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

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.