Pub Date : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-6-17
I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky
The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.
{"title":"The effectiveness of dexmedetomidine cardioprotection during vascular surgery in high cardiac risk patients","authors":"I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky","doi":"10.24884/2078-5658-2024-21-2-6-17","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-6-17","url":null,"abstract":"The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691884","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: 10.24884/2078-5658-2024-21-2-103-111
A. V. Stepanov, K. G. Shapovalov
The search for domestic publications on this publication was conducted in the database on the RSCI website, and foreign ones in the PubMed and Google Scholar databases in the period 2022-2023. Their analysis showed that actively studied approaches to the immunocorrection of sepsis are aimed at changing the content or activity of cytokines, growth factors, the use of immune checkpoint inhibitors, as well as myeloid suppressor cells. When modulating the action of cytokines, a variety of approaches are used, such as changing the affinity of cytokines to their receptors, extending the half-life of cytokines and «fine-tuning» the action of cytokines. For the safe and effective use of bioregulators for immunocorrection in sepsis, additional multicenter studies of their clinical effectiveness are needed, including taking into account the stratification of patients into individual endotypes and the mechanisms of action of bioregulators.
{"title":"Immune correction in patients with sepsis (literature review)","authors":"A. V. Stepanov, K. G. Shapovalov","doi":"10.24884/2078-5658-2024-21-2-103-111","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-103-111","url":null,"abstract":"The search for domestic publications on this publication was conducted in the database on the RSCI website, and foreign ones in the PubMed and Google Scholar databases in the period 2022-2023. Their analysis showed that actively studied approaches to the immunocorrection of sepsis are aimed at changing the content or activity of cytokines, growth factors, the use of immune checkpoint inhibitors, as well as myeloid suppressor cells. When modulating the action of cytokines, a variety of approaches are used, such as changing the affinity of cytokines to their receptors, extending the half-life of cytokines and «fine-tuning» the action of cytokines. For the safe and effective use of bioregulators for immunocorrection in sepsis, additional multicenter studies of their clinical effectiveness are needed, including taking into account the stratification of patients into individual endotypes and the mechanisms of action of bioregulators.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691633","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 : 2024-02-23DOI: 10.24884/2078-5658-2024-21-1-118-124
Yu. V. Bykov, А. А. Muravyeva
Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes mellitus that is associated with a high risk of cerebral edema (CE)and may result in death. DKA is characterized by acute hyperglycemia, ketonemia and metabolic acidosis in the setting of decreased levels of insulin and excessive levels of the counter regulatory hormones. Algorithms of intensive treatment of DKA include such steps as fluid replacement therapy, correction of electrolyte imbalances, and intravenous infusion of insulin, performed in order to resolve metabolic acidosis and hyperglycemia as well as to prevent the development of complications (CE and hypokalemia). The analysis of literature has shown that during fluid replacement the most preferred options are balanced crystalloid solutions (Hartman’s solution and Plasma-Lyte). Infusion therapy is divided into bolus (administration of crystalloid solutions at the rate of 10 ml / kg for 30-60 minutes) and maintenance (administration of solutions for 24-48 hours). Intravenous glucosesolutions (5–10 %) are infused when the patient’s blood glucose falls below 14–16 mmol/L. Electrolyte disturbances (hypokalemia and hyponatremia) are resolved by prompt intravenous infusion of potassium and sodium solutions. Intravenous infusion of insulin is started at the rate of 0.05–0.1 U/kg/h, not earlier than 1 hour after the initiation of fluid resuscitation. Successful treatment of DKA in pediatric practice relies on clear understanding of the pathophysiological mechanisms of this complication and knowledge of the doses of the pharmaceutical drugs and volumes of infusion solutions to be used.
{"title":"Aspects of intensive therapy of diabetic ketoacidosis in pediatric practice (literature review)","authors":"Yu. V. Bykov, А. А. Muravyeva","doi":"10.24884/2078-5658-2024-21-1-118-124","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-118-124","url":null,"abstract":"Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes mellitus that is associated with a high risk of cerebral edema (CE)and may result in death. DKA is characterized by acute hyperglycemia, ketonemia and metabolic acidosis in the setting of decreased levels of insulin and excessive levels of the counter regulatory hormones. Algorithms of intensive treatment of DKA include such steps as fluid replacement therapy, correction of electrolyte imbalances, and intravenous infusion of insulin, performed in order to resolve metabolic acidosis and hyperglycemia as well as to prevent the development of complications (CE and hypokalemia). The analysis of literature has shown that during fluid replacement the most preferred options are balanced crystalloid solutions (Hartman’s solution and Plasma-Lyte). Infusion therapy is divided into bolus (administration of crystalloid solutions at the rate of 10 ml / kg for 30-60 minutes) and maintenance (administration of solutions for 24-48 hours). Intravenous glucosesolutions (5–10 %) are infused when the patient’s blood glucose falls below 14–16 mmol/L. Electrolyte disturbances (hypokalemia and hyponatremia) are resolved by prompt intravenous infusion of potassium and sodium solutions. Intravenous infusion of insulin is started at the rate of 0.05–0.1 U/kg/h, not earlier than 1 hour after the initiation of fluid resuscitation. Successful treatment of DKA in pediatric practice relies on clear understanding of the pathophysiological mechanisms of this complication and knowledge of the doses of the pharmaceutical drugs and volumes of infusion solutions to be used.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"184 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140437663","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 : 2024-02-23DOI: 10.24884/2078-5658-2024-21-1-125-128
I. V. Shlyk, K. G. Shapovalov, R. S. Emelyanov, N. S. Molchan
The objective was to determine the attitude of anesthesiologists and intensivists to the possibility of a complete transition to the use of domestic equipment for mechanical ventilation instead of imported ones.Materials and methods. An anonymous survey of members of the Association of anesthesiologists-intensivists, doctors with experience working on ventilators (code 232870 and 232890), using the Google Forms software service. The survey involved 227 specialists from different regions of the country working in hospitals with both more and less than 1000 beds.Results. At the workplaces of respondents, imported equipment predominates (91.6 %). The majority of experts (92.6 %) believe that the capabilities of domestic equipment relative to imported ones are lower, 0.4 % – higher, 7 % do not see any differences. The main complaints about modern domestic equipment: less reliability (84.1 %), fewer capabilities (71.4 %), worse interface work (60.4 %), worse service (25.6 %). 92.1 % do not consider it advisable to refuse to import devices, although 63.9 % of respondents do not work with domestically produced ventilators at all.Conclusion. Domestic anesthesiologists and intensivists are not ready to use exclusively domestically produced devices in their practical work. It is necessary to improve the interaction of the professional community with manufacturers of domestic respiratory equipment in order to disseminate the positive information about it.
{"title":"Are anesthesiologists and intensivists ready to fully working with domestically produced ventilators?","authors":"I. V. Shlyk, K. G. Shapovalov, R. S. Emelyanov, N. S. Molchan","doi":"10.24884/2078-5658-2024-21-1-125-128","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-125-128","url":null,"abstract":"The objective was to determine the attitude of anesthesiologists and intensivists to the possibility of a complete transition to the use of domestic equipment for mechanical ventilation instead of imported ones.Materials and methods. An anonymous survey of members of the Association of anesthesiologists-intensivists, doctors with experience working on ventilators (code 232870 and 232890), using the Google Forms software service. The survey involved 227 specialists from different regions of the country working in hospitals with both more and less than 1000 beds.Results. At the workplaces of respondents, imported equipment predominates (91.6 %). The majority of experts (92.6 %) believe that the capabilities of domestic equipment relative to imported ones are lower, 0.4 % – higher, 7 % do not see any differences. The main complaints about modern domestic equipment: less reliability (84.1 %), fewer capabilities (71.4 %), worse interface work (60.4 %), worse service (25.6 %). 92.1 % do not consider it advisable to refuse to import devices, although 63.9 % of respondents do not work with domestically produced ventilators at all.Conclusion. Domestic anesthesiologists and intensivists are not ready to use exclusively domestically produced devices in their practical work. It is necessary to improve the interaction of the professional community with manufacturers of domestic respiratory equipment in order to disseminate the positive information about it.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"10 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436865","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 : 2024-02-23DOI: 10.24884/2078-5658-2024-21-1-110-117
A. V. Barminskiy, A. N. Egorov, M. Kirov
Introduction. Adequacy of perioperative analgesia is one of the main issues of surgical care. Anatomo-physiological and psychological characteristics of childhood necessitate more thorough approach to this problem in pediatric anesthesiology, since ensuring optimal analgesia provides prevention of somatic perioperative complications and influences further physiological neuropsychiatric development of a child.The objective was to compare regional techniques of perioperative analgesia during abdominal interventions in children and to discuss the conditionsof their application and effectiveness.Materials and Methods. A literature search was conducted using PubMed, Medline, Embase, and Google Scholar databases. Both English – and Russian-language publications indexed in Scopus and RSCI were included in the search.Results. Among methods of regional anesthesia, neuroaxial blockade options, which have both high proven efficacy and several disadvantages and complications, remain the most popular techniques. Currently, the alternative methods are available, presented as interfascial blockades with anefficacy comparable to neuroaxial techniques and a wide safety profile. Among these techniques, we can distinguish rectus sheath block, transversus abdominis plane block, erector spinae plane block and other methods.Conclusion. Despite advances in pain management, inadequate postoperative analgesia in pediatric practice remains a serious problem. Therefore, it is important to optimize the treatment of postoperative pain in children by applying multimodal analgesia using modern regional blockades.
简介。围术期镇痛的充分性是外科护理的主要问题之一。本研究的目的是比较儿童腹部手术围术期镇痛的区域技术，并讨论其应用条件和有效性。我们使用 PubMed、Medline、Embase 和 Google Scholar 数据库进行了文献检索。Scopus和RSCI收录的英语和俄语出版物均在检索之列。在区域麻醉方法中，神经轴阻滞方法既有公认的高疗效，也有一些缺点和并发症，但仍然是最受欢迎的技术。目前，有一些替代方法可供选择，如筋膜间阻滞，其疗效可与神经轴技术媲美，安全性也很高。在这些技术中，我们可以区分直肌鞘阻滞、腹横肌平面阻滞、竖脊肌平面阻滞和其他方法。尽管疼痛治疗取得了进步，但儿科术后镇痛不足仍是一个严重问题。因此，通过使用现代区域阻滞技术进行多模式镇痛来优化儿童术后疼痛治疗非常重要。
{"title":"Methods of regional analgesia in abdominal surgery in pediatrics","authors":"A. V. Barminskiy, A. N. Egorov, M. Kirov","doi":"10.24884/2078-5658-2024-21-1-110-117","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-110-117","url":null,"abstract":"Introduction. Adequacy of perioperative analgesia is one of the main issues of surgical care. Anatomo-physiological and psychological characteristics of childhood necessitate more thorough approach to this problem in pediatric anesthesiology, since ensuring optimal analgesia provides prevention of somatic perioperative complications and influences further physiological neuropsychiatric development of a child.The objective was to compare regional techniques of perioperative analgesia during abdominal interventions in children and to discuss the conditionsof their application and effectiveness.Materials and Methods. A literature search was conducted using PubMed, Medline, Embase, and Google Scholar databases. Both English – and Russian-language publications indexed in Scopus and RSCI were included in the search.Results. Among methods of regional anesthesia, neuroaxial blockade options, which have both high proven efficacy and several disadvantages and complications, remain the most popular techniques. Currently, the alternative methods are available, presented as interfascial blockades with anefficacy comparable to neuroaxial techniques and a wide safety profile. Among these techniques, we can distinguish rectus sheath block, transversus abdominis plane block, erector spinae plane block and other methods.Conclusion. Despite advances in pain management, inadequate postoperative analgesia in pediatric practice remains a serious problem. Therefore, it is important to optimize the treatment of postoperative pain in children by applying multimodal analgesia using modern regional blockades.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"26 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436238","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 : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-53-64
N. Shen, N. S. Davydova, T. V. Smelaya, E. A. Besedina, L. A. Skorokhodova, P. Boltaev, S. Y. Lukin, I. D. Panov
The objective was to evaluate the clinical effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics. The authors attached great importance to the search for predictors of an unfavorable outcome in patients with severe combined trauma.Materials and methods. This multicenter, non-randomized, open, retro- and prospective cohort study included 65 patients with chest trauma. Pa tients were categorized into three groups depending on the technique of restoration of the disturbed thoracic skeleton. Group 1 included 19 patients with the age of 39.9 ± 2.4 years and severity of MODS-II scale 4.0 ± 0.6, ISS 24.1 ± 1.8 points. In this group, submersible constructs were used to restore sternal reconstruction. Group 2 included 24 patients aged 30.9 ± 2.4 years with MODS-II severity score of 4.3 ± 0.5, ISS 27.1 ± 1.0 points. The stabilization of the frame was carried out using the technique of fixation of the bones of the ribs and sternum with an external fixation device (AVF). Frame stabilization was performed according to the technique of fixation of rib and sternum bones with external fixation apparatus (EFA). Group 3 contained 22 patients aged 48.6 ± 2.9 years with severity of MODS-II scale 3.9 ± 0.3, ISS 24.3 ± 1.3 points and conservative treatment tactics.Results. The respiratory biomechanics parameters in groups 1 and 2 had no statistically significant differences after 24 hours of the surgical interven tion and stabilized the rib cage. The exception concerned increased CO2 accumulation and a distinct tendency to decrease lung tissue extensibility (Slang) in the group 1, which could indicate restriction of chest excursion. The analysis of correlation between clinical and laboratory parameters and lethal outcome indicated that unfavorable outcome was most closely related to prolonged prehospital time, initial severity of the condition according to SOFA and APACHE II integral scales, as well as to the development of acute kidney injury and uncompensated tissue hypoxia.Conclusion. The comparison of the three treatment methods showed that each of them has its own advantages: the technique of surgical treatment using submersible structures is characterized by the greatest aggressiveness for the victim, limits the excursion of the chest in accordance with the biomechanics of respiration, which contributes to the aggravation of tissue hypoxia, but reduces the duration of treatment and financial costs. The least expensive, but comparable in aggressiveness, is the method of hardware fixation. The most sparing for the patient, although lengthening the time of treatment and, accordingly, its cost, is the conservative method of management. Thus, the choice of surgical tactics is left to the attending physician and the patient.
{"title":"Evaluation of the effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics and predictors of an unfavorable outcome in patients with severe combined trauma","authors":"N. Shen, N. S. Davydova, T. V. Smelaya, E. A. Besedina, L. A. Skorokhodova, P. Boltaev, S. Y. Lukin, I. D. Panov","doi":"10.24884/2078-5658-2024-21-1-53-64","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-53-64","url":null,"abstract":"The objective was to evaluate the clinical effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics. The authors attached great importance to the search for predictors of an unfavorable outcome in patients with severe combined trauma.Materials and methods. This multicenter, non-randomized, open, retro- and prospective cohort study included 65 patients with chest trauma. Pa tients were categorized into three groups depending on the technique of restoration of the disturbed thoracic skeleton. Group 1 included 19 patients with the age of 39.9 ± 2.4 years and severity of MODS-II scale 4.0 ± 0.6, ISS 24.1 ± 1.8 points. In this group, submersible constructs were used to restore sternal reconstruction. Group 2 included 24 patients aged 30.9 ± 2.4 years with MODS-II severity score of 4.3 ± 0.5, ISS 27.1 ± 1.0 points. The stabilization of the frame was carried out using the technique of fixation of the bones of the ribs and sternum with an external fixation device (AVF). Frame stabilization was performed according to the technique of fixation of rib and sternum bones with external fixation apparatus (EFA). Group 3 contained 22 patients aged 48.6 ± 2.9 years with severity of MODS-II scale 3.9 ± 0.3, ISS 24.3 ± 1.3 points and conservative treatment tactics.Results. The respiratory biomechanics parameters in groups 1 and 2 had no statistically significant differences after 24 hours of the surgical interven tion and stabilized the rib cage. The exception concerned increased CO2 accumulation and a distinct tendency to decrease lung tissue extensibility (Slang) in the group 1, which could indicate restriction of chest excursion. The analysis of correlation between clinical and laboratory parameters and lethal outcome indicated that unfavorable outcome was most closely related to prolonged prehospital time, initial severity of the condition according to SOFA and APACHE II integral scales, as well as to the development of acute kidney injury and uncompensated tissue hypoxia.Conclusion. The comparison of the three treatment methods showed that each of them has its own advantages: the technique of surgical treatment using submersible structures is characterized by the greatest aggressiveness for the victim, limits the excursion of the chest in accordance with the biomechanics of respiration, which contributes to the aggravation of tissue hypoxia, but reduces the duration of treatment and financial costs. The least expensive, but comparable in aggressiveness, is the method of hardware fixation. The most sparing for the patient, although lengthening the time of treatment and, accordingly, its cost, is the conservative method of management. Thus, the choice of surgical tactics is left to the attending physician and the patient.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"17 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438712","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 : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-75-87
S. K. Sergienko, O. N. Reznik
Intensive care allows maintaining the vital functions of patients with irreversible brain damage for a long time. Under appropriate criteria, human death is determined by brain death, but most patients die after an undetermined period from the inevitable complications. Our legislation does not allow stopping futile treatment and letting a hopeless patient die naturally. In Russia, patient’s right to autonomy and self-determination is fulfilled through the informed consent or refusal to medical intervention. An adult comatose patient with a brain damage isn’t able to make this decision and sign the consent or refusal form, doesn’t have a Health Care Agent, and the medical council makes decision. In this situation, proper treatment is performed regardless of the prognosis. Even if the patient would prefer to die with dignity and comfort, his right to decide cannot be realized.In many countries of the world, there has long been a practice of the advance care planning in case the patient is unable to decide. A person signs advance directives, appoints a Health Care Agent for the medical decision-making. Based on the documented preferences of the patient and communication with his surrogate, doctors can limit the life-sustaining treatment for a hopeless patient and allow him to die. The presented analysis of international data provides basic information for the discussion of the possibility of advance care planning in our country.
{"title":"Patient advance care planning in end of life care: international data review","authors":"S. K. Sergienko, O. N. Reznik","doi":"10.24884/2078-5658-2024-21-1-75-87","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-75-87","url":null,"abstract":"Intensive care allows maintaining the vital functions of patients with irreversible brain damage for a long time. Under appropriate criteria, human death is determined by brain death, but most patients die after an undetermined period from the inevitable complications. Our legislation does not allow stopping futile treatment and letting a hopeless patient die naturally. In Russia, patient’s right to autonomy and self-determination is fulfilled through the informed consent or refusal to medical intervention. An adult comatose patient with a brain damage isn’t able to make this decision and sign the consent or refusal form, doesn’t have a Health Care Agent, and the medical council makes decision. In this situation, proper treatment is performed regardless of the prognosis. Even if the patient would prefer to die with dignity and comfort, his right to decide cannot be realized.In many countries of the world, there has long been a practice of the advance care planning in case the patient is unable to decide. A person signs advance directives, appoints a Health Care Agent for the medical decision-making. Based on the documented preferences of the patient and communication with his surrogate, doctors can limit the life-sustaining treatment for a hopeless patient and allow him to die. The presented analysis of international data provides basic information for the discussion of the possibility of advance care planning in our country.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439405","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 : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-100-109
N. Matinyan, E. Belousova, A. Tsintsadze, D. A. Kuznetsov, E. Kovaleva, A. P. Kazantsev, G. Sagoyan, A. M. Suleymanova, M. Rubanskaya, S. Varfolomeeva
Introduction. Massive perioperative blood loss that accompanies major surgical interventions is a specific critical condition, the pathogenesis of which is dominated by severe hypovolemia, anemia, and threatening coagulopathy in combination with powerful shockogenic sympathoadrenal stress. Both massive blood loss itself and massive transfusion are associated with a significant risk of serious complications, including death. It is worth noting that information on the survival of patients after replacement of several circulating blood volume (CBV) is limited, and most of the articles are devoted to adult patients with highly traumatic surgical interventions.The objective was to present the experience in managing the patient with blood loss of more than 5.5 CBV according to the MT protocol adopted at the Research Institute of Pediatric Oncology and Hematology. The 3-year-old patient underwent surgical intervention in the following volume: median laparotomy, nephradrenalectomy on the right (lesion 10–15–20 cm in size), paracaval and aortocaval lymph node dissection (conglomerate 7–8 cm in size), resection of S5-S6-S7 liver segments, resection of the right domes of the diaphragm. During the surgical intervention of 440 minutes (7.3 hours), the total blood loss was 5.5 CBV (5.500 ml).Results. After surgery, he was transferred to prolonged assisted ventilation of the lungs, the duration of which was 2 days. On the 3rd day after the operation, adjuvant polychemotherapy was started. 17 days after the operation, the patient was transferred to the specialized department for further treatment. The patient was alive for a year after surgery.Conclusion. Maintenance of homeostasis, normothermia, normocoagulation through basic infusion therapy with balanced crystalloid solutions, targeted transfusion therapy with the introduction of fresh frozen plasma, transfusion of donor platelets and donor erythrocytes/autoerythrocytes during anesthesia in the child with extremely massive blood loss, contributed to early post-anesthetic rehabilitation, provided the opportunity to continue special treatment in the intensive care unit.
{"title":"Massive blood loss during highly traumatic surgical intervention in pediatric oncology (clinical case)","authors":"N. Matinyan, E. Belousova, A. Tsintsadze, D. A. Kuznetsov, E. Kovaleva, A. P. Kazantsev, G. Sagoyan, A. M. Suleymanova, M. Rubanskaya, S. Varfolomeeva","doi":"10.24884/2078-5658-2024-21-1-100-109","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-100-109","url":null,"abstract":"Introduction. Massive perioperative blood loss that accompanies major surgical interventions is a specific critical condition, the pathogenesis of which is dominated by severe hypovolemia, anemia, and threatening coagulopathy in combination with powerful shockogenic sympathoadrenal stress. Both massive blood loss itself and massive transfusion are associated with a significant risk of serious complications, including death. It is worth noting that information on the survival of patients after replacement of several circulating blood volume (CBV) is limited, and most of the articles are devoted to adult patients with highly traumatic surgical interventions.The objective was to present the experience in managing the patient with blood loss of more than 5.5 CBV according to the MT protocol adopted at the Research Institute of Pediatric Oncology and Hematology. The 3-year-old patient underwent surgical intervention in the following volume: median laparotomy, nephradrenalectomy on the right (lesion 10–15–20 cm in size), paracaval and aortocaval lymph node dissection (conglomerate 7–8 cm in size), resection of S5-S6-S7 liver segments, resection of the right domes of the diaphragm. During the surgical intervention of 440 minutes (7.3 hours), the total blood loss was 5.5 CBV (5.500 ml).Results. After surgery, he was transferred to prolonged assisted ventilation of the lungs, the duration of which was 2 days. On the 3rd day after the operation, adjuvant polychemotherapy was started. 17 days after the operation, the patient was transferred to the specialized department for further treatment. The patient was alive for a year after surgery.Conclusion. Maintenance of homeostasis, normothermia, normocoagulation through basic infusion therapy with balanced crystalloid solutions, targeted transfusion therapy with the introduction of fresh frozen plasma, transfusion of donor platelets and donor erythrocytes/autoerythrocytes during anesthesia in the child with extremely massive blood loss, contributed to early post-anesthetic rehabilitation, provided the opportunity to continue special treatment in the intensive care unit.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"22 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439057","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 : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-95-99
Ya. A. Lezhepekova, K. V. Pshenisnov, Y. Aleksandrovich
Introduction . Methemoglobinemia is a rather rare cause of hypoxemia and hypoxia, however, with a severe course of the disease and an increase in the concentration of methemoglobin in the blood of more than 20 %, this can cause the development of multi-organ dysfunction and death.The objective was to descript the case of methemoglobinemia in a child with congenital epidermolysis bullosa with the use of a combined drug containing benzocaine.Materials and methods. Newborn premature baby boy, from the first pregnancy, gestation period 36 weeks, suffering from congenital epidermolysis. Birth weight 2850 g, height 47 cm. Apgar score in the first minute – seven, on the fifth – eight points. As a local treatment, an aerosol for external use «Olazol» was prescribed. At the age of 56 hours from the moment of birth, a sharp deterioration in the child’s condition was noted in the form of a decrease in SpO2 to 72–76 %, pronounced tachycardia, an increase in methemoglobin concentration in the blood (53.7 %).Results. A distinctive feature of this case was the presence of severe methemoglobinemia, which led to severe metabolic acidosis, venous hypoxemia and tissue hypoxia. Timely diagnosis and adequate therapy in the early stages of the pathological process contributed to the complete stabilization of the child’s condition and the normalization of the blood gas composition fifteen hours after the start of therapy.Conclusion. The use of drugs containing benzocaine in the early neonatal period is a risk factor for the development of methemoglobinemia, which requires a dynamic assessment of the level of methemoglobin in the blood in order to prevent tissue hypoxia.
{"title":"Methemoglobinemia in a child with congenital epidermolysis bullosa","authors":"Ya. A. Lezhepekova, K. V. Pshenisnov, Y. Aleksandrovich","doi":"10.24884/2078-5658-2024-21-1-95-99","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-95-99","url":null,"abstract":"Introduction . Methemoglobinemia is a rather rare cause of hypoxemia and hypoxia, however, with a severe course of the disease and an increase in the concentration of methemoglobin in the blood of more than 20 %, this can cause the development of multi-organ dysfunction and death.The objective was to descript the case of methemoglobinemia in a child with congenital epidermolysis bullosa with the use of a combined drug containing benzocaine.Materials and methods. Newborn premature baby boy, from the first pregnancy, gestation period 36 weeks, suffering from congenital epidermolysis. Birth weight 2850 g, height 47 cm. Apgar score in the first minute – seven, on the fifth – eight points. As a local treatment, an aerosol for external use «Olazol» was prescribed. At the age of 56 hours from the moment of birth, a sharp deterioration in the child’s condition was noted in the form of a decrease in SpO2 to 72–76 %, pronounced tachycardia, an increase in methemoglobin concentration in the blood (53.7 %).Results. A distinctive feature of this case was the presence of severe methemoglobinemia, which led to severe metabolic acidosis, venous hypoxemia and tissue hypoxia. Timely diagnosis and adequate therapy in the early stages of the pathological process contributed to the complete stabilization of the child’s condition and the normalization of the blood gas composition fifteen hours after the start of therapy.Conclusion. The use of drugs containing benzocaine in the early neonatal period is a risk factor for the development of methemoglobinemia, which requires a dynamic assessment of the level of methemoglobin in the blood in order to prevent tissue hypoxia.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"16 S2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438907","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 : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-88-94
V. M. Luft, A. V. Lapitsky, A. M. Sergeeva
Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment. The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.
{"title":"Organizational aspects of nutritional support for patients in a multidisciplinary emergency hospital","authors":"V. M. Luft, A. V. Lapitsky, A. M. Sergeeva","doi":"10.24884/2078-5658-2024-21-1-88-94","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-88-94","url":null,"abstract":"Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment. The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439213","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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