Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-92-102
V. E. Ironosov, K. V. Pshenisnov, Y. Aleksandrovich
Introduction. Professional burnout syndrome (PBS) in specialists in emergency medicine is one of the global problems of modern health systems, since its presence has a significant impact both on the health of individual employees and the quality of care in general.The objective was to analyze risk factors, peculiarities of the course of professional burnout syndrome and its prevention among physicians of intensive care units based on the data of world literature in order to eliminate them in domestic clinical practice.Materials and methods. The analysis includes 122 publications from abstract databases PubMed and e-library for the period from 2017 to 2023. The search was carried out using keywords: provider burnout syndrome, stress, personality, anesthesiologist, intensive care physician, intensive care unit. After the initial study of abstracts, 72 articles were excluded from the review, where there was no access to the full text or they were devoted to organizational preventive measures.Results. The frequency of professional burnout syndrome among specialists of intensive care units was about 40%, which was significantly higher compared to other medical specialists. It was revealed that PBS is a crisis period in middle-aged specialists due to functional changes in higher nervous activity. The main risk group with the highest probability of developing PBS is the intensive care unit nursing staff. A significant workload combined with a low level of motivation, dissatisfaction with professional activities and the lack of recognition of personal achievements by colleagues and management are key risk factors for the development of emotional burnout syndrome.Conclusion. A high level of professionalism in combination with the spiritual and moral component of the personal life of a specialist and the elimination of reversible negative factors of the medicine of critical conditions will allow with a high probability to prevent the development of professional burnout syndrome.
{"title":"Professional burnout syndrome among physicians of intensive care units","authors":"V. E. Ironosov, K. V. Pshenisnov, Y. Aleksandrovich","doi":"10.24884/2078-5658-2024-21-2-92-102","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-92-102","url":null,"abstract":"Introduction. Professional burnout syndrome (PBS) in specialists in emergency medicine is one of the global problems of modern health systems, since its presence has a significant impact both on the health of individual employees and the quality of care in general.The objective was to analyze risk factors, peculiarities of the course of professional burnout syndrome and its prevention among physicians of intensive care units based on the data of world literature in order to eliminate them in domestic clinical practice.Materials and methods. The analysis includes 122 publications from abstract databases PubMed and e-library for the period from 2017 to 2023. The search was carried out using keywords: provider burnout syndrome, stress, personality, anesthesiologist, intensive care physician, intensive care unit. After the initial study of abstracts, 72 articles were excluded from the review, where there was no access to the full text or they were devoted to organizational preventive measures.Results. The frequency of professional burnout syndrome among specialists of intensive care units was about 40%, which was significantly higher compared to other medical specialists. It was revealed that PBS is a crisis period in middle-aged specialists due to functional changes in higher nervous activity. The main risk group with the highest probability of developing PBS is the intensive care unit nursing staff. A significant workload combined with a low level of motivation, dissatisfaction with professional activities and the lack of recognition of personal achievements by colleagues and management are key risk factors for the development of emotional burnout syndrome.Conclusion. A high level of professionalism in combination with the spiritual and moral component of the personal life of a specialist and the elimination of reversible negative factors of the medicine of critical conditions will allow with a high probability to prevent the development of professional burnout syndrome.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-64-69
V. I. Gorban
The objective was to substantiate components, criteria and levels of the patient safety system of the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital as the methodological basis for their subsequent practical assessment in the Russian Federation.Materials and methods. Content analysis of scientific literature (monographs and articles) on the problem of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Determination of the initial list of criteria (indicators, factors) for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospitals, expert assessment of their significance with identification of the main one, including leading (main) criteria. Justification of the content characteristics of the leading criteria, as well as the levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Expert assessment method. Statistical analysis of data distribution, ranking assessment of their significance.Results. It was established that 17 criteria (factors, indicators) are the main ones for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital, of which five are leading (main) and the most informative. They comprehensively reflect one of the five levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital.Conclusion. The system for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital is multidimensional and dynamic (controllable), its state is characterized by 5 main (leading) components, which are the methodological basis for the practical assessment of one of five levels of the system and determining the directions for its change (control, correction).
{"title":"Components, criteria and levels of the patient safety system of the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital (message 1)","authors":"V. I. Gorban","doi":"10.24884/2078-5658-2024-21-2-64-69","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-64-69","url":null,"abstract":"The objective was to substantiate components, criteria and levels of the patient safety system of the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital as the methodological basis for their subsequent practical assessment in the Russian Federation.Materials and methods. Content analysis of scientific literature (monographs and articles) on the problem of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Determination of the initial list of criteria (indicators, factors) for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospitals, expert assessment of their significance with identification of the main one, including leading (main) criteria. Justification of the content characteristics of the leading criteria, as well as the levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital. Expert assessment method. Statistical analysis of data distribution, ranking assessment of their significance.Results. It was established that 17 criteria (factors, indicators) are the main ones for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital, of which five are leading (main) and the most informative. They comprehensively reflect one of the five levels of ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital.Conclusion. The system for ensuring patient safety at the Department of Anesthesiology and Intensive Care of a multidisciplinary hospital is multidimensional and dynamic (controllable), its state is characterized by 5 main (leading) components, which are the methodological basis for the practical assessment of one of five levels of the system and determining the directions for its change (control, correction).","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"219 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-46-51
I. V. Shlyk, A. A. Spiridonova, V. A. Panafidina
The objective was to evaluate the clinical effectiveness and safety of biapenem (Bianem–AF drug) in the treatment of severe forms of infection in ICU patients.Materials and methods. The prospective observational study. At the first stage, microbiological testing of strains (n = 51) isolated from patients in ICU of the Scientific and Clinical Center of Anesthesiology and Intensive Care of the Pavlov University was performed to determine sensitivity to meropenem and biapenem by serial dilution method with the determination of MIC (Minimal Inhibitory Concentration). The genes of serine and metallocarbapenemases were detected by PCR method. At the second stage, patients over 18 years old with the site of infection that required surgical treatment and with clinical and laboratory signs of sepsis were included (n = 19: 11 females, 8 males, mean age 63.4 years). These patients received therapy with biapenem 600 mg every 12 hours as extended infusions over 1 hours (after bolus injection for the first 24 hours). Daily assessment of the severity of the inflammatory reaction and organ dysfunction was conducted to all patients included in the study. Microbiological analysis of biological material obtained from the site of infection has been obtained. Clinical effectiveness was evaluated as recovery/improvement or lack of effect. Adverse effects were recorded.Results. Among 51 isolates of microorganisms: 27 (52.9%) Klebsiella pneumonia, 16 (31%) strains of other representatives of the order Enterobacteriales, 8 (15,6%) non-fermenting gram-negative microorganisms. 48% of Klebsiella pneumoniae isolates were resistant to meropenem and biapenem. All of them had serine (class A and D) and metallo-carbapenemase (class B) genes, as well as their combination. Of the 16 strains of other representatives of the order Enterobacteriales, only 2 (12.5%) were resistant to meropenem and biapenem. Resistance to carbapenems in the non-fermenting gram-negative microorganisms reached 87.5%. The proportion of ESBL producers among carbapenem-sensitive Enterobacteriales reached 93%. The response to biapenem therapy was received in 100% of patients. A day after the start of biapenem administration, a decrease in the level of procalcitonin was noted from 4.65 ng/ml (1.26; 18.8) to 2.2 (1.3; 16.2), after 72 hours – to 1.9 (0.8; 5.0) ng/ ml, by the 7th day – to 0.6 (0.3; 2.5) ng/ml. The median SOFA score decreased from 3.0 (1.5; 4.0) after 24 hours to 2.0 (0,5; 3,5). The average duration of antibacterial therapy was 6 days, the duration of stay in the ICU was two days, and the duration of hospitalization was 9.5 days. There were no adverse effects when using biapenem.Conclusion. Given the high prevalence of ESBL producers and Pseudomonas aeruginosa strains in hospitals, the more favorable safety profile of biapenem compared to other carbapenems, Biapenem appears to be a justified choice for initial empirical therapy MDR sepsis.
{"title":"The effectiveness of biapenem in the treatment of sepsis","authors":"I. V. Shlyk, A. A. Spiridonova, V. A. Panafidina","doi":"10.24884/2078-5658-2024-21-2-46-51","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-46-51","url":null,"abstract":"The objective was to evaluate the clinical effectiveness and safety of biapenem (Bianem–AF drug) in the treatment of severe forms of infection in ICU patients.Materials and methods. The prospective observational study. At the first stage, microbiological testing of strains (n = 51) isolated from patients in ICU of the Scientific and Clinical Center of Anesthesiology and Intensive Care of the Pavlov University was performed to determine sensitivity to meropenem and biapenem by serial dilution method with the determination of MIC (Minimal Inhibitory Concentration). The genes of serine and metallocarbapenemases were detected by PCR method. At the second stage, patients over 18 years old with the site of infection that required surgical treatment and with clinical and laboratory signs of sepsis were included (n = 19: 11 females, 8 males, mean age 63.4 years). These patients received therapy with biapenem 600 mg every 12 hours as extended infusions over 1 hours (after bolus injection for the first 24 hours). Daily assessment of the severity of the inflammatory reaction and organ dysfunction was conducted to all patients included in the study. Microbiological analysis of biological material obtained from the site of infection has been obtained. Clinical effectiveness was evaluated as recovery/improvement or lack of effect. Adverse effects were recorded.Results. Among 51 isolates of microorganisms: 27 (52.9%) Klebsiella pneumonia, 16 (31%) strains of other representatives of the order Enterobacteriales, 8 (15,6%) non-fermenting gram-negative microorganisms. 48% of Klebsiella pneumoniae isolates were resistant to meropenem and biapenem. All of them had serine (class A and D) and metallo-carbapenemase (class B) genes, as well as their combination. Of the 16 strains of other representatives of the order Enterobacteriales, only 2 (12.5%) were resistant to meropenem and biapenem. Resistance to carbapenems in the non-fermenting gram-negative microorganisms reached 87.5%. The proportion of ESBL producers among carbapenem-sensitive Enterobacteriales reached 93%. The response to biapenem therapy was received in 100% of patients. A day after the start of biapenem administration, a decrease in the level of procalcitonin was noted from 4.65 ng/ml (1.26; 18.8) to 2.2 (1.3; 16.2), after 72 hours – to 1.9 (0.8; 5.0) ng/ ml, by the 7th day – to 0.6 (0.3; 2.5) ng/ml. The median SOFA score decreased from 3.0 (1.5; 4.0) after 24 hours to 2.0 (0,5; 3,5). The average duration of antibacterial therapy was 6 days, the duration of stay in the ICU was two days, and the duration of hospitalization was 9.5 days. There were no adverse effects when using biapenem.Conclusion. Given the high prevalence of ESBL producers and Pseudomonas aeruginosa strains in hospitals, the more favorable safety profile of biapenem compared to other carbapenems, Biapenem appears to be a justified choice for initial empirical therapy MDR sepsis.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-112-121
D. Ivanov, Y. Aleksandrovich, J. A. Temirova
Introduction. Respiratory distress of newborns is one of the most common causes of complications, irreversible damage to the central nervous system and deaths in the neonatal period.The objective was to analyze the current features of epidemiology, risk factors and outcomes of respiratory distress (RD) in newborns according to the literature.Materials and methods. The analysis includes 112 publications included in the abstract PubMed database for the period from 2017 to 2023. The search was carried out using keywords: respiratory distress, respiratory distress syndrome, newborns, favorable outcome, unfavorable outcome, risk factor, epidemiology. After the initial study of abstracts, 62 articles were excluded from the review on predicting disease outcomes and the effect of therapeutic measures on the course of respiratory failure in the neonatal period.Results. Studies on the epidemiology of respiratory distress in newborns are very numerous, but the information available in them is extremely heterogeneous and cannot be extrapolated to patients with neonatal ICUs all over the world. Low weight and short gestation at the time of birth are the main risk factors for an unfavorable neonatal period outcome, especially in developing countries. A special risk group is prematurity with extremely low body weight, especially if they have severe infections and sepsis. Severe hypoxemic respiratory failure in the neonatal period in full-term newborns, in most cases, is noted in persistent pulmonary hypertension, which requires significant costs of all health care resources. Therapeutic strategies that have significantly reduced mortality in newborns with RD are surfactant replacement therapy and various options for non-invasive respiratory support.Conclusion. The most frequent cause of hypoxemic respiratory failure in the neonatal period is respiratory distress syndrome and transient tachypnea of newborns, which is due to nursing full-term newborns and increasing indications for surgical delivery.
{"title":"Respiratory distress in newborns: current state of the problem","authors":"D. Ivanov, Y. Aleksandrovich, J. A. Temirova","doi":"10.24884/2078-5658-2024-21-2-112-121","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-112-121","url":null,"abstract":"Introduction. Respiratory distress of newborns is one of the most common causes of complications, irreversible damage to the central nervous system and deaths in the neonatal period.The objective was to analyze the current features of epidemiology, risk factors and outcomes of respiratory distress (RD) in newborns according to the literature.Materials and methods. The analysis includes 112 publications included in the abstract PubMed database for the period from 2017 to 2023. The search was carried out using keywords: respiratory distress, respiratory distress syndrome, newborns, favorable outcome, unfavorable outcome, risk factor, epidemiology. After the initial study of abstracts, 62 articles were excluded from the review on predicting disease outcomes and the effect of therapeutic measures on the course of respiratory failure in the neonatal period.Results. Studies on the epidemiology of respiratory distress in newborns are very numerous, but the information available in them is extremely heterogeneous and cannot be extrapolated to patients with neonatal ICUs all over the world. Low weight and short gestation at the time of birth are the main risk factors for an unfavorable neonatal period outcome, especially in developing countries. A special risk group is prematurity with extremely low body weight, especially if they have severe infections and sepsis. Severe hypoxemic respiratory failure in the neonatal period in full-term newborns, in most cases, is noted in persistent pulmonary hypertension, which requires significant costs of all health care resources. Therapeutic strategies that have significantly reduced mortality in newborns with RD are surfactant replacement therapy and various options for non-invasive respiratory support.Conclusion. The most frequent cause of hypoxemic respiratory failure in the neonatal period is respiratory distress syndrome and transient tachypnea of newborns, which is due to nursing full-term newborns and increasing indications for surgical delivery.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"229 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-56-63
K. A. Mikaelian, M. V. Petrova, E. V. Filimonova, S. A. Bazanovitch
The objective was to develop a predictive model for assessing the risk of hospital mortality in patients with COVID-19-associated acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Materials and methods. We carried out the analysis of case histories of 123 patients treated in the ICU № 7 of the Moscow City Clinical Hospital 52 during the COVID-19 pandemic period. All patients were treated with the VV-ECMO for COVID-19-associated ARDS according to current indications. We analyzed the characteristics potentially associated with mortality, after which we performed statistical analysis, on the basis of which we created the predictive model.Results. The overall-mortality rate was 87% (107/123). Independent predictors of death in patients with COVID-19 treated with the VV-ECMO were the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO. The quality of the prognostic model: AUC = 0.952 [0.909‒0.995], p < 0.001.Conclusions. The nomogram to assess the risk of death in patients with COVID-19 treated with the VV ECMO has been developed. It includes the assessment of the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO.
{"title":"A nomogram for predicting mortality in patients with COVID-19-associated acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation","authors":"K. A. Mikaelian, M. V. Petrova, E. V. Filimonova, S. A. Bazanovitch","doi":"10.24884/2078-5658-2024-21-2-56-63","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-56-63","url":null,"abstract":"The objective was to develop a predictive model for assessing the risk of hospital mortality in patients with COVID-19-associated acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Materials and methods. We carried out the analysis of case histories of 123 patients treated in the ICU № 7 of the Moscow City Clinical Hospital 52 during the COVID-19 pandemic period. All patients were treated with the VV-ECMO for COVID-19-associated ARDS according to current indications. We analyzed the characteristics potentially associated with mortality, after which we performed statistical analysis, on the basis of which we created the predictive model.Results. The overall-mortality rate was 87% (107/123). Independent predictors of death in patients with COVID-19 treated with the VV-ECMO were the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO. The quality of the prognostic model: AUC = 0.952 [0.909‒0.995], p < 0.001.Conclusions. The nomogram to assess the risk of death in patients with COVID-19 treated with the VV ECMO has been developed. It includes the assessment of the maximum VV-ECMO blood flow rate, the period from the onset of the disease to mechanical ventilation, P/F prior to the VV-ECMO initiation and the fact of septic shock development during VV-ECMO.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 102","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-122-130
A. Ivkin, E. V. Grigoriev
The problem of cerebral protection in cardiac surgery is relevant, despite all the techniques used. Due to its properties, ketamine can occupy its niche in solving this problem. The article analyzes current literature sources and describes the use of ketamine for analgesia, sedation and cerebral protection, and analyzes its properties for reducing the systemic inflammatory response. The mechanisms of its action and recommended doses are given, and schemes for its use both during anesthesia and the postoperative period are presented.
{"title":"The importance of ketamine for cerebral protection in pediatric cardiac surgery","authors":"A. Ivkin, E. V. Grigoriev","doi":"10.24884/2078-5658-2024-21-2-122-130","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-122-130","url":null,"abstract":"The problem of cerebral protection in cardiac surgery is relevant, despite all the techniques used. Due to its properties, ketamine can occupy its niche in solving this problem. The article analyzes current literature sources and describes the use of ketamine for analgesia, sedation and cerebral protection, and analyzes its properties for reducing the systemic inflammatory response. The mechanisms of its action and recommended doses are given, and schemes for its use both during anesthesia and the postoperative period are presented.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-76-81
M. S. Pavlova, S. N. Zainagutdinova
Introduction. Methemoglobinemia is a rare condition characterized by an elevated level of methemoglobin in the blood, leading to chemical hypoxia. The most common symptom is central cyanosis refractory to oxygen therapy. Diagnosis of methemoglobinemia is difficult due to the nonspecific clinical presentation and lack of awareness. Accurate diagnosis requires a thorough medical history, differential diagnosis, and confirmation through laboratory investigations.The objective was to demonstrate the successful use of ascorbic acid in the management of acute secondary methemoglobinemia in an 11-year-old boy on prolonged metoclopramide therapy.Materials and methods. The retrospective analysis was conducted on the clinical course of acute secondary methemoglobinemia in the 11-year-old boy on prolonged metoclopramide therapy, necessitating oxygen therapy and parenteral administration of ascorbic acid solution. Special attention was given to the clinical presentation, characteristic changes in laboratory parameters, and the effectiveness of timely ascorbic acid therapy. Clinical and laboratory improvement was achieved within 24 hours of treatment initiation.Conclusion. Caution should be exercised when prescribing medications that can induce methemoglobinemia, taking into account dosage, duration, and frequency of use. Furthermore, careful attention should be given to the combination of metoclopramide with other drugs that may affect iron heme oxidation reactions.
{"title":"Methemoglobinemia in a child induced by metoclopramide: a clinical case","authors":"M. S. Pavlova, S. N. Zainagutdinova","doi":"10.24884/2078-5658-2024-21-2-76-81","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-76-81","url":null,"abstract":"Introduction. Methemoglobinemia is a rare condition characterized by an elevated level of methemoglobin in the blood, leading to chemical hypoxia. The most common symptom is central cyanosis refractory to oxygen therapy. Diagnosis of methemoglobinemia is difficult due to the nonspecific clinical presentation and lack of awareness. Accurate diagnosis requires a thorough medical history, differential diagnosis, and confirmation through laboratory investigations.The objective was to demonstrate the successful use of ascorbic acid in the management of acute secondary methemoglobinemia in an 11-year-old boy on prolonged metoclopramide therapy.Materials and methods. The retrospective analysis was conducted on the clinical course of acute secondary methemoglobinemia in the 11-year-old boy on prolonged metoclopramide therapy, necessitating oxygen therapy and parenteral administration of ascorbic acid solution. Special attention was given to the clinical presentation, characteristic changes in laboratory parameters, and the effectiveness of timely ascorbic acid therapy. Clinical and laboratory improvement was achieved within 24 hours of treatment initiation.Conclusion. Caution should be exercised when prescribing medications that can induce methemoglobinemia, taking into account dosage, duration, and frequency of use. Furthermore, careful attention should be given to the combination of metoclopramide with other drugs that may affect iron heme oxidation reactions.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-82-91
Yu. V. Bykov, A. N. Obedin, A. Muravyeva, V. V. Fischer, E. V. Volkov, I. Yatsuk, O. N. Zinchenko
In pediatric intensive care practice, a hypertensive crisis (HC) is an acute and urgent condition with a high risk of damage to target organs and organ failure, requiring emergency treatment aimed at decreasing arterial blood pressure (BP) and minimizing the risk of complications. HC is subdivided into uncomplicated (acute), in which no signs of organ damage are present, and complicated (urgent), with acute organ damage (neurological, renal or cardiac dysfunction). The main triggers of HC are concomitant endocrine disorders, renal impairment, and use of certain medications. The clinical signs of HC are diverse and non-specific, and depend on the age of the child and on the type of HC. Intensive care to children with HC is provided in intensive care units and is aimed primarily at gradually decreasing the patient’s BP (by 25% during the first 6–8 hours). In complicated HC, antihypertensive drugs are administered parenterally, whereas patients with uncomplicated HC may receive the drugs in enteral or sublingual form. The main drugs for intensive therapy of HC in children and adolescents are calcium channel blockers, vasodilators, α- and β-blockers, ACE inhibitors, centrally acting agents etc. Each group of antihypertensive drugs has its own peculiarities of pharmacokinetics, pharmacodynamics and dose selection, and its own range of adverse effects and contraindications. Timely recognition and competent intensive treatment of children and adolescents with HC will reduce the risk of complications and improve the therapeutic prognosis of this urgent condition.
在儿科重症监护实践中，高血压危象（HC）是一种急性急症，极有可能导致目标器官受损和器官衰竭，需要进行紧急治疗，以降低动脉血压（BP）并将并发症的风险降至最低。HC 又分为无并发症（急性）和并发症（紧急），前者没有器官损伤的迹象，后者则伴有急性器官损伤（神经、肾或心脏功能障碍）。并发内分泌失调、肾功能损害和服用某些药物是诱发急性肾功能衰竭的主要因素。HC 的临床表现多样且无特异性，取决于患儿的年龄和 HC 的类型。重症监护室为患有 HC 的儿童提供重症监护，主要目的是逐渐降低患者的血压（在最初的 6-8 小时内降低 25%）。对于复杂型高血压，降压药物通过肠外给药，而非复杂型高血压患者可通过肠内或舌下给药。儿童和青少年高血压强化治疗的主要药物有钙通道阻滞剂、血管扩张剂、α 和 β 受体阻滞剂、ACE 抑制剂、中枢作用药物等。每一类降压药在药代动力学、药效学和剂量选择方面都有其自身的特点，也有各自的不良反应和禁忌症。对患有高血压的儿童和青少年进行及时识别和有效的强化治疗，将降低并发症的风险，并改善这种急症的治疗预后。
{"title":"Hypertensive crisis in children and adolescents: aspects of intensive therapy","authors":"Yu. V. Bykov, A. N. Obedin, A. Muravyeva, V. V. Fischer, E. V. Volkov, I. Yatsuk, O. N. Zinchenko","doi":"10.24884/2078-5658-2024-21-2-82-91","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-82-91","url":null,"abstract":"In pediatric intensive care practice, a hypertensive crisis (HC) is an acute and urgent condition with a high risk of damage to target organs and organ failure, requiring emergency treatment aimed at decreasing arterial blood pressure (BP) and minimizing the risk of complications. HC is subdivided into uncomplicated (acute), in which no signs of organ damage are present, and complicated (urgent), with acute organ damage (neurological, renal or cardiac dysfunction). The main triggers of HC are concomitant endocrine disorders, renal impairment, and use of certain medications. The clinical signs of HC are diverse and non-specific, and depend on the age of the child and on the type of HC. Intensive care to children with HC is provided in intensive care units and is aimed primarily at gradually decreasing the patient’s BP (by 25% during the first 6–8 hours). In complicated HC, antihypertensive drugs are administered parenterally, whereas patients with uncomplicated HC may receive the drugs in enteral or sublingual form. The main drugs for intensive therapy of HC in children and adolescents are calcium channel blockers, vasodilators, α- and β-blockers, ACE inhibitors, centrally acting agents etc. Each group of antihypertensive drugs has its own peculiarities of pharmacokinetics, pharmacodynamics and dose selection, and its own range of adverse effects and contraindications. Timely recognition and competent intensive treatment of children and adolescents with HC will reduce the risk of complications and improve the therapeutic prognosis of this urgent condition.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-52-55
G. Ibrahem
Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubationMaterials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1st of January 2022 to 1st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.
{"title":"Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions","authors":"G. Ibrahem","doi":"10.24884/2078-5658-2024-21-2-52-55","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-52-55","url":null,"abstract":"Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubationMaterials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1st of January 2022 to 1st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"171 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-70-75
A. V. Kuligin, A. Lushnikov, A. M. Fisun, A. G. Novikov, O. A. Balatsky, S. N. Shcherbakov, Yu. A. Smirnov, E. A. Lushnikova, N. A. Broyaka, E. E. Zeulina
Neurosurgical operations to remove giant brain tumors, thanks to the development of high-tech operating techniques, are rarely accompanied by massive intraoperative blood loss (especially when removing tumors of glial origin). However, when removing meningiomas characterized by greater variability in location and blood supply, massive intraoperative blood loss may develop. Since May 2023, the State Healthcare Institution «Regional Clinical Hospital» in Saratov, within the framework of interdisciplinary cooperation of services – neuro- and x-ray surgery, anesthesiology-resuscitation and transfusiology, has begun the integrated use of blood-saving technologies in patients during operations to remove giant-brain tumors. The authors present the case of successful use of blood-saving technologies in the coordinated work of the above services to provide surgical treatment of the patient with a giant meningioma of the wings of the sphenoid bone on the left.
由于高科技手术技术的发展，切除巨大脑肿瘤的神经外科手术很少出现术中大量失血的情况（尤其是切除胶质瘤时）。然而，在切除位置和血液供应变化较大的脑膜瘤时，可能会出现术中大量失血的情况。自 2023 年 5 月起，位于萨拉托夫的国家医疗机构 "地区临床医院"（Regional Clinical Hospital）在神经和 X 射线外科、麻醉-复苏和输血科等跨学科合作框架内，开始在切除巨大脑肿瘤的手术中对患者综合使用血液保存技术。作者介绍了在上述部门的协调工作中成功使用血液保存技术对左侧蝶骨翼巨大脑膜瘤患者进行手术治疗的案例。
{"title":"The result of using blood-saving technologies when removing a giant meningioma of the wings of the sphenoid bone: a case report","authors":"A. V. Kuligin, A. Lushnikov, A. M. Fisun, A. G. Novikov, O. A. Balatsky, S. N. Shcherbakov, Yu. A. Smirnov, E. A. Lushnikova, N. A. Broyaka, E. E. Zeulina","doi":"10.24884/2078-5658-2024-21-2-70-75","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-70-75","url":null,"abstract":"Neurosurgical operations to remove giant brain tumors, thanks to the development of high-tech operating techniques, are rarely accompanied by massive intraoperative blood loss (especially when removing tumors of glial origin). However, when removing meningiomas characterized by greater variability in location and blood supply, massive intraoperative blood loss may develop. Since May 2023, the State Healthcare Institution «Regional Clinical Hospital» in Saratov, within the framework of interdisciplinary cooperation of services – neuro- and x-ray surgery, anesthesiology-resuscitation and transfusiology, has begun the integrated use of blood-saving technologies in patients during operations to remove giant-brain tumors. The authors present the case of successful use of blood-saving technologies in the coordinated work of the above services to provide surgical treatment of the patient with a giant meningioma of the wings of the sphenoid bone on the left.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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