Many complications can develop in patients who are in intensive care. One of these most severe conditions is Mendelssohn's syndrome.
Under Mendelssohn syndrome, most oftenimplicit obstructive pulmonary disease with lung tissue damage (pneumonitis), which develops against the background of ingestion of gastric juice in the respiratory tract. This condition was first described in 1946. It is observed in severe patients who underwent craniocerebral trauma, cavitary operations (especially on the abdominal cavity organs) and childbirth. In most cases, the culprit of this kind of pathology is anesthesia (due to it there is a relaxation of smooth muscles).
Several diseases can lead to the development of Mendelssohn's syndrome. These include:
In addition to the listed ailments, pneumonitis cancause severe illness. A significant influence on the development of aspiration is provided by cavitary operations (due to the decrease in the tone of the musculature of organs and its reduction in the backward wave of peristalsis direction) and pregnancy (due to the displacement of the diaphragm). For example, surgical interventions account for up to 70% of cases.
However, the most frequent reason for ingestion of gastric juice in the lower respiratory tract is passive leakage due to improper patient position and weakness of the cardiac sphincter.
Disease develops due to defeatpulmonary and bronchial tissue with hydrochloric acid contained in the stomach. In passing, coagulation necrosis (which, again, is due to the action of acid on the mucous membrane of the bronchi) develops. As a result, the secretory capacity of the bronchi decreases, which leads to their desiccation. In parallel, the acid, penetrated into the lungs, causes the development of pneumonitis - aseptic inflammation of the lung tissue. The respiratory surface of the lungs decreases, the production of the surfactant decreases. All this leads to an increase in the airiness of the said organ (because of this, two forms of pathology are distinguished: asthmatic - with predominant bronchial involvement, and obstructive - with lung tissue damage and development of obstruction syndrome). The degree is determined by the pH of the gastric juice (the lower it is, the more concentrated the acid, and the greater the damage). The most severe changes are observed in the alveoli.
Very often when discussing this or thatdiseases and concomitant symptoms readers are offered photos. Diseases like pneumonitis, as a rule, do not differ in any specific external features. But if you look at the affected area of tissue through a microscope (which is usually done at autopsy), you can detect certain changes.
As a result of all the above processes and underthe effect of gravity hydrochloric acid descends into the alveoli. There, due to local effects on the alveolar tissue, an effusion occurs (most often hemorrhagic). As a result, hemorrhagic pulmonary edema develops.
How can I determine if a patient has aspiration pneumonitis? A specific "photo of the disease" can be represented as follows:
The identification of Mendelssohn's syndrome is a taskit is not simple, since the pathology usually develops in weakened patients, and not always, as was said above, a clinical picture can take place. First of all, the presence of respiratory failure (dyspnea, wheezing, cyanosis) should be determined. These symptoms can not always be detected in patients who are on ventilator. The most accurate method of diagnosing Mendelssohn syndrome is radiography, or lung fluorography.
If nevertheless there was a aspiration of the gastriccontent, treatment should begin immediately. First of all, it is necessary to exclude the re-entry of acid into the lower respiratory tract. To do this (if the patient's condition permits), it is required to raise the head of his bed. Immediately it is necessary to establish ventilation in the lungs and ensure good oxygenation of the blood. Typically, the appointment of ALV under intermittent positive pressure and hyperbaric oxygen saturation (the use of ventilation systems, control over the gas composition of the blood). All this will prevent the development of acidosis.
To reduce the extent of lung tissue damageGlucocorticosteroids are administered intravenously and a small dose of them is intrabronchial. Hormones allow you to suspend the spread of the process and limit it. For the prevention of antibiotics (usually cephalosporins and macrolides) are prescribed. It should also take sympathomimetics (to reduce the formation of secretions in the bronchi and lungs).
With timely treatment, complications are usually avoided. If you are late, aspiration syndrome can lead to dangerous and undesirable consequences.
Often after a disease, if it isflowed with a breakdown of the rhythm, there may be later a fibrillation arrhythmia or a constant form of ventricular fibrillation. If it can not be stopped, but the patient does not make complaints, you can leave the patient under supervision only by the local therapist.
Another complication is the development of atelectasislung, or chronic obstruction. In this case, the process of stabilization of the state will be quite long, and the emphasis, as a rule, is made on the relief of symptoms, since this disease is incurable.
The most severe complication of pneumonitis is death. Especially often it occurs in those cases when aspiration syndrome develops in newborns.
To prevent the development of aspirationpneumonia, it is required to conduct a set of some activities. First of all, all patients and women in labor, who are shown to interfere under general anesthesia, should empty their stomach and intestines. This eliminates the main factor in the development of pneumonitis.
Before anesthesia it is recommended to undergo a fluorographyin order to exclude the content of gastric juice in the respiratory tract. Intubation of the patient should be carried out even when the patient is conscious. Lay the person so that the upper part of the trunk is slightly raised. This is achieved by adjusting the head of the bed or the operating table (thus eliminating the possibility of passive flowing of the contents of the digestive system in the respiratory tract).
Provided that the technique of intubation is observed and the patient is properly prepared for surgery, the risk of Mendelssohn syndrome is minimal.
The prognosis for this disease is as follows: usually up to 56 percent of patients with developed pneumonitis of the respiratory tract. If the treatment measures were started in a timely manner, the risk of complications and death is reduced to zero.
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