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[Comparative evaluation of different tracheal accesses for artificial ventilation of the lungs in patients with depressed hematopoiesis].

The purpose of this study was to analyze the complications and errors in tracheal intubation and tracheostomy, development of algorithm of steps for provision of endotracheal access in patients with hematological diseases. Provision of endotracheal access in 115 patients with blood system diseases is analyzed retrospectively. A total of 113 orotracheal, 50 nasotracheal intubations, and 48 tracheostomies were carried out. In 6 patients fibrobronchoscope was used for intubation because of pronounced hemorrhagic syndrome, inflammatory changes, and soft tissue edema of the face and neck; in 2 patients tracheostoma was inserted under local anesthesia. In 12 patients nasotracheal intubation was complicated by nasal bleeding. The most frequent and serious complication in patients with a tube in the trachea was obturation of the tube with sputum (9.7% of orotracheal intubations, 30% of nasotracheal intubations, and 15% of tracheostomas). Extubation/decannulation was carried out in 20 patients. One patient developed cicatricial stenosis of the trachea after tracheostoma. Hemorrhagic tracheobronchitis was endoscopically diagnosed most often (in 55 cases). Autopsy showed hemorrhages in the mucosa in 68.2%, in soft tissues adjacent to tracheostoma in 41.4%, and suppurative inflammation in 15.2% cases. Hence, hemorrhagic tracheobronchitis, hemorrhages in the mucosa, soft tissues of the trachea and bronchi are the most frequent clinical and morphological complications in patients with depressed hemopoiesis. Indications for nasotracheal intubation in this patient population should be limited. Early tracheostomy is recommended. Algorithm of steps ensuring the patency of airways in patients subjected to forced ventilation of the lungs is offered.