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.

1. Kit OI, Turkin IN, Kharagezov DA, Lazutin YuN, Leiman IA, Chubaryan AV, Mirzoyan EA. Sequential bronchoplastic upper lobectomy as a surgical component of multimodal treatment for synchronous bilateral multiple primary non-small cell lung cancer. Siberian Journal of Oncology. 2022; 21(3): 143–150. (In Russ.) https://doi.org/10.21294/1814-4861-2022-21-3-143-150. EDN: DGVUWW

2. Merabishvili VM, Yurkova YuP, Shcherbakov AM, Levchenko EV, Barchuk AA, Krotov NF, Merabishvili EN. Lung cancer (C33, 34). Morbidity, mortality, accuracy of registration, localization and histological structure (population study). Voprosy onkologii. 2021; 67(3): 361-7. (In Russ.) https://doi.org/10.37469/0507-3758-2021-67-3-361-367. EDN: MHNNMT

3. McIntyre A, Ganti AK. Lung cancer-A global perspective. J Surg Oncol. 2017;115(5):550-554. https://doi.org/10.1002/jso.24532.

4. Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J. 2023; 1;61(4):2300239 https://doi.org/10.1183/13993003.00239-2023.

5. Chronic obstructive pulmonary disease. Clinical guidelines of the Ministry of Health of the Russian Federation 2023. Moscow, 2023:98. (In Russ.)

6. Dobner SYu, Fedosenko SV, Rodionov EO, Yarovoy ND, Petrov VA, Tuzikov SA, Starovoitova EA, Samykina IA. Lung cancer in patients with COPD and factors associated with reduced survival. Bulletin of Siberian Medicine. 2022;21(3):41–49. (In Russ.) https://doi.org/10.20538/1682-0363-2022-3-41-49 EDN: BMYBMY

7. Batchelor TP, Rasburn NJ, Abdelnour-Berchtold E. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery after Surgery Society and the European Society of Thoracic Surgeons. European Journal of Cardio-thoracic Surgery. 2019; (55):91–115. https://doi.org/1093/ejcts/ezy.

8. Avdeev S.N. Pathologic physiology of exacerbations of chronic obstructive pulmonary disease. Messenger of anesthesiology and resuscitation. 2019; 16(2):75-82. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-2-75-82. EDN: ZIZXKP

9. Burton BN, Khoche S, A'Court AM, Schmidt UH, Gabriel RA. Perioperative Risk Factors Associated With Postoperative Unplanned Intubation After Lung Resection. J Cardiothorac Vasc Anesth. 2018; 32(4):1739-1746. https://doi.org/10.1053/j.jvca.2018.01.032

10. Ramachandran SK, Nafiu OO, Ghaferi A, Tremper KK, Shanks A, Kheterpal S. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology. 2011;115(1):44-53. https://doi.org/10.1097/ALN.0b013e31821cf6de

11. Pismenny VI, Seregin AS, Krivoshchekov EP, Romanov VE, Shteiner ML, Tsymbalyuk VV, Pismenny IV, Grigorieva TS, Alyapyshev GS. Complications of tracheostomy and their prevention in surgical patients. Doctor. 2021; 32 (10): 54-57. (In Russ.) https://doi.org/10.29296/25877305-2021-10-10. EDN: YILUMG

12. Merten M, Sattler PB, Karagiannidis C. Perkutane dilatative Tracheotomie – Schritt für Schritt [Step-by-Step tutorial of bedside percutaneous dilatational tracheostomy]. Dtsch Med Wochenschr. 2019; 144(8):547-552. https://doi.org/110.1055/a-0665-6444