andreyThis article is written by Dr. Novozhilov, The Russian patent holder of the Buteyko Breathing method. He discusses in detail how mechanical ventilation is used to compensate for respiratory failure in patients with COVID-19, meanwhile, according to media reports, there is an extremely high mortality rate for patients connected to the ventilator. What can we learn from Dr. Buteyko that will help us now during this pandemic?

 

 

1. In New York, 80% of COVID-19 patients who are connected to mechanical ventilation devices die, the reason is unclear

2. Long-term hyperventilation of the lungs is the cause of high mortality on the ventilator with COVID-19

3. Treatment of respiratory failure with COVID-19 according to the method proposed by KP Buteyko

            Prevention and treatment of cell hypoxia

            Prevention and treatment of arterial hypoxemia

            Prevention and treatment of cell and arterial hypercapnia

            Danger of mechanical ventilation

            Limiting the effectiveness of oxygen therapy

            Cause of acute lung damage with COVID-19

            Prevention of acute respiratory distress syndrome (ARDS) with COVID-19

4. Prevention of respiratory failure with COVID-19 according to the method proposed by KP Buteyko

 

 

1. In New York, 80% of COVID-19 patients who are connected to mechanical ventilation devices die, the reason is unclear

Mechanical ventilation is used to compensate for respiratory failure in patients with COVID-19, meanwhile, according to media reports, there is an extremely high mortality rate for patients connected to the ventilator.

 

Associated Press

April 10, 2020 reports that according to the Associated Press news agency in New York, 80% of COVID-19 patients who are connected to mechanical lung ventilation are dying. At the same time, the usual mortality rate for patients with difficulty breathing is 40-50%, the agency indicates with reference to data from federal and local authorities.

A small study showed a mortality rate of 86% in Wuhan, China, and one report in the UK reports 66% deaths among patients with COVID-19 connected to ventilators.

 The cause of this mortality is unclear. 

Chinese doctors in February expressed doubt about the effectiveness of mechanical ventilation, since intensive breathing only worsened lung function, and intubation carried additional risks for a seriously ill patient.

At the same time, doctors are trying alternative methods of treatment, for example, laying the patient in such poses so that different parts of the lungs can open better or use an apparatus for invasive extracorporeal oxygen saturation of the blood. ”

 

Newspaper.ru

On April 10, 2020, in an interview with doctors, they reported "about ventilator-associated lung injuries, knowing about which, resuscitation doctors choose sparing modes, small tidal volumes, and try not to force an increase in airway pressure."

It is reported that “in a patient with COVID-19, the oxygen tension in the blood decreases as a result of damage to the virus over a large area of ​​the lungs, which ceases to transmit oxygen from the outside to the blood, compensatory shortness of breath occurs. In such a situation, the patient’s coup from the back to the stomach leads to the fact that the fluid accumulated in the lungs does not compress the lungs, does not affect gas exchange and allows you to survive a critical situation. ”

 

2. Long-term hyperventilation of the lungs is the cause of high mortality on the ventilator under COVID-19 

The cause of high mortality in mechanical ventilation with COVID-19 is prolonged hyperventilation. 

In a normal situation, lung ventilation, significantly exceeding normal values, can lead to the death of a healthy person within 10 minutes. 

At the beginning of the last century, during the period of rapid scientific discoveries in physiology, laboratory studies on animals showed an amazing phenomenon: excessive ventilation of the lungs for several minutes leads to the death of a completely healthy laboratory animal.

However, they were able to explain this phenomenon only after 70 years, thanks to the scientific research of a Russian doctor and scientist Konstantin P. Buteyko (M.D, Ph.D). 

Under normal conditions, in a healthy person, hyperventilation of the lungs for 10 minutes can reduce the pressure of carbon dioxide (CO2) in the lungs, arterial blood, and cells to a level incompatible with life, as a result of which the body dies or compensatory reactions of the respiratory system arise, whose action will be aimed at normalizing gas constants (constant values ​​for oxygen and carbon dioxide) and respiratory homeostasis as a whole.

The most striking reactions whose action is aimed at normalizing respiratory homeostasis are reversible bronchial obstruction and an asthma attack in patients with asthma or spasm of blood vessels and an increase in blood pressure, as well as a prolonged respiratory arrest in sleep (apnea) in a snoring person. 

 

3. Treatment of respiratory failure under COVID-19 according to the method proposed by Dr. Buteyko

Respiratory failure is a violation of the normal gas composition of blood and cells, which with COVID-19 occurs due to prolonged hyperventilation of the lungs, impaired patency of the bronchi, an increase in uneven ventilation, changes in the pH of arterial blood and fragmentary destruction of the lung tissue.

According to various researchers, the area of gas exchange in the lungs of an adult is about 100 square meters. A huge area of gas exchange provides the metabolic needs for oxygen with varying degrees of physical activity: from severe physical inactivity to professional sports. During breathing, the metabolism that happens (takes place) in the cells of the body receives oxygen and gets rid of carbon dioxide, which is the final product of metabolism.

Respiration is the gas exchange between the cells of the body and the air, and the movement of respiratory gases is the main regulator of the pH of blood and cells.

A number of diseases lead to fragmented destruction of the lung tissue and a decrease in the gas exchange area to 1/4 of the original, which reduces the efficiency of gas exchange in the lungs, primarily affects the ability to perform physical activity and gradually reduces the quality of life.

 

Prevention and treatment of cell hypoxia 

Hyperventilation of the lungs, characteristic of the acute phase of respiratory diseases, reduces the partial pressure of carbon dioxide in the lungs (pCO2A), in arterial blood (pCO2a), in cells.

Hypocapnia (CO2 deficiency) at all levels changes the pH of the blood and disrupts the dissociation (decomposition) of oxyhemoglobin, which complicates the transfer of oxygen into cells and creates cellular hypoxia.

The effect, as a result of which the blood is completely saturated with oxygen, but at the same time there is a deficiency of oxygen in the cells at the metabolic level, was first discovered by Russian scientist, professor Bronislav  Verigo in 1898, rediscovered by Danish scientist Christian Bohr in 1904 and was called the Verigo-Bohr effect.

 

At this stage of the disease, normalization of external respiration according to the method proposed by Dr. Buteyko allows:

- eliminate pulmonary hyperventilation, eliminate alveolar, arterial, cellular hypocapnia;

- elimination of arterial hypocapnia will allow normalizing the pH of arterial blood, dissociation of oxyhemoglobin and effectively eliminating cellular hypoxia. 

 

Prevention and treatment of arterial hypoxemia 

Scientific research of a Russian doctor and scientist Konstantin P. Buteyko (M.D, Ph.D) showed that excess breathing, in which there is an increase in general ventilation of the lung relative to the needs of metabolism, violates bronchial patency, creates uneven ventilation, reduces the area of ​​gas exchange, which significantly reduces its effectiveness.

 

Alveolar CO2 deficiency (alveolar hypocapnia) resulting from pulmonary hyperventilation creates a functional (reversible) hypocapnic bronchoconstrictor effect (a decrease in airway clearance due to bronchospasm), which, together with other elements of latent bronchial obstruction (edema of the bronchi and hypersecretion of sputum) bronchi, creates uneven ventilation of the lungs and reduces the area of ​​gas exchange, which may be the cause of a decrease in oxygen pressure in the arterial first blood (arterial hypoxemia).

Arterial hypoxemia joins cellular hypoxia, and cell and arterial hypercapnia (excess CO2) begins to develop as a result of a decrease in gas exchange efficiency. 

At this stage of the disease, normalization of external respiration according to the method proposed by Dr. Buteyko allows:

- eliminate pulmonary hyperventilation and elements of latent bronchial obstruction resulting from alveolar hypocapnia;

- normalization of bronchial patency allows you to normalize the gas exchange area and eliminate arterial hypoxemia, eliminate the initial cell and arterial hypercapnia;

- elimination of arterial hypo- or hypercapnia normalizes the pH of arterial blood, the breakdown of oxyhemoglobin and eliminates cellular hypoxia.

 

Prevention and treatment of cell and arterial hypercapnia

A functional decrease in the efficiency of gas exchange as a result of pulmonary hyperventilation at the initial stage of the disease in a short time gets negative development as a result of lung destruction in response to the invasion of the virus.

The destruction of lung tissue additionally reduces the area and efficiency of gas exchange in the lungs, which can be the cause of an increase in arterial hypoxemia, significant cellular and arterial hypercapnia, and death of the patient.

 

At this stage of the disease, normalization of external respiration according to the method proposed by Dr. Buteyko allows:

- eliminate pulmonary hyperventilation and elements of latent bronchial obstruction resulting from alveolar hypocapnia, which will ensure normal gas exchange through intact areas of the lungs and will quickly eliminate significant cellular and arterial hypercapnia;

- normalization of gas exchange through intact areas of the lungs will eliminate arterial hypoxemia;

- elimination of arterial hypercapnia normalizes the pH of arterial blood, the breakdown of oxyhemoglobin and will eliminate cellular hypoxia.

 

Cause of acute lung damage under COVID-19 

Coronavirus (lat. Coronaviridae) infection COVID-19 (Corona virus disease 2019) is an acute infection caused by the SARS-CoV-2 coronavirus (Severe Acute Respiratory Syndrome), which can occur in the form of an acute respiratory infection with complications in viral pneumonia and acute respiratory distress syndrome (Acute Respiratory Distress Syndrome - ARDS).

 Acute respiratory distress syndrome (ARDS) develops as a result of a strong immune response to virus invasion and the onset of acute diffuse pneumonia. 

In the initial (exudative) phase of diffuse pneumonia, anti-inflammatory substances are released that damage the capillaries and alveoli, as a result of which the exudate penetrates the alveolar air space, which damages the lungs and disrupts gas exchange.

 

Activation of a strong immune response by the virus and a large release of anti-inflammatory substances are one of the causes of acute lung damage and the development of ARDS.

 

Prevention of acute respiratory distress syndrome (ARDS) under COVID-19

The acute respiratory distress syndrome (ARDS) that occurs with COVID-19 can be prevented or stopped at an early stage of development by reducing the activity and inhibiting the development of pneumonia with corticosteroids in small doses and normalizing the pressure of carbon dioxide in the lungs (pCO2A) by the method proposed by Dr. Konstantin P. Buteyko (M.D, Ph.D).

  

Danger of mechanical ventilation

Mechanical ventilation is used to compensate for respiratory failure, normalize the gas composition of blood and cells.

Relatively safe while maintaining disputable effectiveness may be the mechanical ventilation of the lungs with a small volume of air at low pressure, with the settings as close as possible to the physiological norm of a state of rest.

 

1. The main danger of mechanical lung ventilation is prolonged hyperventilation of the lungs, which makes the ventilator procedure dangerous and low effective.

 

Hyperventilation of the lungs creates alveolar and, at the initial stage, arterial hypocapnia, which changes the pH of the blood and causes cellular hypoxia.

 

Alveolar hypocapnia creates a hypocapnic bronchoconstrictor effect, which with other elements of latent bronchial obstruction significantly reduces the gas exchange area and can be the cause of arterial hypoxemia.

At this stage, arterial hypocapnia gradually turns into hypercapnia as a result of a decrease in the area and efficiency of gas exchange.

 

2. Appearance of hidden bronchial obstruction, increasing unevenness of ventilation and acute death of the lungs (acute respiratory distress syndrome - ARDS) do not allow the necessary gas exchange through intact lung areas to eliminate cell and arterial hypercapnia.

 

3. As a result, prolonged hyperventilation of the lungs, which does not allow normalization of gas constants, makes the area of ​​ventilation of the lungs excessive in relation to metabolism and leads to the rapid development of pneumofibrosis as a compensatory reaction of respiratory homeostasis.

 

Limiting the effectiveness of oxygen therapy

 

Breathing with a gas mixture with a high oxygen content is intended to increase the saturation of arterial blood and body cells with oxygen. 

Nevertheless, it is known that blood is always and under any conditions, including with a significant decrease in the area of ​​the ventilated surface of the lungs, completely saturated with oxygen, that is, all hemoglobin, which is a physical carrier of oxygen, is occupied. 

The cause of arterial hypoxemia may be insufficient intake of air into the gas exchange zone.

Hyperventilation of the lungs, creating a hypocapnic bronchoconstrictor effect, increases the unevenness of ventilation of the lungs, violates the patency of the bronchi, forms elements of extensive hidden bronchial obstruction, which may be the main reason for the decrease in oxygen in arterial blood (arterial hypoxemia). 

An oxygen supply in excess of physiological and normal rates for minute breathing volumes, for example, 10 liters per minute with a norm of 5.3 l/min, will always give a negative result and an increase in arterial hypercapnia, and the cause is hyperventilation of the lungs and hypocapnic (alveolar) bronchoconstrictor an effect sharply reducing the area of ​​gas exchange in the lungs.

 

At this stage of the disease, normalization of external respiration according to the method proposed by Dr. Buteyko normalizes bronchial patency, increases the gas exchange area, including through intact areas of the lungs, which is especially important with COVID-19 and normalizes arterial blood oxygenation in a natural way.

 

In most cases, the fact that the transition of oxygen from blood to cells is regulated by the pH of the blood, and not by the degree of saturation of the blood with oxygen, is overlooked.

Under normal conditions, hyperventilation of the lungs for 10 minutes, creating a deficiency of CO2 in the lungs and blood, leads to a change in blood pH and a violation of the dissociation of oxyhemoglobin, which leads to a paradoxical situation: the blood is completely saturated with oxygen, since gas exchange in the lungs is not disturbed, but oxygen does not enter the cells and  tissue, and cellular hypoxia occurs, which cannot be eliminated without normalizing the pH of the blood (Verigo-Bohr effect).

 

An insignificant clinical effect due to oxygen breathing may be due to an increase in oxygen in the blood plasma, while in order to effectively eliminate cellular hypoxia, it is necessary to normalize the blood pH and general ventilation. 

 

4. Prevention of respiratory failure according to the method proposed by Dr. Buteyko

 

To prevent cellular hypoxia, arterial hypoxemia, cellular and arterial hypercapnia, it is enough to eliminate pulmonary hyperventilation and normalize external respiration according to the method proposed by Dr. Buteyko.

 

1. In the absence of damage to the lung tissue, gas exchange is normalized as a result of elimination of elements of latent bronchial obstruction, normalization of blood pH and normal dissociation of oxyhemoglobin.

 

2. In the event of damage to any area of ​​the lung tissue, gas exchange will be carried out in sufficient volume through healthy areas in the absence of latent bronchial obstruction and normal arterial blood pH.

 

Restore breathing through the nose in full, eliminate noisy and deep breathing through the mouth, put a patient with respiratory failure on his stomach to limit the excursion of the chest and abdomen, and to reduce pulmonary hyperventilation - these measures will have a greater positive effect than mechanical ventilation and oxygen therapy.

 

April 16, 2020