RU2752856C1 - Method for rehabilitation of post-viral injuries of lung parenchyma and device for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions group relates to medicine, namely to pulmonology, and can be used in the treatment and rehabilitation of post-viral injuries of the lung parenchyma. For this, a method is proposed, which consists in inhaling a gas mixture of xenon with oxygen to a patient before the onset of signs of a therapeutic effect. Inhalation is carried out using a device operating in a semi-closed circuit. The composition of the xenon-oxygen gas mixture: xenon 70-79 vol.%, oxygen - 30-21 vol.%. The maximum time for one inhalation is 60 seconds. Inhalations are carried out daily for 5 days. Also proposed is a device for implementing the method comprising a source of a gas mixture of xenon and oxygen connected to a breathing bag. The breathing bag is connected to the breathing circuit through a valve. The breathing circuit is connected through a breathing tube and an antibacterial filter to a mouth-nose mask. The inspiratory and expiratory lines are made in the form of separate channels equipped with directional valves. At the same time, a port is installed on the inhalation line for additional supply of a gas mixture or oxygen, and an overpressure relief valve and a column with a carbon dioxide sorbent are installed on the exhalation line.

EFFECT: inventions provide effective rehabilitation of post-viral injuries of the lung parenchyma, shorten the time of the inhalation procedure, reduce xenon consumption, simplifying the inhalation device.

2 cl, 2 tbl, 2 ex, 1 dwg

Description

The invention relates to medicine and can be used in therapy, pulmonology in the treatment and rehabilitation of post-viral lesions of the lung parenchyma.

One of the approaches in the treatment and rehabilitation of lung diseases is the inhalation route of delivery of therapeutic agents.

In this regard, the use of inert gases, which is widespread in clinical practice, is of great interest. It is well known to use an oxygen-helium mixture for the treatment of lung diseases and warming the body during hypothermia [1], oxygen-xenon mixture in neurological practice and psychiatry [2]. Also, xenon is now widely used for the diagnosis of lung diseases, in particular their terminal divisions [3]. The main obstacle to the widespread introduction of noble gases into practical medicine is their high cost and the need to use complex and expensive equipment.

Currently, a certain efficiency of the heated oxygen-helium mixture Heliox (70% helium / 30% oxygen) has been shown in the complex intensive care of patients in the initial stages of hypoxemia with COVID-19 to improve aeration of areas of the lungs with impaired bronchial patency [4].

The disadvantage of this method is that it does not significantly affect the alveolar regions of the lungs, which provide gas exchange. Therefore, the method is used at the stages of intensive therapy and is of little use in the restoration of lung tissue during the rehabilitation period, since it is aimed only at overcoming violations of bronchial conduction and is not very effective in the treatment of disorders of diffusion lung function.

The known "method of inhalation and a device for its implementation" [5]. In this method, the goal is to achieve sub-drug concentrations of xenon in blood and tissues. For this, a gas mixture of xenon and oxygen heated to 90 ° C is inhaled in the ratio: xenon not more than 70 vol%, oxygen not less than 30 vol%. To implement the method, it is mandatory to prepare the patient in compliance with the following conditions: "fasting", preliminary intensive ventilation of the lungs with air, respiratory rate during inhalation of 5-10 breaths per minute. The inhalation time for the gas mixture is 2 minutes or more. For carrying out the method the device is used for inhalation of a gas mixture of xenon and oxygen, which has a block gas supply different gas sources breathing circuit comprising a breathing mask, disinfecting elements absorber of CO _2, the gas chamber, the sensors of the gas analyzer, the valve device with the channels of inhalation and exhalation , a flap at the outlet of the breathing gas chamber, after the valve device, heating elements, additional breathing containers, it is also equipped with a compressor, a xenon capture unit, and a gas analyzer.

This method and device are the closest to the claimed invention in terms of technical essence and the achieved result and are selected as prototypes.

The disadvantage of the prototype method is the impossibility of its use in patients with severe impaired lung function: - respiratory failure excludes the possibility of independent intensive ventilation of the lungs with atmospheric air; - in case of respiratory failure, 2-4 minutes independent inhalation of the gas mixture through a closed breathing circuit is impossible; - the respiration rate proposed in the method (from 5 to 10 per minute) during the procedure is obviously not feasible in case of respiratory failure; - in case of respiratory failure, there is a high probability of non-occurrence of signs of xenon action (euphoria, nystagmus, parasthesia, etc.) even with 2-4 minutes of inhalation of the gas mixture, which excludes operational objective monitoring of the patient's condition.

In the device for implementing the method, selected as a prototype, there are significant disadvantages regarding the technical complexity and complicating its use in patients with severe impaired lung function: - the presence of xenon recycling elements that increase breathing resistance; - the presence of a heating block (heating the gas mixture can lead to an increase in the temperature of the lungs, which leads to an increase in the process of inflammation and a rise in body temperature); - the presence of duplication of disinfecting elements of the respiratory mixture (UV - emitter and antibacterial filter with a sufficient degree of protection against infection); - presence in the common circuit of the unit for sorption of СО ₂ ; - significant volume of the breathing circuit; - no separation of the "inhalation" and "exhalation"contours; - the overpressure relief valve is located in the common breathing circuit; - lack of a tool for supplying additional gas mixtures; - high cost of the device.

The objective of the invention is to improve the efficiency of the method for the rehabilitation of post-viral injuries of the lung parenchyma, to reduce the duration of the inhalation procedure, to reduce the consumption of xenon, and to simplify the inhalation device.

To solve the set problem in the method of rehabilitation, which consists in the patient breathing a gas mixture of xenon with oxygen before the onset of signs of a therapeutic effect: - facilitating breathing, reducing the respiratory rate, increasing blood oxygen saturation during inhalation. According to the invention, breathing with a gas mixture of xenon with oxygen is carried out from a device operating in a semi-closed circuit. The composition of the xenon-oxygen gas mixture is: xenon - 70-79 vol. %, oxygen 30-21 vol. %. The ratio of vol. % of xenon and oxygen in the gas mixture is determined by the volume of damage to the lung parenchyma: if the lungs are damaged (estimated by CT) in a volume of 60% or more, the oxygen content in the gas mixture cannot be less than 30 vol. % and, therefore, xenon will be represented by 70 vol. %; in case of lung damage (assessed by CT) in a volume of up to 60% or less, the oxygen content in the gas mixture cannot be less than 21 vol. % and, therefore, xenon will be represented by 79 vol. %. The maximum time for one stage of inhalation is 60 seconds. Efficiency control is performed for objective signs (heart rate, BH, SpO _2). Single inhalation procedures are carried out within 5 days.

For the method proposed as the invention, no preliminary preparation is required, since the main goal is to restore the function of external respiration due to the accumulation of a xenon-oxygen gas mixture in the alveolar space.

The invention will be clear from the following description and the accompanying figure.

FIG. 1 shows a schematic diagram of a device for implementing a method for the rehabilitation of post-viral injuries of the lung parenchyma 1 - a source of a gas mixture, 2 - a breathing bag, 3 - a valve, 4 - a port for additional supply of a gas mixture or oxygen, 5 - an inhalation direction valve, 6 - inspiratory line, 7 - breathing tube, 8 - antibacterial filter, 9 - mouth mask, 10 - exhalation line, 11 - overpressure relief valve, 12 - exhalation direction valve, 13 - sorbent column.

The device proposed in claim 2 (Fig. 1) contains a source of a gas mixture of xenon and oxygen 1, connected to a breathing bag 2, which, through a slide valve 3, is connected to the inhalation line 6, then, through the inhalation guide valve 5, a breathing tube 7 and, through an antibacterial filter 8, with a rotonos mask 9, which, in turn, is connected through an exhalation guide valve 12 with an exhalation line 10 equipped with a column with a sorbent 13, while an overpressure relief valve 11 is installed on the exhalation line, and inspiratory line 6 port for additional supply of gas mixture or oxygen 4.

The separation of the inspiratory and expiratory lines and the installation of a column with a sorbent and an overpressure relief valve on the expiratory line allows for better sorption of carbon dioxide contained in the exhaled air and reduces breathing resistance. The port for the additional supply of the gas mixture, or oxygen, located in the inspiratory line, in emergency situations, or with a significant increase in the tidal volume, allows the supply of the gas mixture or oxygen directly to the patient bypassing the exhalation line, which also reduces breathing resistance.

The device for inhalation of a gas mixture provides for operation along a semi-closed circuit, but, in the event of an increase in resistance to exhalation, an overpressure relief valve located on the exhalation line opens, transferring the operation of the device to operation along a semi-closed circuit.

The set of essential features that characterize the invention does not follow from the prior art in this field and is not obvious to a person skilled in the art. An identical set of features was not found in the patent and medical scientific literature.

The proposed invention can be used in practical health care to improve the efficiency of the rehabilitation process of patients with lesions of the lung parenchyma.

Based on the foregoing, the proposed invention should be considered as corresponding to the conditions of patentability "Novelty", "Inventive level", "Industrial applicability".

The method is carried out as follows:

From the gas source 1, the breathing bag 2 is filled with a gas mixture of xenon and oxygen, while the valve valve 3 is closed. After filling the breathing bag 2, the mouth mask 9 is applied to the face of the "patient". The gate valve 3 opens. The "patient" begins to inhale the gas mixture of xenon and oxygen from the breathing bag 2, which enters through the inhalation line 6, through the inhalation guide valve 5, the breathing tube 7 and the antibacterial filter 8 into the oronasal mask 9. After inhalation, the patient »Begins to exhale, while the exhaled air containing xenon, oxygen, carbon dioxide enters the mouth mask 9 and then through the antibacterial filter 8, the breathing tube 7 enters the exhalation line 10. Then, through the directional valve 12 and the column with the sorbent 13, the exhaled air enters through open valve 3 into the breathing bag 2. When overpressure occurs in the expiratory line 10, the overpressure relief valve 11 releases part of the exhaled air that creates overpressure into the atmosphere.

At the next inhalation on the inspiratory line 6, the inspiratory direction valve 5 opens, and the exhalation line 10 is closed by the exhalation direction valve 12. The patient breathes for 60 seconds, while monitoring the respiratory rate, heart rate and blood oxygen saturation using a pulse oximeter. After the end of the inhalation procedure, the valve 3 is closed, the mouth mask 9 is removed from the patient's face. If the blood oxygen saturation level drops below the initial one, oxygen is supplied through the additional gas supply port 4 to the inhalation line 6.

Example 1. Patient A. 48 years old. Complaints at the time of treatment: severe shortness of breath on inspiration at rest, weakness, cough, palpitations. Depressed mood. When walking, shortness of breath increases sharply.

From the anamnesis: seven days ago I was discharged from the hospital. Diagnosis at discharge: main: Other viral pneumonia, community-acquired bilateral polysegmental pneumonia, severe course, respiratory failure of the 2nd degree. Additional diagnosis: Coronavirus infection caused by COVID-19 virus, virus identified. Complications: Respiratory failure of the 2nd degree. On admission to the hospital for MSCT: the lesion of the parenchyma of both lungs is about 90%. At discharge for MSCT: lesion of the parenchyma of both lungs 60%.

On examination: shallow breathing, shortness of breath on inhalation, with auscultation, breathing is weakened over all parts of the lungs. Respiratory rate 32 in 1 minute, heart rate - 92 beats. per minute, Sp02 91%. There were no improvements while at home.

Diagnosis at treatment: main: Other viral pneumonia, bilateral polysegmental pneumonia. Complications: Respiratory failure of the 1st degree. Asthenic syndrome. Depression on a Beck scale of 25 points (moderate).

Rehabilitation of post-viral lesions of the lung parenchyma was prescribed: inhalation of xenon-oxygen mixture in the ratio of 71% xenon to 29% oxygen, lasting 1 minute for 5 days.

1st inhalation. Objective indicators before inhalation: heart rate 102 beats. 1 minute, SpO ₂ - 91%, respiratory rate - 32 per one minute. During inhalation (at 50 seconds) I felt relief of breathing. After 5 minutes after inhalation: heart rate - 77 beats per 1 minute, SpO ₂ - 96%, no cough, respiratory rate 12 in 1 minute. In the evening after inhalation I walked for 2 hours. The mood has improved.

5 inhalations were performed. On examination: no complaints, heart rate 78 bpm in 1 minute, SpO ₂ - 97%, frequency of 10 breaths in one minute. The state of health is good, there is no coughing, the working capacity has recovered. Depression on the Beck scale - 15 points - mild depression. Diagnosis: condition after bilateral polysegmental pneumonia. Coronavirus infection. There is no respiratory failure.

Example 2. Patient C., 58 years old. Complaints at the time of treatment: severe shortness of breath on inspiration at rest, weakness, cough, palpitations. Decreased performance. When walking, shortness of breath increases sharply. Cannot walk more than 100 meters.

From the anamnesis: three weeks ago I was discharged from the hospital. Diagnosis at discharge: main: Other viral pneumonia, community-acquired bilateral polysegmental pneumonia, respiratory failure of the 1st degree. Additional diagnosis: Coronavirus infection caused by COVID-19 virus, virus identified. Complications: Respiratory failure of the 1st degree. On admission to the hospital for MSCT of the lungs: the lesion of the parenchyma of both lungs is about 60%. At discharge for MSCT: damage to the parenchyma of both lungs is 40%.

On examination: breathing is shallow, shortness of breath on inspiration, on auscultation, breathing is weakened over the lower parts of the lungs. Respiratory rate 25 in 1 minute, heart rate - 116 beats. per minute, SpO ₂ 93%. There were no improvements while at home.

Diagnosis at treatment: main: Other viral pneumonia, bilateral polysegmental pneumonia. Complications: Respiratory failure of the 1st degree. Asthenic syndrome. Depression on a Beck scale of 21 points (moderate).

Rehabilitation of post-viral injuries of the lung parenchyma was prescribed: inhalation with xenon-oxygen mixture in the ratio of 79% xenon - 21% oxygen, duration of inhalation 1 minute for 5 days.

1st inhalation. Objective indicators before inhalation: heart rate 116 beats. 1 minute, SpO ₂ - 93%, respiratory rate - 25 per one minute. During inhalation (at 40 seconds) I felt a sharp relief of breathing. After 5 minutes after inhalation heart rate - 88 beats per 1 minute, SpO ₂ - 97%, no cough, respiratory rate 14 breaths 1 minute. The next day after inhalation I walked about 10 km. Mood is good.

5 inhalations were performed. On examination, no complaints, heart rate 66 bpm in 1 minute, SpO ₂ - 96%, frequency of 12 breaths in one minute. She feels well, there is no coughing, her working capacity has recovered, there is no shortness of breath when walking. Depression on the Beck scale - 12 points - mild depression. Diagnosis: condition after bilateral polysegmental pneumonia. Coronavirus infection. There is no respiratory failure. There are no asthenic phenomena.

The proposed invention was tested on 21 patients and makes it possible to increase the efficiency and shorten the rehabilitation period for patients with post-viral injuries of the lung parenchyma.

Bibliography

1. Pavlov B.N., Dyachenko A.I., Shulgin Yu.A. et al. Investigation of the physiological effects of breathing with heated oxygen-helium mixtures // Human Physiology. - 2003. - T.29. - No. 5. - S. 69-73.

2. Naumov S.A. et al. The role of xenon in the treatment of opium addiction // Questions of narcology. - 2002. - No. 6. - S. 13-18.

3. Ouriadov A., Guo F., McCormack DG, Parraga G. Accelerated ¹²⁹ Xe MRI morphometry of terminal airspace enlargement: Feasibility in volunteers and those with alpha-1 antitrypsin deficiency // Magn Reson Med. 2019; 00: 1-11.doi: 10.1002 / mrm.28091

4. Temporary guidelines. Prevention, diagnosis and treatment of new coronavirus infection (SOUSH-19), Ministry of Health of the Russian Federation. Version 8 (03.09.2020). P. 69.

5. RF patent No. 2317112. Inhalation method and device for its implementation. Naumov S.A., published on 20.02. 2008. Bul. No. 5.

Claims (2)

1. A method for the rehabilitation of post-viral lesions of the lung parenchyma, which consists in inhaling a gas mixture of xenon with oxygen to a patient before the onset of signs of a therapeutic effect, characterized in that the inhalation is carried out using a device operating in a semi-closed circuit, while the composition of the xenon-oxygen gas mixture is as follows: xenon 70-79 vol. %, oxygen - 30-21 vol. %, the maximum time of one inhalation is 60 seconds, inhalations are carried out daily for 5 days. 2. A device for implementing the method according to claim 1, comprising a source of a gas mixture of xenon and oxygen connected to a breathing bag, the breathing bag is connected through a valve valve to the breathing circuit, the breathing circuit is connected through a breathing tube and an antibacterial filter with a rotonos mask, characterized in that that the inspiratory and expiratory lines are made in the form of separate channels equipped with directional valves, while a port is installed on the inspiratory line for additional supply of a gas mixture or oxygen, and an overpressure relief valve and a column with a carbon dioxide sorbent are installed on the expiratory line.

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