1. Introduction

With a duration of mechanical ventilation of lungs risk of pneumonia increases. Thus, according to an epidemiological study EPIC II (Russia), which included more than 14 thousand ICU patients have shown that every second patient have some signs of infection. In this case, 70% of patients the source of infection is the lungs.[2] Among the factors determining the etiological structure of bronchopulmonary complications, above all, should be made prior antimicrobial therapy and duration of mechanical ventilation[11]. Thus, according to Engelgart, only 20% of hospital-acquired pneumonia were of exogenous origin. An important role is played by translocation conditionally pathogenic bacteria in the gastrointestinal tract. At various critical conditions developed ischemia of the intestinal wall, broken motor and intestinal barrier function. In these conditions, the penetration of bacteria and their toxins in the portal and systemic circulation occurs. In addition, the observed retrograde colonization of the overlying parts of the intestinal tube. It is also submitted real that limfogematogen way of spreading bacteria from extrapulmonary sites of infection.

It is conclusively proven, that early adequate empirical antibiotic therapy (EAT) for LAVL significantly reduces the risk of VAP and adverse outcome[3].

The important and urgent is the problem of prevention of scar stenosis of the trachea occurs after prolonged mechanical ventilation. Etiopathogenic found that as a result of ischemia tracheal mucosa in the area of localization inflatable cuff endotracheal tube developed granulation and cicatricial stricture[2]. Violation of purulent sputum expectoration of the tracheobronchial tree in the presence of tracheal stenosis worsens during the process, in the area of tracheal mucosal injury occurs pathological focus accession nosocomial infection.

The correct choice of empirical EAT scheme is crucial, but a variety of reasons of acute respiratory failure, the differences in the severity of the initial status of the patients, especially the earlier EAT most significantly affect the etiology of chronic inflammatory diseases of the lungs and makes it difficult, so the search for effective measures to prevent and treatment remains an urgent problem in modern resuscitation.

2. Objective

The aim of this study was to evaluate the effectiveness of the proposed algorithms predict, prophylaxis and treatment of bronchopulmonary complications in prolonged mechanical ventilation.

3. Materials and Methods (Experimental)

The material for the study is based on the results of bacteriological studies of crops from the trachea, throat, bronchial washings 58 operated patients who were on PIVL for 2010-2011-2012 (I-IX months.) years in the RSCS named after ac. V.Vahidov. The patients were divided into two groups: the main group included patients who used domestic product "FarGALS" (in 1:4 dilution) as inhalation therapy and bronchial lavage passed through the instrument channel fiberoptic (37 patients) in the control group included Patients treated by traditional methods (nebulizer with antibacterial drugs, bronchodilators and mucolytic - 21 patients). The mean age was 37,3 ± 12,6 years. The study included patients after various operations, the nature of which is presented in Table 1.

Table 1. The nature of surgical procedures performed in patients who were in the postoperative period for prolonged mechanical ventilation

Species specificity of the isolated microorganisms were determined by conventional methods using identification media (production'' HiMedia'', India). Sensitivity of microorganisms to antibiotics: cephalosporins, aminoglycosides, tetracyclines, fluoroquinolones, carbapenems, polymyxin B, and so on, as well as to antifungal drugs - were determined by the agar diffusion of the disks. Antimicrobial activity of biotech drugs, topical "FarGALS" against multiresistant hospital strains were determined by the agar diffusion. The results obtained, is to measure the diameters of the zones of inhibition of growth of test cultures around the wells. When zones up to 10 mm inclusive culture considered to be stable in zones 11-14 mm - moderately resistant, with zones of 15 mm and above - sensitive.

On pharmaceutical properties of drug belongs to antiseptic and healing wounds. "FarGALS" has a broad spectrum of antimicrobial action (active against gram-positive and gram-negative, aerobic and anaerobic, asporogenous and spore-forming bacteria, etc., fungi Candida, and Helicobacter pylori). Clinical studies have shown that the drug "FarGALS" can be used as an antimicrobial agent in the treatment of topically necrotic processes, has strong antibacterial and nekroliticheskim action speeds up cleaning of wounds and the appearance of granulation tissue, reduces contamination of tissues, provides faster healing has a strong local anti-inflammatory effect.

4. Results and Discussion

Total examined 340 samples of clinical material, of which 136 (40.0%) samples were identified different types of microorganisms (Table 2).

Table 2. The distribution of selected microorganisms, depending on the biomaterial

Analysis of research on different types of biomaterials inoculation revealed: in the study group (out of 88 positive samples) - throat - 21 (23.8%), bronchial washings - 9 (10.2%), trachea - 58 (66.0%) in the control group (out of 48 positive samples) - throat - 16 (33.3%), bronchial washings - 6 (12.5%), trachea - 26 (54.2%).

Of the isolates are most frequently encountered Candida spp. - 25,7%, Acinetobacter spp. - 19,0%, Esherichia coli-14,7%, Pseudomonas aeruginosa-12,5%, Klebsiella pneumoniae-11,0%, Staphylococcus spp.–8,8%, Staphylococcus aureus – 8,0%.

Antibiogram analysis of isolated cultures in patients on LAVL shows high resistance to a wide range of antibiotics, namely: Acinetobacter spp. - Highly resistant to all antibiotics except imipenem (0% resistant strains), polymyxin B (0% resistant strains) and tetracycline (7-15,4% of resistant strains). Esherichia coli - in its active against imipenem (10.5% of resistant strains), polymyxin B (10.5% of resistant strains), amikacin (31.5% of resistant strains) and cefoperazone/sulbactam (31.5% resistantstrains). Klebsiella pneumoniae was sensitive to imipenem (0% resistant strains), polymyxin (0% resistant strains), amikacin (0% resistant strains), ofloxacin (40.0% of resistant strains) and antibiotic – resistance cefoperazone / sulbactam (40.0% of resistant strains), piperacillin / tazobactam (40.0% of resistant strains). Staphylococcus aureus was sensitive to the III generation cephalosporins (cefotaxime, ceftriaxone, cefoperazone) and tetracyclines - 36.3% of resistant strains. To cefoperazone / sulbactam, and vancomycin-resistant strains were not. Staphylococcus spp. showed good sensitivity to a wide range of antibiotics.

Sensitivity analysis of fungi to antifungal r.Candida showed nitroksolin - 11.4% resistant strains, amphotericin B and fluconazole - 48.5% resistant strains, terbinafine - 51.4% of resistant strains. Analysis of the antimicrobial activity of the drug "FarGALS" against all tested crops (gram-positive organisms, gram-negative microorganisms, fungi), showed a high sensitivity (Table 3).

Table 3. Resistance level selected antimicrobial agents

Thus, over the period studied, from the material of patients are on LAVL, the trend is the prevalence of gram-negative microorganisms planting and expanding the range allocated to crops, isolated cultures of gram-negative microorganisms are resistant to a broad range of antibiotics, clinical improvement when using "FarGALS" occurred after 2 - 3 days. The frequency of specific bronchopulmonary complications was lower in the group and not more than 8% against 23% in the control group. Terms of clinical recovery was 5-6 days, whereas in the traditional 8-10 days.

5. Conclusions

In patients on prolonged mechanical ventilation, the tendency of the prevalence of gram-negative microorganisms planting, and for the last two years, the array of multi-resistant flora released. Gram-negative microorganisms isolated cultures are resistant to a broad range of antibiotics.

Analysis of the antimicrobial activity of the domestic drug "FarGALS" against all tested crops (gram-positive organisms, gram-negative microorganisms, fungi), shows a high sensitivity.

Inclusion in the complex post-operative prophylaxis and treatment of inflammatory lung disease in patients on prolonged mechanical ventilation drug "FarGALS" in the form of inhalation therapy and Fibro-broncho-kopic bronchial lavage reduces the incidence of early and late specific bronchopulmonary complications from 23% to 8%, achieve clinical improvement of the patients already at 2-3 days and shorten recovery period from 8-10 to 5-6 days.

High activity of the domestic drug "FarGALS" against multiresistant strains of causes feasibility of further study and application of patients are on LAVL.