Bronchoobstructive syndrome

One of the clearly outlined clinical manifestations of acute respiratory failure of the ventilating type is bronchoobstructive syndrome, in the pathogenesis of which the leading role is played by spasm of small bronchi in combination with edema of their mucous membrane and hypersecretion of sputum.

[1], [2], [3], [4], [5], [6]

Causes of bronchial obstruction syndrome

Bronchoobstructive syndrome develops as a result of viral inflammation of the bronchial mucosa with a clinical picture of bronchiolitis in children of the first months of life and obstructive bronchitis in older children. A clinical example of an allergic inflammation of the bronchial mucosa, accompanied by a broncho-obstructive syndrome, is bronchial asthma, which is usually formed in children older than 3 years, but cases are described in infancy.

Bronchoobstructive syndrome most often occurs in young children, and particularly severe forms (bronchiolitis) are observed in the first months of life against the background of PC infection. Bronchoobstructive syndrome can develop in other acute respiratory infections (with influenza).

[7], [8], [9], [10]

How is bronchoobstructive syndrome manifested?

Symptoms of bronchial obstructive syndrome are the dyspnea of the expiratory type (elongation of exhalation time), the appearance in the lungs of dry, wheezing wheezing, audible symmetrically in the inter- and subscapular spaces. 

With percussion of the chest, a boxed tone of sound is determined as a result of acute emphysema and expiratory closure of bronchioles. X-ray reveals the intensification of the pulmonary pattern, the expansion of the roots of the lungs against the background of their emphysema bloating.

Treatment of bronchial obstructive syndrome

The principles of treatment of bronchial obstruction syndrome are as follows:

• removal of bronchospasm with the help of theophylline preparations (euphyllin, aminophylline, etc.) and modern selective inhalation sympathomimetics (salbutamol, fenoterol, etc.). Children of early age have effective nebulizer therapy with selective bronchodilators. For arresting an attack of bronchial asthma, this scheme is usually used: 1-2 inhalations from standard inhalers with a repetition of 5-10 minutes until a clinical improvement (no more than 10 breaths). With improvement of health, repeated inhalations are carried out after 3-4 hours;
• improvement of drainage function of bronchi and rheological properties of sputum, for which they use:
• restoration of HAE by introducing fluid into the interior or intravenous infusion of saline;
• humidification of inhaled air with the help of inhalation ultrasonic devices and sputtering of physiological solution;
• the appointment of drugs that stimulate and facilitate coughing (mucolytics, ciliokinetics);
• vigorous chest massage after inhalation of saline or bronchodilators (especially useful in children with bronchiolitis);
• etiotropic treatment: antiviral (ribavirin, RNA-aza, DNA-ase, etc.) and immune preparations in severe forms of viral OS, antibiotics in case of suspected bacterial nature of the disease or with the development of bacterial complications;
• with severe OS and IIN III-II, resort to short courses (1-5 days) of prednisolonotherapy (daily dose 1-2 mg / kg);
• Oxygen therapy is indicated for all forms of OS, but long-term use of high concentrations (> 60 vol.%) should be avoided;
• bronchoobstructive syndrome of severe form, especially in children of the first months of life, may be accompanied by severe hypoxemia, which is the basis for respiratory support; The ventilation is performed in the mode of moderate hyperventilation with the choice of the ratio of the inhalation-expiration time (1: E = 1: 3 to 1: 1 or 2: 1) and mandatory synchronization of the patient and ventilator with diazepam, GHB.