evaluation of the effectiveness and safety of vibro-acoustic pulmonary therapy (vapt) in complex therapy for acute respiratory failure of mixed type i-ii stages in comparison with percussion massage in cardiac surgical patients in the early postoperative period

Conditions: Cardiac Surgical Patients (CABG,Mammary Coronary Bypass Surgery,Plastic and Replacement of Valves, Atrial Septal Defect,Ventricular Septal Defect)

Summary: the goal of this observational study is to evaluate the effectiveness and safety of vibro-acoustic pulmonary therapy (vapt) in complex therapy for the acute respiratory failure of mixed type i-ii stages in comparison with percussion massage in cardiac surgical patients in the early postoperative period.


Eligibility criteria:
inclusion criteria: * age from 18 years to 80 years inclusive * body mass index from 18.5 to 35 * physical status according to asa ii to asa iii (inclusive) * performed planned cardiac surgery (cs) under general anaesthesia with tracheal intubation and mechanical ventilation lasting more than 3 hours using a heart-lung machine (no more than 120 minutes) * left ventricular injection fraction before surgical treatment is above 40% * development of postoperative mixed arf grade 1-2 (clinical criteria). spo2 less than 95% with fio2 21%. * stable-severe condition of the patient according to vital signs: 1. stable hemodynamics (norepinephrine and/or adrenaline less than 0.15 mcg/kg/min, and/or dobutamine less than 10 mcg/kg/min, and/or no need for vasopressin (adh) for 6 hours or more) 2. absence of acute kidney injury (urine output more than 500 ml/day) 3. stable respiratory dynamics.p/f more than 150 units, spo2 more than 70% with fio2 21%.tracheal extubation within 8 hours of completion of surgery 4. absence of critical coagulopathy (platelets more than 50 units/l) 5. absence of acute cerebral insufficiency (gcs more than 12 points) 6. absence of acute liver failure (bilirubin less than 30 units/l) * relieved postoperative pain syndrome and delirium (nrs less than 5 points, bps less than 6 points, cam-icu (-), rass -3-0 points). exclusion criteria: * the presence of implanted or external medical electronic-mechanical devices in the impact projection (pacemaker, circulatory support devices, etc.); * severe hypocoagulation, risk of hematoma formation or bleeding in the projection of exposure; * severe hypercoagulation, risk of formation and/or migration of blood clots or emboli along the great vessels in the projection of exposure; * acute cerebrovascular accident (acb), first 1-3 days; * cerebral edema; * high intracranial pressure; * the presence of many purulent or burn wound surfaces in the projection of exposure; * presence of an unstable rib fracture; * pneumohemomediastinum and/or subcutaneous emphysema of the chest; * risk of development of hemo-pneumothorax; * osteomyelitis of the ribs and/or thoracic spine; * spinal fracture without orthopedic fixation; * trauma to the chest or abdomen with bleeding; * high risk of seizures (cns pathologies); * the presence of an oncological process in the projection of exposure with destruction of tumor tissue and the risk of bleeding and/or metastasis; * the presence of endothoracic and/or large endovascular implants (aortic stents, intra-aortic balloon pumps, endocardial catheters, mechanical heart valves, vena cava filters, subcutaneous venous ports, permanent hemodialysis devices); * heart rhythm disturbances (ventricular fibrillation, ventricular tachycardia); * hypovolemia; * disturbances of water-electrolyte balance and acid-base balance; * meningoencephalitis; * destructive purulent pneumonia; * high risk of pulmonary hemorrhage; * hiatal hernia; * risk of dislocation of implanted drainage tubes and catheters; * the presence of multiple wound surfaces in the projection of exposure; * severe bullous deformation of the lungs; * severe kyphoscoliosis; * spontaneous pneumothorax within the last year; * estimated systolic pressure over the pulmonary artery more than 50 mm hg. art.