General Reanimatology (E-Journal) / Общая реаниматология
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Современный взгляд на проблему трахеостомии
Get PDFThe paper reviews urgent approaches to tracheostomy in intensive care unit patients, by analyzing the data available in the modern Russian and foreign references. It describes moot points on indications for, time and methods of tracheostoma application. Key words: tracheostoma; time of tracheostomy; techniques for tracheostomy; percutaneous dilatational tra-cheostomy; puncture dilatational tracheostomy.Представлен обзор актуальных подходов к проведению трахеостомии у больных в отделениях реанимации и интенсивной терапии на основании анализа данных современной отечественной и зарубежной литературы. Изложены спорные вопросы о показаниях, сроках и методах наложения трахеостомы. Ключевые слова: трахеостомия, сроки трахео-стомии, методы трахеостомии, чрескожная дилятационная трахеостомия, пункционно-дилятационная трахеостомия
Влияние раствора хлорида натрия и гидроксиэтилкрахмала (200/0,5) на функцию легких и гемодинамику больных, оперированных с искусственным кровообращением
Get PDFObjective: to study the effect of 7.2% NaCl/hydroxyethyl starch 200/0.5 on extravascular lung water and respiratory and cardiovascular systems in patients with coronary heart disease (CHD) after myocardial revascularization under extracorporeal circulation (EC). Subjects and methods. A prospective, randomized study was conducted in 40 patients with coronary artery disease. A study group (n=20) received 7.2% NaCl/hydroxyethyl starch 200/0.5; a control group (n=20) had 0.9% NaCl in a dose of 4 ml/kg within 30 min before EC. Extravascular lung water and central hemodynamic parameters were assessed using transpulmonary thermodilution and a Swan-Ganz catheter; respiratory function was estimated by the arterial oxygenation index, alveolar-arterial oxygen tension difference, and venous shunt fraction. Plasma osmolality and Na concentration were determined using an Osmomat 030 device. Conclusion. The intraoperative use of 7.2% NaCl/hydroxyethyl starch 200/0.5 in patients with CHD leads to a significant reduction in extravascular lung water after myocardial revascularization, thereby effectively protecting pulmonary oxygenizing function. The single administration of 7.2% NaCl/hydroxyethyl starch causes a short-term increase in cardiac index and it is a relatively safe in preventing neurological disorders and heart failure. Key words: 7.2% NaCl/hydroxyethyl starch 200/0.5; extravascular lung water, respiratory function, cardiac index, osmolarity
Механизмы фармакологического прекондиционирования мозга и сравнительная эффективность препаратов — ингибиторов гликоген-синтетазы-киназы — 3 бета прямого и непрямого действия (экспериментальное исследование)
Get PDFПрогностическая ценность шкал в определении летальности у пациентов с различным уровнем постоянного потенциала при острой толстокишечной непроходимости
No full textObjective: to upgrade the quality of predicting an outcome in patients with acute colonic ileus (ACI) in relation to the level of a constant potential. Material and methods. Four hundred and seventy-one case histories of patients operated on for ACI caused by colonic cancer were retrospectively analyzed. Results. An analysis of the capacity of scales to accurately predict a fatal outcome in the general population showed that the CR-POSSUM scale significantly underrated the risk for a fatal outcome (O/R ratio = 1.684 (1.515—1.871); however, the APACHE III and SAPS II scales demonstrated an adequate accuracy (O/R ratio = 1.112 (1.088—1.136) and 1.069 (1.054—1.085), respectively). When dividing subgroups according to the value of constant potential, the greatest agreement was achieved predominantly in Subgroup 1, by using the CR-POSSUM and APACHE III scales (the area under the characteristic curve was 0.913 and 0.93, respectively). It should be pointed out that all the scales had a good calibration after additional identification of subgroups, unlike in the general population of patients (p>0.05). The SAPS II scale also demonstrated a good calibration, but a low discriminating power particularly in groups with average and low negative values of a constant potential. Key words: severity rating scales, acute colonic ileus, constant potential
Лечение фибрилляции предсердий на догоспитальном этапе: клинико-экономические аспекты
Get PDFObjective: to retrospectively study the results of emergency medical care for patients with uncomplicated attacks of atrial fibrillation and to provide a clinical and economic assessment of their prehospital management tactics. Material and methods. A comparative retrospective study was conducted to examine the results of emergency medical care rendered to 1200 patients with uncomplicated atrial fibrillation attacks lasting as long as 24 hours. Ambulance call and outpatient cards and inpatient case reports were used. A clinical and economic assessment of the prehospital management tactics for the patients was made. Results. The prehospital therapy of atrial fibrillation was found to be ineffective in the first hour of observation. In more than 90% of cases, an atrial fibrillation attack was eliminated by the end of the first 24 hours regardless of which antiarrhythmic agent had been used. Conclusion. The proposed prehos-pital management tactics for patients with uncomplicated atrial fibrillation attacks lasting as long as 24 hours make it possible to decrease the length of stay of a called ambulance team and to enhance its efficiency, without reducing the clinical effect of performed antiarrhythmic therapy. Key words: atrial fibrillation, emergency medical care, prehospi-tal stage, clinical and economic analysis
Оптимизация лечения острых отравлений угарным газом
Get PDFObjective: to evaluate the efficiency of combination use of hyperbaric oxygenation, succinate-containing solutions, and anti-edematous agents in patients with acute carbon monoxide poisoning. Subjects and methods. The results of treatment were analyzed in 32 patients admitted in 2009—2011 for severe acute carbon monoxide poisoning and a Glasgow coma score of 6—8. The patients were divided into 2 groups: 1) patients whose combination therapy involved hyperbaric oxygenation, Succinasol infusions, and L-lysine-aescinate injections; 2) those who received traditional therapy. All the patients underwent complex clinical, laboratory, and neurophysiologic examinations. Results. Just 24 hours after the combination use of Succinasol and L-lysine-aescinate, Group I patients were observed to have substantially reduced lactate, the content of the latter approached the normal value following 48 hours, which was much below the values in the control group. The similar pattern was observed when endogenous intoxication parameters were examined. During the performed therapy, the level of consciousness and that of intellect according to the MMSE and FAB scales were restored more rapidly in the study group patients than in Group 2. Conclusion. The combination use of hyperbaric oxygenation, the succinate-containing solution Succinasol, and the anti-edematous agent L-lysine-aescinate considerably enhances the efficiency of intensive therapy for acute carbon monoxide poisoning. Key words: carbon monoxide, toxic hypoxic encephalopathy, combination therapy, hyperbaric oxygenation, succinic acid, L-lysine-aescinate
Эфферентное лечение критических состояний
Get PDFEndogenous intoxication as a typical pathological process has been and remains one of the key problems in virtually all fields of medicine and mainly in reanimatology. Accumulation of endogenous toxic substances is an integral component of any critical condition and accompanies severe injury, generalized infections, abdominal organ derangement. Loss of the function of detoxifying systems in multiple organ dysfunction leads to progressive endotoxicosis and worsening gas exchange disorders, including detoxification in the organs themselves, thus closing the vicious circle of tanatogenesis. Endogenous intoxication is a multidisciplinary problem that is the area of many different fields of practical medicine, experimental pathophysiology, and biomedical technology. Thus, current efferent therapeutic techniques for critical conditions and extracorporeal detoxification in particular are being introduced into clinical practice. The V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, has been studying the theoretical and applied issues concerning the problem of endotoxicosis for many years. This review attempts to generalize the main results the Institute’s activity in this area. Key words: endogenous intoxication, efferent therapy, detoxification
Постреанимационные изменения мозга на уровне нейрональных популяций: закономерности и механизмы
Get PDFThe paper presents the results of a comprehensive study of postresuscitation brain changes at the level of neuronal populations. The study has revealed the general patterns and individual, typological, and sex features of changes in the neuronal populations and determined the association of neurological recovery with morphological changes of these populations. The factors influencing the resistance of neurons to ischemia/reperfusion have been found. The postresuscitation brain changes at the level of neuronal populations have been shown to be of concern in the pathogenesis of posthypoxic encephalopathies. Key words: postresuscitation period; neuronal populations; general patterns of neuronal morphological changes; individual, typological, and sex features.Представлены результаты комплексного исследования постреанимационных изменений мозга на уровне нейрональных популяций. Выявлены общие закономерности, индивидуально-типологические и половые особенности изменений ней-рональных популяций. Установлена взаимосвязь восстановления неврологического статуса с морфофункциональными изменениями нейрональных популяций. Выявлены факторы, влияющие на устойчивость нейронов к ишемии-реперфу-зии. Показано значение постреанимационных изменений мозга на уровне нейрональных популяций в патогенезе пост-гипоксических энцефалопатий. Ключевые слова: постреанимационный период, нейрональные популяции, общие закономерности морфофункциональных изменений нейронов, индивидуально-типологические и половые особенности
Новый/старый взгляд на проблему анестезиологического обеспечения колоноскопии
Get PDFObjective: to compare different modes of anesthesia maintenance for colonoscopy on the basis of internal audit of critical incidents. Subjects and methods. This investigation was conducted at the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, from 2009 to 2011. One hundred and fifty-six patients undergoing colonoscopy under different modes of anesthetic accompaniment were examined. Results. The authors made an internal audit of critical incidents during anesthetic accompaniment of colonoscopy on the basis of controlled sedation with propo-fol, total intravenous anesthesia, inhalational induction, and sevoflurane-maintained anesthesia. Controlled sedation with propofol was shown to have shortcomings. Conclusion. Inhalational induction and sevoflurane-maintained anesthesia are the most effective and safe method of anesthetic accompaniment. Key words: anesthesia, sevoflurane, sedation, propofol, colonoscopy, inhalational induction