General Reanimatology (E-Journal) / Общая реаниматология
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Минимальная альвеолярная концентрация угнетения дыхания для севофлурана
Get PDFObjective: to provide a rationale for a need to introduce the new constant — the minimum alveolar concentration for respiratory depression (MACrespiratory depression) and to determine its value. Subjects and methods. Forty-three patients aged 20— 45 years, who had normal weight and ASA physical status I—II, were examined. All the patients underwent induction of sevorane anesthesia without narcotic analgesics, nitrous oxide, and myorelaxants. A laryngeal mask was installed after MAClm was achieved. Sevorane concentrations were increased on a vaporizer, by changing Etanesth at a rate of 0.2 vol% per min until Etanesthresp;ratory depression was achieved. Results. A rationale was provided for a need to introduce the new inhalation anesthesia constant MACrespiratory depression that is, in accordance with the MAC conception, regarded as the inhalation anesthetic concentration that necessitates assisted ventilation in 50% of the patients. MACrespiratory depression was 1.8 MAC. This is essentially more than both MAC and 1.3 MAC, the anesthetic concentration at which any operation can be performed in 90% of patients. At the same time, the derived value of 3.7 vol% is somewhat below MACbarr (4.07 vol%), which means that anesthesia with sevorane only under spontaneous respiration will be inadequate in few patients or its performance will be associated with the risk of hypoxia. Conclusion. The authors’ successively developed concept of anesthesia with preserved spontaneous respiration necessitates the introduction of the new inhalation anesthesia constant MACrespiratory depression. Its value is 3.7% vol% for sevoflurane. Key words: induction of anesthesia, minimum alveolar concentration, spontaneous respiration, inhalation anesthesia
Механизмы вторичного повреждения нейронов при тяжелой черепно-мозговой травме (часть 1)
No full textОбзор посвящен механизмам вторичного гипоксически-ишемического повреждения головного мозга при тяжелой черепно-мозговой травме. Приводятся новые данные по механизмам глутамат-кальциевого повреждения нейронов и ок-сидантного стресса. Ключевые слова: центральная нервная система, черепно-мозговая травма, гипоксия, ишемия, глутамат-кальциевый каскад, оксидантный стресс
Эффективность заместительной почечной терапии при кардиогенном шоке, осложненном полиорганной недостаточностью
Get PDFObjective: to analyze the efficiency of renal replacement therapy (RRT) for acute myocardial infarction complicated by cardiogenic shock and multiorgan dysfunction. Subjects and methods. Sixty-six patients with acute myocardial infarction complicated by cardiogenic shock were enrolled in the study. The postoperative period after coronary angioplasty was complicated by multiorgan dysfunction in all the patients. Results. The efficiency of postoperative RRT in abolishing systemic inflammatory response was evaluated. Conclusion. RRT incorporated within the first 12 hours following coronary angioplasty into an intensive care package for acute myocardial infarction complicated by cardiogenic shock has an effect in preventing multiorgan dysfunction and assists in reducing deaths due to extracardiac causes inflammatory response. Key words: acute myocardial infarction, cardiogenic shock, multiorgan dysfunction, renal replacement therapy.Цель исследования — анализ эффективности заместительной почечной терапии при остром инфаркте миокарда, осложненным кардиогенным шоком и полиорганной недостаточностью. Материал и методы. 66 пациентов с острым инфарктом миокарда, осложненным кардиогенным шоком, были включены в исследование. У всех больных послеоперационный период после проведенной коронарной ангиопластики осложнился полиорганной недостаточностью. Результаты. Проведена оценка эффективности заместительной почечной терапии (ЗПТ) в послеоперационном периоде с позиций купирования системного воспалительного ответа. Заключение. Включение ЗПТ в ближайшие 12 часов после коронарной ангиопластики в комплекс интенсивной терапии острого инфаркта миокарда, осложненного кардиогенным шоком, обладает эффектом предотвращения развития полиорганной недостаточности и способствует сокращению летальности от внекардиальных событий. Ключевые слова: острый инфаркт миокарда, кардиогенный шок, полиорганная недостаточность, заместительная почечная терапия
Автоматизированное отключение от респиратора у пациентов с тяжелой сочетанной травмой
Get PDFSudden cardiac arrest (SCA) is a most important cause of death. SCA bystander first aid and cardiopulmonary resuscitation (CPR) play a key role in helping protect victims. Early defibrillation that can be made just before arrival of a professional rescue service is the optimal intervention. For this, different countries are elaborating public access defibrillation (PAD) programs based on the use of automated external defibrillators (AEDs) by nonmedical professionals. Since 2009, the service vehicles of the police of the Czech Republic and the urban police of the city of Prague, which serve its districts, have been provided by AEDs. The use of the latter in a SCA victim was first documented in spring 2010. CPR and defibril-lation were successfully carried out in the victim, which permitted neurological complications to be prevented. There is no question that AEDs can effectively defibrillate in ventricular fibrillation. CPR performed by first-contact persons correctly and successively remains to play a key role. Only if AED is incorporated into the adequately operating system, its use may be of life-saving importance to protect a number of patients. Key words: automated external defibrillation, sudden cardiac arrest, ventricular fibrillation, defibrillation.Цель исследования — изучение эффективности и безопасности автоматизированной системы отлучения от респиратора у пациентов с ОРДС, находившихся на длительной ИВЛ. Материал и методы. Было обследовано 28 пациентов с диагнозом тяжелой сочетанной травмы. В связи с развитием ОРДС все пациенты находились на длительной ИВЛ. Пациенты основной группы (n=10) переводились на самостоятельное дыхание через автоматизированную вентиляционную систему Smart Care®, в контрольной группе (n=18) отлучение от респиратора под контролем реаниматолога. Учитывали продолжительность вентиляции в режиме Smart Care®, длительность периода отлучения пациентов под контролем реаниматолога, необходимость в повторной интубации, постинтубационные осложнения. Результаты. Применение режима автоматизированного процесса отлучения пациентов от респиратора позволило в 1,3 раза сократить период нахождения пациентов с тяжелым ОРДС в условиях вспомогательного режима вентиляции. Ключевые слова: респираторный дистресс-синдром, ИВЛ, отлучение от вентилятора
Инфекционные осложнения катетеризации центральных вен
Get PDFThe extensive introduction of invasive diagnosis and treatment methods into medical practice is inseparably linked with the necessity of catheterizing the vessels to monitor patient status and to administer medications and other agents into the vascular bed. This results in increased number of cases of catheter-related blood stream infections, which are more than 60% of hospital-acquired bacteremias and 11—37% of all nosocomial infections in Europe. The association of sepsis with an infected catheter is 20—29 to 55%. No specific clinical manifestations of catheter septicemia (and hence its late diagnosis and delayed treatment) and difficulties in identifying a venous catheter as a source of a septic process make it necessary to pay particular attention to the prevention of infectious complications both when placing a central venous catheter and when applying a venous access. Various preventive measures have been developed to reduce the incidence of infections. The measures decreasing catheter-site or infusion system colonization are most effective. Key words: puncture, catheterization, venous access, central venous catheter, colonization, infection, nosocomial infections, catheter-related blood stream infections, septicemia, catheter sepsis
Влияние полного парентерального питания на метаболические процессы в раннем послеоперационном периоде у онкологических больных
Get PDFObjective: to estimate blood glucose levels during complete parenteral nutrition (CPN), by using the three-in-one system with a high glucose level. Subjects and methods. Thirty adult patients without diabetes mellitus (including 18 men) were examined. Twelve and 18 patients were operated on for colonic and gastric cancers, respectively. CPN (Oliclinomel No. 7 — 1000, 1500 ml; glucose, 240 g in 1500 ml, Baxter, Belgium) was carried out at the Surgery Department in the early postoperative period (3-5 postoperative days) with stable hemodynamics and no organ dysfunction (acute respiratory, renal, hepatic failure). The preparation was administered at a rate of about 83 ml/h over 18 hours. Insulin was not used. Serum glucose concentrations were measured before the study and then for 24 hours at an interval of 6 hours. Results. Glucose concentrations were not found to exceed the allowable values in the majority of patients during CPN at the given rate. In 5 (16.7%) patients, short-term glucose increases up to 13.3 mmol/l were corrected, by decreasing the infusion rate. There was no hypoglycemia or other complications during CPN. Conclusion. Our findings suggest that three-in-one parenteral feeding is safe and causes no metabolic disturbances if simple principles are followed, the basic ones of which are to observe the intake of an adequate total dose and the rate of administration of nutrients. Key words: parenteral feeding, hyperglycemia, metabolic disturbances
