Multidrug-resistant tuberculosis (as defined by the WHO) includes pathogens resistant to at least H and R.The detection of a multidrug-resistant pathogen to a combination of the main and reserve drugs in TB patients puts the physician in an extremely difficult situation in terms of the possibility of providing chemotherapy.

In this case, the chemotherapy regimen is forced, and the treatment regimen may include reserve drugs to which sensitivity is preserved and some of the main drugs, such as Z and E. Drug resistance to these drugs and aminosalicylic acid develops rather slowly, at the same time they to some extent prevent its development to other drugs. Involuntary regimens of chemotherapy are especially necessary in preparation of patients for surgical interventions and in the postoperative period.

COLLAPSOTHERAPY treatment by creating an artificial pneumothorax or artificial pneumoperitoneum.

An artificial pneumothorax is the introduction of air into the pleural cavity, causing the affected lung to collapse.

Types of artificial pneumothorax: Unilateral.

Bilateral (applied simultaneously or consecutively).

VARIANTS OF THE FORMED ARTIFICIAL PNEUMOTHORAX:

1.Complete hypotensive pneumothorax.

2.Complete hypertensive pneumothorax.

3.Selective-positive pneumothorax.

4.Selective-negative pneumothorax.

BASIC INDICATIONS:

1.Multiple drug resistance to MBT.

2.Intolerance or hypersensitivity of patients to TB drugs.

3.Concomitant diseases and conditions that limit the provision of adequate chemotherapy in its entirety and in due time.

4.Patients who have undergone a 3-month course of chemotherapy in the presence of unclosed caverns or decay cavities in infiltrative, focal, cavernous and limited hematogenous disseminated pulmonary tuberculosis in the decay phase.

5.On urgent or vital indications (in severe recurrent pulmonary bleeding, not amenable to other methods of treatment).

6.Social.

7.Epidemiological.

CONTRAINDICATIONS TO APPLICATION OF ARTIFICIAL PNEUMOTHORAX:

GENERAL:

•Age older than 60 years and younger than 10 years.

•Respiratory failure of II - III degrees.

•Chronic lung diseases (chronic obstructive pulmonary disease, bronchial asthma).

•Severe lesions of the cardiovascular system, circulatory disorders.

•Some neurological and mental diseases (epilepsy, schizophrenia, drug addiction).

PARTICULAR (determine clinical form of the disease, prevalence or localization of the process, presence of complications).

Such changes are detected in: -Caseous pneumonia.

-Disseminated disseminated pulmonary tuberculosis.

-Fibrotic cavernous tuberculosis. -Cirrhotic tuberculosis.

-Exudative or adhesive tuberculous pleurisy. -Tuberculous empyema of the pleura. -Tuberculosis of the bronchi.

-Tuberculoma.

COMPLICATIONS ASSOCIATED WITH THE APPLICATION OF AN ARTIFICIAL PNEUMOTHORAX:

1.Traumatic lung injury (2 - 4%).

2.Subcutaneous or mediastinal emphysema (1 - 2%).

3.Air embolism (less than 0.1%).

COMPLICATIONS ARISING DURING MAINTENANCE OF ARTIFICIAL PNEUMOTHORAX:

1.Pneumopleuritis (10-12%).

2.Rigid pneumothorax (5 - 7%).

3.Atelectasis (3 - 5%).

ARTIFICIAL PNEUMOPERITONEUM

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Injection of gas into the abdominal cavity to limit diaphragm motility.

MECHANISMS OF CURATIVE ACTION OF ARTIFICIAL PNEUMOPERITONEUM:

1.Mechanical - reduction of elastic tension and partial rapprochement of the cavern walls.

2.Neuroreflexive - reduction of tone of elastic and smooth muscle elements of the lung.

It contributes to:

•redistribution of microcirculation;

•development of relative hypoxia that restrains MBT growth;

•development of lymphostasis and slowing down absorption of toxins.