Messenger of ANESTHESIOLOGY AND RESUSCITATION / Вестник анестезиологии и реаниматологии
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КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ ПО ДИАГНОСТИКЕ И ЛЕЧЕНИЮ ТЯЖЕЛОГО СЕПСИСА И СЕПТИЧЕСКОГО ШОКА В ЛЕЧЕБНО-ПРОФИЛАКТИЧЕСКИХ ОРГАНИЗАЦИЯХ САНКТ-ПЕТЕРБУРГА
Get PDFThe letter contains comments on the draft clinical recommendations for diagnostics and treatment of severe sepsis and septic shock in medical units of St. Petersburg, prepared by St. Petersburg Society of Sepsis Specialists (www.spbsepsis.ru). The number of principal comments has been stated and the opinion is expressed that the use of publication of these recommendations in the present form is doubtful.В письме содержится комментарий к проекту клинических рекомендаций по диагностике и лечению тяжелого сепсиса и септического шока в лечебно-профилактических организациях Санкт-Петербурга, подготовленных Санкт-Петербургским обществом специалистов по сепсису (www.spbsepsis.ru). Сформулирован ряд принципиальных замечаний и высказано суждение, что полезность их издания в представленном виде сомнительна
ПРОФИЛАКТИКА СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ В НЕКАРДИАЛЬНОЙ ХИРУРГИИ У ПАЦИЕНТОВ СО СНИЖЕННОЙ ФРАКЦИЕЙ ИЗГНАНИЯ ЛЕВОГО ЖЕЛУДОЧКА: ЛЕВОСИМЕНДАН ИЛИ АНЕСТЕТИЧЕСКАЯ КАРДИОПРОТЕКЦИЯ? (рандомизированное мультицентровое исследование)
Get PDFBasing on the existing data about the positive impact of inhalation induction and anesthetic support (IIAS) and levosimendan it is planned to study and compare within framework of the coming study the impact of IIAS and pre-operative preparation through administration of levosimendan on the rates of myocardial contractility during intra and early post-operative periods, the need in inotropic agents, and 30-day and 1 year mortality of the patients with lower ejection fraction of left ventricular during surgery on infrarenal part of aorta. На основании уже имеющихся данных о положительных эффектах применения ингаляционной индукции и поддержания анестезии (ИИПА) и левосимендана в рамках предстоящего исследования планируется изучить и сравнить влияние ИИПА и предоперационной подготовки путем введения левосимендана на показатели сократимости миокарда в интра- и раннем послеоперационном периодах, потребность в применении инотропных препаратов, а также 30-дневную и годовую летальность у пациентов со сниженной фракцией изгнания левого желудочка (ФИЛЖ) при операциях на инфраренальном отделе аорты.
ГЕМОТРАНСФУЗИИ В ЛЕЧЕНИИ ПОСТРАДАВШИХ: РАЦИОНАЛЬНЫЕ ПУТИ УМЕНЬШЕНИЯ ИХ ОБЪЕМА В ОСТРОМ ПЕРИОДЕ ТРАВМАТИЧЕСКОЙ БОЛЕЗНИ (сообщение третье)
Get PDFGoal: to develop the intensive care programme aimed at the rational reduction of blood transfusions in those with massive hemorrhage of the very severe degree. Materials. Specific course of traumatic disease was analyzed in 112 patients with multiple traumas and acute massive hemorrhage of the very severe degree. Retrospective group 1 included 52 patients, prospective groups 2 and 3 – 39 and 21 patients respectively. Management tactics did not differ principally but for the therapy purposefully aimed at the rational reduction of transfusion of erythrocyte preparations. Results. Using differential management tactics for coagulopathy during acute period of wound disease in those with massive hemorrhage of the very severe degree aimed at the rational reduction of blood transfusions is accompanied by the tendency of lower severity of wound disease in general. Conclusion: In order to reduce the volume of blood transfusions during traumatic shock in those injured it is feasible to use preparations containing key coagulation factors. Rational reduction of blood transfusion volume is accompanied by the tendency of the better treatment results in such patients in general.
ГЕМОТРАНСФУЗИИ В ЛЕЧЕНИИ ПОСТРАДАВШИХ: ИНДИВИДУАЛИЗАЦИЯ ПОКАЗАНИЙ В ПОСТШОКОВЫХ ПЕРИОДАХ ТРАВМАТИЧЕСКОЙ БОЛЕЗНИ (сообщение второе)
Get PDFGoal of the study: to develop the tactical score system for indicators for blood transfusions in those injured with the acute massive blood loss of extremely severe degree in the post shock period of trauma. Research methods included evaluation by score system of severity of trauma and patients' state and their relevant changes by the admission to hospital. Main patients' survival functions were monitored and clinical laboratory tests were performed. Results. Expansion of indicators for repeated blood transfusions in the post-shock period of trauma in those injured with the acute massive blood loss is not accompanied by increase of blood transfusion volume in general. The frequency of complications related to the syndrome of massive blood transfusions does not increase. Applying tactics of transfusion therapy with the use of developed tactic score of military field surgery and blood transfusion (Intensive Care Department) in those with the acute massive blood loss of extremely severe degree is accompanied by the fast improvement of hemodynamics, tissue respiration, and reduction of staying in the intensive care department.
ОСНОВЫ ЭФФЕКТИВНОСТИ АНТИОКСИДАНТНОЙ ТЕРАПИИ ПРИ ОСТРОМ ПАНКРЕАТИТЕ (экспериментальное исследование)
Get PDFThe activation of membrane lipid peroxidation, circulatory and tissue hypoxia are crucial triggers for membrane destroying events in acute pancreatitis. The use of anti-oxidant therapy in acute experimental pancreatitis reduces the intensity of lipid peroxidation (the level of diethenoid conjugates statistically confidently reduces by 30.4-32.5%) and restores the tissue respiration (oxidation-reduction potential is above the control one by 10-15%). Such therapy provides less effect on the microcirculation. Важнейшими триггерными механизмами мембранодеструктивных явлений при остром панкреатите являются активизация перекисного окисления мембранных липидов, циркуляторная и тканевая гипоксия. Применение антиоксидантной терапии при остром экспериментальном панкреатите снижает интенсивность перекисного окисления липидов (уровень диеновых конъюгатов статистически значимо снижается на 30,4–32,5%) и восстанавливает тканевое дыхание (окислительно-восстановительный потенциал выше контроля на 10–15%). На микроциркуляцию такого рода терапия оказывает меньшее влияние.
ИНФЕКЦИЯ, ВЫЗВАННАЯ ACINETOBACTER BAUMANNII, В ОТДЕЛЕНИЯХ РЕАНИМАЦИИ И ИНТЕНСИВНОЙ ТЕРАПИИ МНОГОПРОФИЛЬНОГО ГОСПИТАЛЯ
Get PDFThe objective of the study: to investigate the course of infection, caused by A. baumannii, in the patients in the intensive care units of a general hospital. Methods. The retrospective cohort study was conducted, which included 830 patients of the intensive care wards suffering from nosocomial infections caused by Acinetobacter baumanii. The bacterial diagnostics and drug susceptibility testing were performed using the analyzer of ADAGIO (Bio Rad, USA), Vitex 2 Compact 60 (bio Mariex, France) and the bacteriological analyzer for testing of sterile blood cultures of Bact Alar 3D60 (bio Mariex, France). As a result, certain specific features of this infection were identified: higher frequency of this disease in the patients with unfavorable co-morbid background (p = 0.042), prevailing lesions of abdomen (p = 0.04), skin and soft tissues (p = 0.02), frequent manifestations of septic shock (14%; p = 0.025) with a high mortality rate (16%; p = 0.025). Conclusions. 1. In 28% of cases, Acinetobacter baumannii accounts for the development of nosocomial infection in the patients staying in the intensive care ward. 2. Abdomen (18%), skin and soft tissues (8%) are most frequent sites where lesions caused by this infection are diagnosed. 3. The co-infection caused by A. baumannii most often develops in the patients with compromised co-morbid background (Charlson score makes 4.6 ± 0.3), which explains the severity of their state (APACHE II score makes 18.0 ± 1.6), development of organ failures (SOFA scores make 6.00 ± 0.05) and high frequency of septic shock (14%; p = 0.025). 4. The high mortality is typical of the course of the infection caused by A. baumannii, (16% versus 5.6%) in the patients with nosocomial infections caused by the other gram-negative bacteria.
КОМФОРТ ВО ВРЕМЯ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ В УСЛОВИЯХ РЕГИОНАРНОЙ АНЕСТЕЗИИ С ПОЗИЦИИ ВРАЧА И ПАЦИЕНТА
Get PDFПОДХОДЫ К ПОСЛЕОПЕРАЦИОННОМУ ОБЕЗБОЛИВАНИЮ ПРИ ОПЕРАЦИЯХ ТОТАЛЬНОГО ЭНДОПРОТЕЗИРОВАНИЯ КОЛЕННОГО И ТАЗОБЕДРЕННОГО СУСТАВОВ
Get PDFThe review describes modern approaches to pain relief in the patients after total knee and hip replacement. It covers the principles of multi-modal analgesia, benefits and drawbacks of such ways of pain relief as intravenous analgesia with opioids, spinal and epidural analgesia; it compares different variants of peripheral blocks, and puts some light on a relatively new method of local periarticular infiltration anesthesia.The authors agree that further research is needed to optimize post-operative pain relief after total knee and hip replacement.В обзоре представлены современные подходы к обезболиванию пациентов после операций тотального эндопротезирования коленного и тазобедренного суставов. Затронуты принципы мультимодальной анальгезии, рассмотрены преимущества и недостатки таких способов обезболивания, как внутривенная анальгезия опиоидами, спинальная и эпидуральная анальгезия, проведено сравнение различных вариантов периферических блокад, а также освещен сравнительно новый метод местной периартикулярной инфильтрационной анестезии.Авторы разделяют мнение о необходимости дальнейших исследований, направленных на оптимизацию послеоперационного обезболивания после тотального эндопротезирования коленного и тазобедренного суставов
ОЦЕНКА ЭФФЕКТИВНОСТИ РАННЕЙ НЕИНВАЗИВНОЙ РЕСПИРАТОРНОЙ ПОДДЕРЖКИ У ДОНОШЕННЫХ НОВОРОЖДЕННЫХ
Get PDFNon-invasive respiratory support by continuous positive airway pressure (CPAP) is the most common management technique of the respiratory distress syndrome in newborns. Goal: to evaluate efficiency of non-invasive respiratory support by CPAP in mature newborns depending on the start of therapy. Materials and methods. 39 newborns were enrolled into the study. Depending on the start of respiratory support infants were divided into 2 groups: Group 1 (n = 14) – therapy was started during the first 10 minutes after birth, Group 2 (n = 25) – therapy was started after transfer to Newborns Intensive Care Department. Results. Group 1 had lower rates of SpO2 intermediately after birth and higher rates of oxygen and carbon dioxide tension in blood. In Group 2 the correlation (r = 0.559; p < 0.05) has been found between the number of disorders of the newborn and duration of stay in Newborns Intensive Care Department . No significant differences in the outcome were found between the groups. Conclusion: The start of the non-invasive respiratory support during first 30 minutes after the birth results in the positive clinical effect and favorable impact on the outcome of the disease.