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Optimization of early diagnoses and treatment of patients with acute lung injury / acute respiratory distress syndrome


Author: Cojocaru Doriana
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2008
Scientific adviser: Boris Pîrgari (decedat)
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:

Status

The thesis was presented on the 3 September, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document – 0.29 Mb / in romanian

Keywords

acute lung injury(LPA), Acute Respiratory Ditsress Syndrome(ARDS), sepsis,septic shock, Multiple Organ Dysfunction Syndrome(MODS), Systemic Inflammatori Response Syndrome(SIRS) ,APACHE II score, SIRS score,hypoxemia, acid-base disorders, positive end-expiratory pressure(PEEP).

Summary

This study presents the results of performed study based on 626 patients which received the intensive treatment in Clinic Nr.2 of Anesthesiology Reanimatology department (chair) of USMF “N.Testemitanu” during 2003-2007 years. The purpose of this study is the evaluation of risk factors in LPA/SDRA development, the elaboration of an algorithm of early diagnoses and multimodal intensive treatment of LPA/SDRA in units of intensive treatment condition.

The batch of patients of devised in two groups depending on the factors, which develops the acute pulmonary lesions: I group includes 77 patients with LPA/SDRA, which the unleash factors have the pulmonary origin; II group includes 549 patients with LPA/SDRA which the unleash factors have the extra pulmonary origin. For severity degree patient distribution we used the LPA/SDRA classification into 3 groups: light, moderate, severe, each having own physiopathology and clinic characteristics which needs established group of curative measures. The somatic state was evaluated by estimation of nutritional state, evaluation of bronchopulmonary, cardiovascular, hepatic, renal, neurological dysfunction grounds, acid -basic and gases status, ionograms, fluid-coagulant status.

It was performed a complex study for risk factors estimation in unleash of acute pulmonary lesions/syndrome of respiratory acute distress. It was performed an analyses of clinic evolution of acute pulmonary lesions/syndrome of respiratory acute distress in dependence of unleash cause. It was studied the acid -basic and gases and electrolytic status by patients with LPA/SDRA in dependence of pulmonary lesion origin and severity degree of the syndrome. It was demonstrated the negative repercussion of acute pulmonary lesions/syndrome of respiratory acute distress on haemostatic and hematological statement.

Based on received data was elaborated an algorithm of early diagnoses and multimodal intensive treatment of respiratory acute distress in units of intensive treatment condition