FIOOT

OZONE THERAPY IN THE PROCESSING OF THE PULMONARY ABSCESS.

Complication of the pneumonia by aspiration.

Fabio Antúnez, Adolfo Rendón, Pedro Bravo.

GeneCell Investigation and development.

 

1. Introduction.

 

The pulmonary aspiration is an important serious cause of illness, in the older adult that can cause the death. It is presented in patient hospitalized and in centers of retired. Different syndromes of aspiration exist pulmonary, being of vital importance the diagnostic efficient to determine the suitable processing, lamentably, three common problems exist to distinguish the pneumonia by aspiration of the pneumonitis by aspiration (Mendelsonn’s Syndrome) (1):

 

- The tendency to consider that all the pulmonaries complications, by aspiration they are infectious.

- The spectrum fails it to recognize of pathogenics in patient with infectious complications.

- The Mendelson’s Syndrome is a chemical wound caused by the inhalation of contained gastric sterile, as opposed to the pneumonia by bronco-aspiration that is the inflammation of the parenchyma pulmonary, caused by the strange entrance of material in the tree trachea-bronchial. (2)

 

2. Definition.

 

The pneumonia by bronco-aspiration is an infectious process caused by the inhalation of secretions gold pharyngeal colonized by bacterium pathogenic. (3)

 

3. Epidemiology.

 

Various studies indicate that 5% to 15% of the cases of pneumonia acquired in the community, they are pneumonia by bronco-aspiration. (4)

 

4. Physio-pathology.

 

The clinical consequences and pathological of the pneumonia by bronco-aspiration depend on the pH of the material aspired, its volume, the presence of particles (as them you would feed) in said material and the contamination bacterium. (5)

 

5. Clinical picture.

 

The pneumonia by bronco-aspiration develops after the inhalation of contained gastric and bacterium buco-faríngeas they are presented in healthy persons during the dream. The aspiration of secretion colonized, is the primary mechanism, by which, the bacterium they gain entrance to the lungs. The signs of hypoxemia, as the taquipnea, tachycardia and cyanosis, arise in immediate form and they persist during several hours. The auscultation thoracic indicates the presence of panting, noisy breathing and snores, and is feasible that the patient one expectorate large volumes of spit, bloody and foamy. The main agents bacterium found in the spit of these patients are the Streptococcus pneumonae and the Haemophilus influenzae. The serious bronco-aspiration gives for result insufficiency respiratory with a combination of acidosis metabolic and respiratory. The hypotension and collision, appear with rapidity on account of the step of liquid to the spaces alveolar. The clinical picture is similar to that of the edema pulmonary, but the function ventricle left continues being normal. (6)

 

 

6. Complications.

 

The insufficiency respiratory sharp is the most serious complication of the bronco-aspiration but, the chronic sequels they include fibrosis and abscesses pulmonary, besides empiema. The mortality on account of this disorder varies in the scale of 40-70% with the bronco-aspiration of liquids whose pH is less than 2.5%. In patient that aspire material contaminated, as occurs in the, blockage obstruction the mortality is nearby to the 100 %. (7)

 

7. Conventional processing.

 

The therapy with antibiotic is indicated in patient with pneumonia by bronco-aspiration. The antibiotic of election the clinical framework depends in which the aspiration occur and the general health of the patient one. Different studies mention the preference of handling antibiotics with activity anaerobic in patient with illness periodontal, evidence of necrotic pneumonia or pulmonary abscess observed in thorax radiographies. (8)

 

 

 

 

 

 

8. Pulmonary Abscess.

 

Is a cavitation in the parenchima pulmonary that arises as a result of the suppuration local with necrosis central, usually, after bronco-aspiration of secretions buco-faríngeas that appears a to two weeks after that. The signs and symptoms cover cough productive with spit bloody and foamy and fetidness, fever, pain of thorax, lack of air, weakness and decrease weight. The diagnosis is confirmed for the cavity observable in the thorax radiograph. (9)

 

9. Ozone therapy.

 

The ozone that is employed with medicinal end, is a gas constituted by the mixture of oxygen-ozone and the action of a field of effluvium electric of high tension. Chemically it is a triatomic molecule, variety allotropy of the oxygen. (10) As the ozone is an extremely unstable gas and reagent, has been postulate its mechanism of action, through the secondary generation of products, such as, peroxide of hydrogen, ozonidos, aldehyde, among others. (11)

 

10. Discussion.

 

Although references about the employment do not exist of the ozone therapy in the pulmonary abscess by bronco-aspiration. The possible therapeutic actions of the ozone are evidence in various aspects.

 

11. Effect germicide.

 

Although the effects germ-killing and fungicide of the Ozone have known themselves by practically a century, (fact repeatedly confirmed) went not until the last 20 years that intense investigations upon the formation of peroxides in the blood are log on and the plasma, Washüttl, Buckley et and Freeman. Verifying, in this manner, that their therapeutic effect is achieved thanks to the induction of certain metabolites of the ozone. (10)

 

 

Figure 1.

 

 

 

 

 

 

 

 

 

Initiation metabolic of the ozone (12)

 

 

 

 

 

12. Effect of the ozone upon germs.

 

The 90% of the cause that to cause the pulmonary abscess is, directly, related to the flora bacterial that produces the illness of the gums and the teeth. In the following board 1 the studies are shown In Vitro upon some microorganisms that, they have behaved as sensitive to the exposition of the ozone. (10)

 

 

 

 

 

 

 

 

 

 

 

 

Tabla 1.

 

 

Germicide Inhibition of the ozone

 

 

 

 

 

 

 

 

13. Increment of the supply of Oxygen to the weaves.

 

The metabolites of the ozone produced by the interaction with the membranes cells they are capable of penetrate and to penetrating various processes biochemical basic. One of their effects is to increase the production of 2,3 difosfoglicerato, which, is known that facilitates the liberation of oxygen as of the oxy-haemoglobin, to level of the weaves.

 

Figure 2

 

 

 

 

The experimental demonstration of this effect can be observed in the results shown in the following Figure 2, that, they correspond to a clinical study with 20 patient dealt with ozone therapy, during which was measured the 2,3 DPG in corpuscles red, and also, the uric acid (UA) in the plasma. This last one permits us to give us an idea of the level of oxidizers circulating. As it can be observed, the 2,3 DPG enlarges significantly, with which, the oxy-haemoglobin yields more oxygen to the weaves, while, the UA diminishes, indicating the decrease of the level of oxidizers circulating. All it becoming a notable one improvement in the state of the cells. (10)

 

14. Ways of Application.

 

The ways of application utilized in these patients are: The ennvein, major ozone autohaemotherapy (O3-AHT) due to the activation of metabolites of the ozone, that they induce to the cell to free a waterfall of reactions biochemical favourable. The insufflation rectal as processing systemic.

 

Concentrations and dose of Ozone during the processing by O3-AHT.

 

The concentrations that are recommended to these patient, is in a rank among 10 to 40 ug of ozone by ml. of blood, since, they have shown to be cash to activate the metabolism of the 2,3 DPG, as well as, the immune system after the administration of the ozone therapy systemic. (12)

 

 

CASE CLINICO

 

Patient male of 62 years of age, who presents difficulty respiratory important (disnea of most minimum efforts), noysis breathing audible to the distance, hypertermia, cough productive in accesses. It studies with the antecedent of 8 days of ingest of alcoholic beverages, of which, is derived a gastritis by reflux and a Bled of High Digestive Pipe (STDa). Studies of routine are log on to integrate its diagnostic, reported the following thing: Glucose: 580md/dl, Urea: 86mg/dl, Creatinine: 1.53, Triglycerides: 195 mg/dl EGO: Proteins 150mg/dl, Glucose 1000 mg/dl, Erythrocytes 50 TGO: 18.2, TGP: 12.5, Bilirrubin direct 1.55, Bilirrubin indirect 1.1, Phosphatase alkaline 17

The diagnostic impression went the following one: Pulmonary Abscess right + Discharge pleural + Diabetes Mellitus Type 2.

 

 

Imagen 1.

 

Pulmonary Abscess right, discharge pleural, cardiomegaly

 

 

 

Imagen 2.

 

Processing Systemic of Ozone Therapy.

 

 

 

 

 

 

 

 

 

 

Imagen 3.

 

After 20 sessions of ozone therapy.

 

 

 

 

 

 

 

Conclusions.

 

The possible therapeutic mechanisms of action of the ozone in the pulmonary abscess p can relate to the stimulation of the 2,3 DPG, that at the same time, increases the contribute of oxygen to the weaves and the marked character germicide that possesses the ozone. He fits to stand out that, we should have a number of patients greater to determine the possible therapeutic success of the ozone therapy in this phatology.

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Bibliographical References.

 

 

1. Marrie TJ, Durant H, Kwan C. Nursing home-acquired pneumonia: a case-control study. J Am Geriatr Soc., 1986; 34:697-702.
2. Georges CB. Neumonía por bronco-aspiración, empiema y absceso pulmonar. En: Tintinalli JE, Kromer RL, Ruiz E. Medicina de Urgencias. 4^th edición. 1998. Interamericana McGraw Hill. México.
3. Irwin RS. Aspiration. IN: Irwin RS, Cerra FB, Rippe JM, eds, Irwin and Rippe´s intensive care medicine. 4^th ed. Vol. 1. Philadelphia: Lippincott-Raven, 1999: 685-92.
4. Torres A, Serra-Batlles J, Ferrer A, et al. Severe community acquired pneumonia: epidemiology and prognostic factors. Am Rev. Respir. Dis., 1991; 144:312-8.
5. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet, 1996; 348:123-4.
6. Tuomanen EI. Austrian R, Masure HR. Pathogenesis of pneumococcal infection. N Engl. J Med, 1995; 332:1280-72.
7. Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest, 1997; 111:1266-72.
8. Limeback H. Implications of oral infections on systemic diseases in the institutionalized elderly with a special focus on pneumonia. Ann periodontal, 1998; 3:262-75.

 

9. Cassiere HA, Niederman MS. Aspiration pneumonia, lipoid pneumonia and lung abscess. In: Baum GL, Crapo JD, Celli BR, Karlinsky JB, eds. Textbook of pulmonary diseases. 6^th th ed. Vol. 1. Philadelphia: Lippincott-Raven, 1998:645-55.

 

10. Viebahn R. The use of ozone in Medicine. 2^nd. Rev. Haugh Pub. Ed., Germany, 1994; 100,103, 113-4.

 

11. Gabrielson E.W.,X,Y Spannhake W.E. Comparison of the toxic effects of hydrogen peroxide and ozone on cultured human bronchial epithelial cells. Env. Health Persp., 1994: 102, 927.

 

12. Notes of the authors.