blood pressure and heart rate were 123.0±9.4 mm Hg, 81.2±11.3 mm Hg, 70.1±6.1 beats per minute in patients of the first group in 6 hours after admission. In patients of the comparison group the following parameters were measured as 157±12.4 mm Hg, 90.2±10.1 mm Hg, 92.6±10.2 beats per minute. The absolute risk increase of arrhythmias related to reperfusion myocardial injury was 17.8% (р <0.05) for the patients from the second group. Ejection fraction on a transthoracic echocardiogram (Teichholz method) was measured as 47.0±4.0 and 60.5±7.4% in patients from the first and the second groups respectively (р <0.05). Conclusion. Non-invasive mechanical ventilation decreases the risk for arrhythmias related to reperfusion myocardial injury, and increases the ejection fraction compared to conventional treatment and can be applied in patients with STEMI.
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##article.viewOnOriginalSite##About the authors
M I Neimark
Altay State Medical University, Barnaul, Russia
S V Zayashnikov
Altay Regional Dispensary of Cardiology, Barnaul, Russia
Email: staszayashnikov@mail.ru
O A Kalugina
Altay Regional Dispensary of Cardiology, Barnaul, Russia
L N Berestennikova
Altay Regional Dispensary of Cardiology, Barnaul, Russia
References
- Клинические рекомендации. Кардиология / Под ред. Ю.Н. Беленкова, Р.Г. Оганова. - М.: ГЭОТАР-Медиа, 2007. - 640 с.
- Руксин В.В. Неотложная кардиология. - М.: ГЭОТАР-МЕД, 2007. - 512 с.
- Сатишур О.Е. Механическая вентиляция лёгких. - М.: Мед. лит., 2011. - 352 с.
- Ухолкина Г.Б., Костянов И.Ю., Кучкина Н.Д. и др. Влияние оксигенотерапии в сочетании с реперфузией на течение острого инфаркта миокарда // Кардиология. - 2005. - №5. - С. 59-66.
- Ухолкина Г.Б., Костянов И.Ю., Кучкина Н.Д. и др. Оксигенотерапия в комплексе с эндоваскулярной реперфузией в ранние часы острого инфаркта миокарда: клинико-лабораторные сопоставления // Междун. ж. интервенц. кардиоангиол. - 2005. - №9. - С. 51-60.
- Чазов Е.И., Беленков Ю.Н. Рациональная фармакотерапия сердечно-сосудистых заболеваний. - М.: Литтерра, 2004. - 972 с.
- Focused Update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction. ACC/AHA practice guidelines // Сirculation. - 2008. - Vol. 117, N 2. - Р. 296-329.
- Braunwald E. Heart Disease. - W.B. Saunders company, 1980. - P. 585-586.
- Guidelines on the diagnosis and treatment of acute heart failure - full text. The Task Force on Acute Heart Failure of the European Society of Cardiology. Endorsed by the European Society of Intensive Care Medicine (ESICM) // Eur. Heart J. - 2007. - Vol. 26. - P. 384-416.
- Management of acute myocardial infarction in patients presentings with ST-segment elevation. The Task Force on the management of acute myocardial infarction of the European Society of cardiology // Eur. Heart J. - 2003. - Vol. 24. - P. 28-66.
- Mohamed M., Andrzej S., Kosinski et al. Reperfusion ventricular arrhythmia «bursts» in TIMI 3 flow restoration with primary angioplasty for anterior ST-elevation myocardial infarction: a more precise definition of reperfusion arrhythmias // Oxford J. Medicine. - 2008. - Vol. 10. - P. 988-997.
- Masip J., Roque M., Sanchez B. et al. Noninvasive ventilation in acute cardiogenic pulmonary edema - systematic review and meta-analysis // JAMA. - 2005. - Vol. 294. - P. 3124-3130.
- Philip-Joet F.F., Paganelli F.F., Dutau H.L., Saadjian A.Y. Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure // Respiration. - 1999. - Vol. 66. - P. 136-143.
- Rasanen J., Heikkila J., Downs J. et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema // Am. J. Cardiol. - 1985. - Vol. 55. - P. 296-300.
- Winck J.C., Azevedo L.F., Costa-Pereira A. et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema: a systematic review and meta-analysis // Crit. Care. - 2006. - Vol. 10. - P. 2-10.
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