Dykyy O. M., Sonnyk E. H., Shumeiko O. H.


About the author:

Dykyy O. M., Sonnyk E. H., Shumeiko O. H.



Type of article:

Scentific article


Artificial ventilation of lungs (mechanical ventilation) in critical patients can save lives, but also lead to undesirable complications. Such complicated are fan-associated tracheobronchitis (FAT) and pneumonia (FAP). Consider a certain sequence of this process. First, the presence of a center of an infectious agent outside the respiratory tract (nasooropharyngeal gastrointestinal tract, hands of medical personnel, various manipulations, equipment for mechanical ventilation, etc.). Then comes the colonization of the lower respiratory tract and the interaction of the infectious agent with the body. This struggle may end with the colonization of the respiratory tract, the development of tracheobronchitis or pneumonia. The pathophysiological mechanisms of the onset of infection of the lower respiratory tract are multifaceted and not yet fully elucidated. Extremely high importance is the state of self-defense of the organism (local and general immunity). Most researchers agree that the condition for establishing the diagnosis of FAT are signs of infection, persistent secretion of sputum from the respiratory tract, the absence of infiltrative shadows on the chest X-ray. These signs develop not later than 48 hours after the start of mechanical ventilation. Therapy of the FAT is carried out in accordance with the general principles. The need for antibiotics in this pathology is controversial. Most authors consider expedient introduction of antibiotics at FAT. In this case, there is an opportunity to transfer the patient to spontaneous breathing earlier, less duration of stay in the intensive care unit, less frequent development of the FAP. All authors agree that if patients are hemodynamically unstable and the FAT proceeds with a high temperature, other causes of antibiotics are excluded. Inhalation therapy allows a lower concentration of antibiotic in the blood to achieve the effect and prevent the side effects of antibiotics. Important are the preventive measures of FAT. Diagnosis of FAP needs the use of clinical, X-ray laboratory and histological indicators. Infection of the early FAP (1-4 days of mechanical ventilation) is often associated with microorganisms that colonize or enter the oropharynx during the intubation. Late nosocomial FAT develops not earlier than 5 days of hospitalization. It is more often caused by the microflora of the intensive care unit where the patient is located and it is often multiresistant to antibiotics. The FAP therapy envisages, in the first place, timely and adequate antibiotic therapy and the restriction of inappropriate and excessive use of antibiotics. Therapy begins with the introduction of broad-spectrum antibiotics. After 48 hours the effectiveness of therapy is evaluated and for the third day, if necessary, its change is made taking into account the results of the microbiological study. One of the controversial question in diagnostics is the optimal method of taking the material from the respiratory tract to a microbiological study: endotracheal aspiration, protected brush or bronchoalveolar lavage and their evaluation. In wide clinical practice, there is a problem in terms of obtaining the results of sputum research on the microflora, its number and sensitivity to antibiotics. Laser (MALDTOF) method of microbiological study of sputum, which allows you to quickly obtain a result, still inaccessible. The use of broad-spectrum antibiotics against Gram negative bacteria is associated with an increased rate of development of antibiotic resistance and selection of more virulent pathogens. In addition, damage to the kidneys and the development of diarrhea. On the other hand, aminoglycosides and b-lactyms badly penetrate the pulmonary parenchyma with intravenous administration. Therefore, more and more attention has recently been paid to the possibilities of inhalation therapy for lower respiratory tract infections. Not antibiotic therapy is important, but in this work it is not considered.


artificial ventilation of the lungs, fan-associated tracheobronchitis, fan-associated “early” or “late” pneumonia, diagnosis, antibiotic resistance, treatment, prophylaxis, nebulizers


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Publication of the article:

«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 22-29 pages, index UDK 616.234-0022-02:615.8116.2