General Reanimatology (E-Journal) / Общая реаниматология
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Итоги 75-летней научно-клинической деятельности научно-исследовательского института им. В. А. Неговского РАМН
Get PDFResults of the 75-year Research and Clinical Activities of the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical SciencesИтоги 75-летней научно-клинической деятельности Научно-исследовательского института им. В. А. Неговского РАМ
Положительное давление в конце выдоха как фактор, влияющий на церебральное перфузионное давление (экспериментальное исследование)
Get PDFObjective: to evaluate the effect of positive end-expiratory pressure (PEEP) on cerebral perfusion pressure (CPP) in intracranial hypertension in an experiment using a biological model. Materials and methods. The experiment was carried out on 10 pigs aged 2 months and weighing 17—20 kg. The experimental animals were anesthetized. The authors monitored the following parameters: invasive arterial and central venous pressures, intracranial pressure (ICP), and peak inspiratory pressure. ICP was simulated with a subdurally placed balloon. During mechanical ventilation (MV), PEEP was gradually increased up to 5, 10, 15, and 20 cm H2O. Results. PEEP elevation during MV was accompanied by a progressive rise in intrathoracic pressure and a reduction in mean blood pressure. When PEEP was increased, there was a significant rise in ICP in the intact brain and basic subcompensated intracranial hypertension; no statistically significant change in ICP was observed in decompensated intracranial hypertension. The safe PEEP with regard to CPP was determined by the severity of basic intracranial distention (it was 15 cm H2O in the intact brain and 10 cm H2O in subcompensated hypertension); PEEP exerted no significant effect on CPP in decompensated intracranial hypertension. Conclusion. The effect of PEEP on CPP is determined by not only the value of PEEP, but also by the severity of brain damage. Key words: positive end-expiratory pressure, intracranial pressure, cerebral perfusion pressure
Оптимизация ПДКВ у больных с острым респираторным дистресс-синдромом, вызванным прямыми и непрямыми повреждающими факторами
Get PDFObjective: to study the clinical efficiency of undifferentiated and differentiated use of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) resulting from direct and indirect damaging factors. Subjects and methods. During a prospective study, 24 examined patients (16 men, 8 women; their age was 22 to 65 years) with ARDS of different genesis were divided into 2 groups. Group A (n=11; 7 men, 4 women) and Group B (n=13; 9 men, 4 women) included patients with ARDS arising from both direct (gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia) and indirect (abdominal sepsis, severe nonthoracic injury, and acute massive blood loss) damaging factors. The results of treatment via differentiated or undifferentiated, according to the cause of ARDS, use of escalation and de-escalation procedures for PEEP optimization were assessed in Groups A and B patients. Results. The differentiated, according to the cause of ARDS, use of escalation and de-escalation procedures for PEEP optimization makes it possible to more effectively improve the parameters of pulmonary gas exchange and biomechanics and to reduce the length of respiratory support and stay in the intensive care unit, the incidence of ventilator-associated pneumonia, and mortality rates in patients with ARDS resulting from direct and indirect damaging factors. Conclusion. It is advisable to apply the differentiated, according to the cause of ARDS, approach to choosing escalation or de-escalation procedures to optimize PEEP in patients with ARDS of different genesis. Key words: acute respiratory distress syndrome, direct damaging factors, indirect damaging factors, mechanical ventilation, positive end-expiratory pressure, escalation PEEP optimization procedure, de-escalation PEEP optimization procedure, lung opening manoeuver
Эффективность и безопасность электрической дефибрилляции желудочков сердца: эксперимент и клиника
Get PDFThe paper provides the results of the 1990—2010 experimental and clinical studies on the optimization of the efficiency of electrical ventricular defibrillation using the Russian bipolar quasi-sinusoidal impulse. The comprehensive study of the influence of major cardiac and extracardiac factors, such as heart failure, the type and duration of fibrillation, its amplitude and frequency characteristics, chest resistance, electrode sizes, administration of antiarrhythmic drugs, and phase 2 impulse amplitude on the efficiency and safety of defibrillation, could formulate a number of new propositions and solve some methodological and methodic issues. The dose-dependent effectiveness of the quasi-sinusoidal impulse has been first investigated in patients with induced, spontaneous primary and secondary fibrillation and ventricular tachycardia. Low-energy (Key words: defibrillation, bipolar quasi-sinusoidal impulse
Совершенствование диагностики и лечения острого аппендицита у беременных
Get PDFObjective: to improve the diagnosis of acute appendicitis and the results of its treatment in pregnant women. Subjects and methods. Two hundred and forty-three pregnant women sent with the diagnosis of acute appendicitis were followed up. Clinical and laboratory methods were used to diagnose acute appendicitis. One hundred and thirty-nine pregnant women were operated on, of them 47 underwent laparotomy, two-step abdominal sanitation, and drainage for general purulent peritonitis. Results. The authors have elaborated and introduced into practice a diagnostic algorithm for acute appendicitis in pregnant women, a procedure to estimate an electrical cecal cupula potential that allows its location to be specified, improved laparo-scopic techniques, and introduced a procedure long-term autonomous intestinal motility stimulation, which fails to affect uterine tone in pregnant women. An antibiotic cocktail that has an effect on different types of the microflora has been proposed to sanitize the abdomen in pregnant women with complicated acute appendicitis. Conclusion. Examination of pregnant women with suspected appendicitis according to the proposed algorithm makes it possible to rule out diagnostic errors, to specify indications for appendectomy, to correctly choose an access, by estimating the electrical potential of the cecal cupula, to guard against the development of peritonitis, by administering the proposed antibiotic cocktail, to implement a package of measures for the detoxification and early recovery of intestinal motility, and to prevent antenatal fetal death. The mortality rates in pregnant women with acute appendicitis were 0.7%. Key words: acute appendicitis in pregnant women
Выбор способа оптимизации ПДКВ у больных с острым респираторным дистресс-синдромом
Get PDFObjective: to study the clinical efficiency of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) resulting from direct and in indirect damaging factors. Subjects and methods. During a prospective study, 46 examined patients (30 men, 16 women; their age was 21 to 67 years) with ARDS of different genesis were divided into 2 groups: 1) 22 patients (14 men and 8 women) in whom the causes of ARDS were direct damaging factors: gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia; 2) 24 patients (16 men and 8 women) in whom the causes of ARDS were indirect damaging factors: abdominal sepsis, severe nonthoracic injury, and acute massive blood loss. In Groups 1 and 2, the efficiency of the escalation and de-escalation procedures for PEEP optimization was compared during controlled MV with a managed object. Results. In the patients with ARDS caused by direct damaging factors, the escalation procedure for PEEP optimization was more effective than the de-escalation one. In those with ARDS caused by indirect damaging factors, the de-escalation procedure for PEEP optimization was more effective than the escalation one. Conclusion. It is expedient to use a differential approach to choosing an escalation or de-escalation procedure for PEEP optimization in patients with ARDS induced by direct and indirect damaging factors. Key words: acute respiratory distress syndrome; direct and indirect damaging factors; mechanical ventilation; positive end-expiratory pressure; escalation procedure for PEEP optimization; de-escalation procedure for PEEP optimization; lung opening maneuver
Сравнение симпатомиметиков при коррекции артериальной гипотензии в ходе сочетанной анестезии
Get PDFObjective: to make a comparative assessment of hemodynamic parameters when correcting combined anesthesia-induced arterial hypotension with dopamine, adrenaline, mesatone, or noradrenaline. Subjects and methods. A prospective study enrolled patients who had undergone prosthetic hip replacement under combined lumbar epidural (ropivacaine)/general (sevoflurane) anesthesia. Intravenous sympathomimetic infusion was initiated when the mean blood pressure decreased below 55 Hg mm. Cardiac index (CI) and systemic vascular resistance index (SVRI) were calculated by impedance cardiography. Fifty-six subjects (14 in each group) were selected for analysis. Results. During the study, CI remained in the normal range for all sympathomimetics. When adrenaline was administered, there was an obvious tendency to maintain blood pressure due to heart rate (HR) with preserved low SVRI. The use of mesatone caused a considerable reduction in HR. No statistically significant differences were found between the dopamine and noradrenaline groups in any of the study stages. The start of infusion of these agents was attended by SVRI normalization and HR maintenance within 60—70 beats per minute. Conclusion. The infusion of dopamine, adrenaline, mesatone, or noradrenaline to correct arterial hypotension resulting from combined epidural block/general anesthesia with sevoflurane ensures maintenance of CI within the normal range. That of noradrenaline and dopamine was ascertained to have a more balanced impact on HR and systemic vascular resistance. Key words: combined anesthesia, epidural block, hemodynamics, sympathomimetics, adrenaline, dopamine, mesatone, noradrenaline
Периферическая микроциркуляция и функции эндотелия при комах, обусловленных острым нарушением мозгового кровообращения
Get PDFObjective: to study the state of systemic microcirculation and endothelial function in comas induced by acute cerebrovascular accident (ACA). Subjects and methods. The study was conducted within the first 7 days of ACA in 38 coma patients, who were divided into groups according to the etiology of stroke: Group 1 comprised 20 patients with hemorrhagic stroke; their mean age was 56.6±2.3 years; Group 2 consisted of 18 patients with ischemic stroke; their mean age was 58.5±2.2 years. A control group included 34 apparently healthy individuals; their mean age was 55.1±2.1 years. The microcirculatory bed was evaluated within 7 days, by applying cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer made in Russia (LAZMA Research-and-Production Association, the Russian Federation). Coincidentally with recording of the microcirculatory blood flow, blood samples were collected to explore the serum concentrations of endothelin-1, stable nitric oxide metabolites, van Willebrand factor, and thrombomodulin. Results. Throughout the study, the patients with coma induced by ACA were found to have microcirculatory disorders consisting in higher microperfusion along with the markedly increased influence of active modulators of vascular tone, as well as endothelial functional structural changes. Conclusion. The data obtained in the study suggest that there were uniform changes in the state and regulation of systemic microcirculation in patients with ACA irrespective of the type of stroke (hemorrhagic or ischemic). Key words: stroke, microcirculation, microvascular bed, micro blood flow, tissue perfusion, endothelium
Связь между концентрацией триглицеридов плазмы и тяжестью острого респираторного дистресс-синдрома
Get PDFTriglycerides (TG) may be involved in the pathogenesis of critical impairments. Objective: to study the relationship between the plasma concentration of TG, the outcome of the disease, and the markers of its severity in intensive care unit patients with early-stage acute respiratory distress syndrome (ARDS). Subjects and methods. The prospective study included 18 patients with acute lung injury (ALI), who needed respiratory support. For further analysis, all the patients were divided into groups with TG < 1.00 mmol/l (TGlow; n=7) and >1.00 mmol/l (TGhigh; n=11). Results. A negative correlation was found between plasma TG concentration and oxygenation index (PaO2/FiO2). In the TG^jgh group, extravas-cular lung water index was significantly higher and cardiac index was lower than those in the TGlow group. Among the deceased patients, there was a 1.03 mmol/l reduction in TG concentration by day 4 of the study whereas in the survivors, TG concentration increased by an average of 0.15 mmol/l (p=0.02). Conclusion. In the patients with ALI, the plasma concentration of TG is related to oxygenation impairments and the degree of pulmonary edema, as well as with the outcome of the disease. Key words: triglycerides, acute lung injury, extravascular lung water index, pulmonary edema
Седация в интенсивной терапии. Обзор современного состояния проблемы
Get PDFThe review deals with sedation in intensive care unit patients. It covers problems in monitoring, choice of a goal sedation level, use of a sedation pause and timely choice of medications. Key words: intensive care unit sedation, sedation scale, sedation pause, goal sedation level.Обзор посвящен проблеме седации пациентов в отделении реанимации и интенсивной терапии. Освещены вопросы мониторинга, выбора целевого уровня седации, применения паузы седации, а также современный выбор препаратов. Ключевые слова: седация в ОРИТ, шкала седации, пауза седации, протокол седации, целевой уровень седации