PROLONGED ARTIFICIAL VENTILATION AND LONG-TERM TRACHEOSTOMY IN A PATIENT WITH FIBROUS-CAVERNOUS PULMONARY TUBERCULOSIS: A CLINICAL CASE

Introduction. A case is described of long-term carriage of permanent cannulas after tracheostomy with the use of prolonged artificial ventilation for the treatment of destructive pulmonary tuberculosis and its consequences. The progressive initial failure that arose in the early postoperative period associated with secondary nosocomial pneumonia, the operated right lung, as well as the fibrous-cavernous tuberculosis of the left lung with abundant purulent sputum, required long-term ventilatory support and constant sanitation of the tracheobronchial opening. The prescription of a tracheostomy was determined by the severity of the disease and its indications. Aim. Analysis of the clinical case of fibrous-cavernous pulmonary tuberculosis and nosocomial pneumonia with tracheostomy. Materials and Methods. A temporary tracheostomy was performed with the placement of a tracheostomy cannula in a patient with the nosocomial pneumonia of the post-surgery right lung and the fibrocavernous tuberculosis in the left lung. The patient was treated at Novosibirsk Tuberculosis Research Institute, Russian Federation. Results and Discussion. This paper presents a clinical case where the patient did not comply with the treatment, tuberculosis lasted more than 7 years, and there was a severe concomitant pathology. The severe course of an infectious destructive lesion of both lungs, associated with a secondary nosocomial infection after the four-rib osteoplastic thoracoplasty on the right, causing polysegmental pneumonia and Herpes zoster, necessitated intensive resuscitation, the use of mechanical ventilation, and the imposition of a long-term (144-day) tracheostomy. The patient management strategy chosen alleviated the course of the disease considerably, relieved the symptoms of respiratory failure, ensured the adequate, regular sanitation of the tuberculosis by using fiberoptic bronchoscopy and closed aspiration systems, and accelerated the patient’s rehabilitation process. Conclusions. Obviously, you should not be wary of the early tracheostomy or the long-term wearing of a permanent cannula whether in critical care settings at the point of care or in the dedicated unit. It is advisable to expand the indications for tracheostomy in this category of patients until the signs of hypoxemia and septic complications appear.