Pub Date : 2024-02-22DOI: 10.24884/2078-5658-2024-21-1-65-74
M. G. Pukhtinskaya, V. V. Estrin
The objective was to predict the fatal outcome of the disease in newborns on artificial lung ventilation by means of an intelligent analysis of the immunological database.Materials and methods. The retrospective clinical study included 108 mature newborns. Upon admission to the intensive care unit, on the 3rdday and at the end of the disease, the plasma concentrations of IL-1β, IL-6, IL-8, TNF-α, G-CSF, s-Fas, FGF, NO were determined by ELISA; the relative content of CD3+CD19–, CD3–CD19+, CD3+CD4+, CD3+CD8+, CD69+, CD71+, CD95+, HLA-DR+, CD34+; CD14+, CD3–CD56+ by immunophenotyping; relative content of lymphocytes with expression of AnnexinV-FITC+PI–, AnnexinV-FITC+PI+. By the method of decision trees, the rule of predicting death was formulated.Results. The patient is predicted fatal outcome if, upon admission to intensive care, he has the relative content of lymphocytes with expression of AnnexinV-FITC+PI+ ≥ 0.95 % and plasma concentration of G-CSF ≤ 1.46 pgml or G-CSF ≥ 1.46 pgml and AnnexinV-FITC+PI+ ≥ 4.75 %(specificity 98.68 %; sensitivity 96.97 %; accuracy 98.68 %).Conclusion. In newborns with respiratory pathology and perinatal involvement of the central nervous system on artificial ventilation, death is determined by the high activity of T-lymphocyte apoptosis mediated by the low plasma concentration of granulocyte colony stimulating factor.
{"title":"Algorithm for predicting death in newborns with respiratory pathology and perinatal damage to the central nervous system on artificial ventilation","authors":"M. G. Pukhtinskaya, V. V. Estrin","doi":"10.24884/2078-5658-2024-21-1-65-74","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-65-74","url":null,"abstract":"The objective was to predict the fatal outcome of the disease in newborns on artificial lung ventilation by means of an intelligent analysis of the immunological database.Materials and methods. The retrospective clinical study included 108 mature newborns. Upon admission to the intensive care unit, on the 3rdday and at the end of the disease, the plasma concentrations of IL-1β, IL-6, IL-8, TNF-α, G-CSF, s-Fas, FGF, NO were determined by ELISA; the relative content of CD3+CD19–, CD3–CD19+, CD3+CD4+, CD3+CD8+, CD69+, CD71+, CD95+, HLA-DR+, CD34+; CD14+, CD3–CD56+ by immunophenotyping; relative content of lymphocytes with expression of AnnexinV-FITC+PI–, AnnexinV-FITC+PI+. By the method of decision trees, the rule of predicting death was formulated.Results. The patient is predicted fatal outcome if, upon admission to intensive care, he has the relative content of lymphocytes with expression of AnnexinV-FITC+PI+ ≥ 0.95 % and plasma concentration of G-CSF ≤ 1.46 pgml or G-CSF ≥ 1.46 pgml and AnnexinV-FITC+PI+ ≥ 4.75 %(specificity 98.68 %; sensitivity 96.97 %; accuracy 98.68 %).Conclusion. In newborns with respiratory pathology and perinatal involvement of the central nervous system on artificial ventilation, death is determined by the high activity of T-lymphocyte apoptosis mediated by the low plasma concentration of granulocyte colony stimulating factor.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140440790","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 : 2024-02-21DOI: 10.24884/2078-5658-2024-21-1-46-52
A. V. Marukhov, M. V. Zakharov, E. V. Murzina, L. V. Buryakova, G. А. Sofronov, I. K. Zhurkovich, E. V. Ostrovidova, D. U. Lazarenko, T. G. Kriylova
The objective was to evaluate the effect of renal replacement therapy on the concentration of tigecycline in the blood in the treatment of patients with sepsis and acute kidney injury.Materials and methods. The serum level of tigecycline was analyzed in three patients with sepsis-associated acute kidney injury against the back -ground of renal replacement therapy (RRT) in the hemodiafiltration mode. The quantitative content of tigecycline was determined by high-performance liquid chromatography.Results. Significant variability of serum tigecycline levels was revealed in patients with sepsis-associated acute kidney injury (AKI) under the conditions of the use of RRT. The use of standard dosage regimens of tigecycline in this situation may be accompanied by both a significant increase in the concentration of the drug in the blood relative to the target values, and its low level, which does not reach the values of the minimum inhibitory concentration (MIC) for pathogenic strains.Conclusion. Significant variability of serum concentrations of tigecycline in patients with sepsis-associated AKI against the background of RRT causes the emergence of potential risks associated with both insufficient safety of treatment due to possible accumulation and significant excess of the target concentration value against the background of inhibition of the functions of the physiological excretory systems of the body, so with the low effectiveness of antibacterial therapy in conditions of increasing the rate of elimination of the drug from the systemic bloodstream due to extracorporeal clearance and reducing the concentration of the antibiotic to subtherapeutic.
目的是评估在治疗脓毒症和急性肾损伤患者时，肾脏替代疗法对血液中替加环素浓度的影响。以血液滤过模式下的肾脏替代疗法（RRT）为背景，分析了三名脓毒症相关急性肾损伤患者血清中替加环素的含量。结果显示，血清中替加环素的含量存在显著差异。结果显示，在使用 RRT 的条件下，脓毒症相关急性肾损伤（AKI）患者血清中替加环素的含量存在显著差异。在这种情况下使用替加环素的标准剂量方案，血液中的药物浓度相对于目标值可能会显著增加，而其水平较低，达不到对病原菌株的最低抑制浓度（MIC）值。在 RRT 背景下，脓毒症相关性 AKI 患者血清中替加环素浓度的显著变化会导致潜在风险的出现，既可能因蓄积而导致治疗安全性不足，也可能在抑制人体生理排泄系统功能的背景下导致目标浓度值显著超标、因此，在体外清除导致药物从全身血液中排出的速度加快、抗生素浓度降低到治疗浓度以下的情况下，抗菌治疗的有效性较低。
{"title":"The effect of renal replacement therapy on the concentration of tigecycline in the blood in patients with sepsis-associated acute kidney injury","authors":"A. V. Marukhov, M. V. Zakharov, E. V. Murzina, L. V. Buryakova, G. А. Sofronov, I. K. Zhurkovich, E. V. Ostrovidova, D. U. Lazarenko, T. G. Kriylova","doi":"10.24884/2078-5658-2024-21-1-46-52","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-46-52","url":null,"abstract":"The objective was to evaluate the effect of renal replacement therapy on the concentration of tigecycline in the blood in the treatment of patients with sepsis and acute kidney injury.Materials and methods. The serum level of tigecycline was analyzed in three patients with sepsis-associated acute kidney injury against the back -ground of renal replacement therapy (RRT) in the hemodiafiltration mode. The quantitative content of tigecycline was determined by high-performance liquid chromatography.Results. Significant variability of serum tigecycline levels was revealed in patients with sepsis-associated acute kidney injury (AKI) under the conditions of the use of RRT. The use of standard dosage regimens of tigecycline in this situation may be accompanied by both a significant increase in the concentration of the drug in the blood relative to the target values, and its low level, which does not reach the values of the minimum inhibitory concentration (MIC) for pathogenic strains.Conclusion. Significant variability of serum concentrations of tigecycline in patients with sepsis-associated AKI against the background of RRT causes the emergence of potential risks associated with both insufficient safety of treatment due to possible accumulation and significant excess of the target concentration value against the background of inhibition of the functions of the physiological excretory systems of the body, so with the low effectiveness of antibacterial therapy in conditions of increasing the rate of elimination of the drug from the systemic bloodstream due to extracorporeal clearance and reducing the concentration of the antibiotic to subtherapeutic.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443134","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 : 2024-02-21DOI: 10.24884/2078-5658-2024-21-1-35-45
S. V. Masolitin, D. N. Protsenko, I. N. Tyurin, E. Shifman, M. Magomedov, E. B. Gelfand, S. V. Lomidze, A. Bykov, L. A. Grishina, I. V. Kolerova, D. V. Losev, K. F. Shukurova, N. A. Kashentseva, N. A. Gagieva
Introduction . The choice of the method and time of initiation of extracorporeal detoxification (ECD) in septic shock (SSh) complicated by acute kidney injury (AKI) is a debatable problem.The objective was to evaluate the influence of various ECD tactics on the dynamics of markers of systemic endotoxicosis and acid-base status (ABS) in patients with SSh complicated by AKI.Materials and methods. Study included 57 patients. Group 1 – 36 patients used continuous veno-venous hemodiafiltration (CVVHDF) for urgent indications. Group 2 – 21 patients used early combined ECD (LPS-sorption and CVVHDF). A comparative analysis of the main laboratory parameters between the groups was performed.Results. Early combined ECD made it possible to reduce the concentration of leukocytes by the 3rd day of therapy from 20.6 to 12.5 ·109/l (39.3 %) from the initial level in group 2, and from 22.2 to 19.15·109/l (13.7 %) in group 1 ( p=0.04); C-reactive protein by the 5th day of therapy from 284 to 145 mg/l (48.9 %) in group 2, and from 299.3 to 199.8 mg/l (33.2 %) in group 1 ( p=0.02); procalcitonin by the 5th day of therapy from 7.2 to 1.6 ng/ml (77.8 %) in group 2, and from 7.8 to 4.45 ng/ml (42.9 %) in group 1 ( p= 0.02); pH by the 3rd day of therapy from 7.17 to 7.37 in group 2, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).Conclusions. Early combined ECD more quickly reduces markers of systemic endotoxicosis and eliminates impairment of ABS, than CVVHDF.
简介 .本研究旨在评估各种体外排毒策略对脓毒性休克并发急性肾损伤（AKI）患者全身内毒素中毒和酸碱状态（ABS）指标动态的影响。研究包括 57 名患者。第1组--36名患者因急症使用连续静脉血液滤过（CVVHDF）。第2组--21名患者使用早期联合 ECD（LPS-吸附和 CVVHDF）。对各组的主要实验室参数进行了比较分析。早期联合 ECD 使第 2 组患者的白细胞浓度从治疗第 3 天的 20.6 降至 12.5 -109/l (39.3%)，第 1 组患者的白细胞浓度从 22.2 降至 19.15-109/l (13.7%) ( p=0.04)；第 2 组患者的 C 反应蛋白从治疗第 5 天的 284 降至 145 mg/l (48.9%)，第 1 组患者的 C 反应蛋白从 299.3 降至 199.8 mg/l (33.2%) ( p=0.02)；降钙素原从治疗第 5 天的 284 降至 145 mg/l (48.9%)，第 1 组患者的降钙素原从治疗第 5 天的 299.3 降至 199.8 mg/l (33.2%)。02）；降钙素原在治疗第 5 天时，第 2 组从 7.2 降至 1.6 纳克/毫升（77.8%），第 1 组从 7.8 降至 4.45 纳克/毫升（42.9%）（P=0.02）；pH 值在治疗第 3 天时，第 2 组从 7.17 降至 7.37, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).与 CVVHDF 相比，早期联合 ECD 能更快地降低全身内毒素中毒的标志物并消除 ABS 的损伤。
{"title":"Dynamics of markers of systemic endotoxicosis in patients with gram-negative septic shock during the use of early combined extracorporal detoxification: a prospective multicentric study","authors":"S. V. Masolitin, D. N. Protsenko, I. N. Tyurin, E. Shifman, M. Magomedov, E. B. Gelfand, S. V. Lomidze, A. Bykov, L. A. Grishina, I. V. Kolerova, D. V. Losev, K. F. Shukurova, N. A. Kashentseva, N. A. Gagieva","doi":"10.24884/2078-5658-2024-21-1-35-45","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-35-45","url":null,"abstract":"Introduction . The choice of the method and time of initiation of extracorporeal detoxification (ECD) in septic shock (SSh) complicated by acute kidney injury (AKI) is a debatable problem.The objective was to evaluate the influence of various ECD tactics on the dynamics of markers of systemic endotoxicosis and acid-base status (ABS) in patients with SSh complicated by AKI.Materials and methods. Study included 57 patients. Group 1 – 36 patients used continuous veno-venous hemodiafiltration (CVVHDF) for urgent indications. Group 2 – 21 patients used early combined ECD (LPS-sorption and CVVHDF). A comparative analysis of the main laboratory parameters between the groups was performed.Results. Early combined ECD made it possible to reduce the concentration of leukocytes by the 3rd day of therapy from 20.6 to 12.5 ·109/l (39.3 %) from the initial level in group 2, and from 22.2 to 19.15·109/l (13.7 %) in group 1 ( p=0.04); C-reactive protein by the 5th day of therapy from 284 to 145 mg/l (48.9 %) in group 2, and from 299.3 to 199.8 mg/l (33.2 %) in group 1 ( p=0.02); procalcitonin by the 5th day of therapy from 7.2 to 1.6 ng/ml (77.8 %) in group 2, and from 7.8 to 4.45 ng/ml (42.9 %) in group 1 ( p= 0.02); pH by the 3rd day of therapy from 7.17 to 7.37 in group 2, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).Conclusions. Early combined ECD more quickly reduces markers of systemic endotoxicosis and eliminates impairment of ABS, than CVVHDF.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"225 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443478","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 : 2024-02-20DOI: 10.24884/2078-5658-2024-21-1-17-23
V. Evreinov
Introduction. Valproic acid is one of the commonly prescribed basic anticonvulsants for the treatment of epileptic seizures in children with cerebral palsy. Its active metabolites can cause hematological and coagulation disorders, cause valproate-induced steatohepatitis.The objective was to assess the level of hematological, biochemical and coagulation blood parameters in the perioperative period in children with severe forms of cerebral palsy during the treatment of concomitant epilepsy with valproic acid.Materials and methods. A prospective cohort study included 72 patients with cerebral palsy, spastic hip dislocations, who underwent reconstructive interventions on hip joints. Depending on the presence of concomitant epilepsy, the patients were divided into two groups. Perioperative laboratory blood parameters, complication incidence, the duration of stay in the intensive care unit and hospitalization were assessed.Results. In patients with epilepsy, the number of platelets in the blood was lower compared to the control group. The level of alkaline phosphatase before and after surgery in 34 % of children who took anticonvulsants exceeded the maximum value of the norm. Groups differed in terms of peri -operative coagulogram and thromboelastography. The frequency of complications in patients with epilepsy ranged from 0.08 % to 16.2 %.Conclusions. Basic therapy with valproic acid in children with severe forms of cerebral palsy and concomitant epilepsy is associated with a tendency to hypocoagulation, but was not accompanied by clinically significant thrombocytopenia or coagulopathy during hip surgery. Taking valproic acid drugs in patients with cerebral palsy and epilepsy was not accompanied by an increase in serum liver enzymes at all stages of observation, which minimized the likelihood of valproate-induced hepatotoxicity. Anticonvulsant therapy with valproate in children with severe forms of cerebral palsy and concomitant epilepsy did not increase the potential risk of complications in the perioperative period, did not affect the duration of stay of patients in the intensive care unit and hospitalization.
{"title":"Hematological, biochemical, coagulation profiles of patients with cerebral palsy and epilepsy on the background of taking valproic acid in the perioperative period","authors":"V. Evreinov","doi":"10.24884/2078-5658-2024-21-1-17-23","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-17-23","url":null,"abstract":"Introduction. Valproic acid is one of the commonly prescribed basic anticonvulsants for the treatment of epileptic seizures in children with cerebral palsy. Its active metabolites can cause hematological and coagulation disorders, cause valproate-induced steatohepatitis.The objective was to assess the level of hematological, biochemical and coagulation blood parameters in the perioperative period in children with severe forms of cerebral palsy during the treatment of concomitant epilepsy with valproic acid.Materials and methods. A prospective cohort study included 72 patients with cerebral palsy, spastic hip dislocations, who underwent reconstructive interventions on hip joints. Depending on the presence of concomitant epilepsy, the patients were divided into two groups. Perioperative laboratory blood parameters, complication incidence, the duration of stay in the intensive care unit and hospitalization were assessed.Results. In patients with epilepsy, the number of platelets in the blood was lower compared to the control group. The level of alkaline phosphatase before and after surgery in 34 % of children who took anticonvulsants exceeded the maximum value of the norm. Groups differed in terms of peri -operative coagulogram and thromboelastography. The frequency of complications in patients with epilepsy ranged from 0.08 % to 16.2 %.Conclusions. Basic therapy with valproic acid in children with severe forms of cerebral palsy and concomitant epilepsy is associated with a tendency to hypocoagulation, but was not accompanied by clinically significant thrombocytopenia or coagulopathy during hip surgery. Taking valproic acid drugs in patients with cerebral palsy and epilepsy was not accompanied by an increase in serum liver enzymes at all stages of observation, which minimized the likelihood of valproate-induced hepatotoxicity. Anticonvulsant therapy with valproate in children with severe forms of cerebral palsy and concomitant epilepsy did not increase the potential risk of complications in the perioperative period, did not affect the duration of stay of patients in the intensive care unit and hospitalization.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"94 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449163","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 : 2024-02-20DOI: 10.24884/2078-5658-2024-21-1-24-34
I. Sychev, O. Ignatenko, S. Yakovlev, L. Fedina, E. Burmistrova, M. Suvorova, T. Rastvorova, E. V. Strigunkova, R. K. Mukhamadiev
The objective was to study the risk factors, outcomes of infections caused by colistin-resistant K. pneumonia (CRKP) and to evaluate the sensitivity of these microorganisms to antibacterial agents to determine the most adequate antibiotic therapy options.Materials and methods. Klebsiella pneumoniae strains isolated in the ICU of an acute care hospital between October 2020 and August 2022 were included in the study. Microorganisms were identified using an automatic analyzer PHOENIX. The determination of antibiotic sensitivity was studied by the method of serial micro-dilutions in agar with the determination of MIC EUCAST criteria were used to interpret sensitivity. Detection of carbapenemases was carried out by PCR. Clinical efficacy of starter therapy was evaluated as recovery/improvement and no effect.Results. The infection was characterized by a severe course in 58.9 % of patients, with SOFA scores ranging from 1 to 16 points (mean 5.8 points). 88.2 % of patients had received prior antibiotics, most commonly carbapenems. CRKP infections occurred more frequently in older men with comorbidity. The clinical efficacy of initial antibiotic therapy was 41.2 %. In 47.1 % of cases, there was no effect, which required adjustment of therapy. Excluding patients in whom it was impossible to evaluate the effect, eradication was achieved in 33.3 % of patients. 64.6 % of patients were discharged or transferred to another hospital; 6 patients died between 5 and 41 days after diagnosis of CRKP infection. Fatal outcome was more frequent in women ( p=0.042), patients with higher comorbidity index (p=0.027), in case of sepsis and/or septic shock ( p=0.011), and in earlier detection of CRKP after hospitalization ( p<0.001).Conclusion. The efficacy of initial antibiotic therapy after detection of CRKP infection has been shown to be associated with patient survival and reduced risk of mortality with an odds ratio of 3.5. We also identified risk factors for mortality in CRKP infection: comorbidity, sepsis, duration of hospitalization and female gender.
{"title":"A pilot study of the clinical significance and outcomes of infections in the ICU caused by colistin-resistant Klebsiella pneumoniae","authors":"I. Sychev, O. Ignatenko, S. Yakovlev, L. Fedina, E. Burmistrova, M. Suvorova, T. Rastvorova, E. V. Strigunkova, R. K. Mukhamadiev","doi":"10.24884/2078-5658-2024-21-1-24-34","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-24-34","url":null,"abstract":"The objective was to study the risk factors, outcomes of infections caused by colistin-resistant K. pneumonia (CRKP) and to evaluate the sensitivity of these microorganisms to antibacterial agents to determine the most adequate antibiotic therapy options.Materials and methods. Klebsiella pneumoniae strains isolated in the ICU of an acute care hospital between October 2020 and August 2022 were included in the study. Microorganisms were identified using an automatic analyzer PHOENIX. The determination of antibiotic sensitivity was studied by the method of serial micro-dilutions in agar with the determination of MIC EUCAST criteria were used to interpret sensitivity. Detection of carbapenemases was carried out by PCR. Clinical efficacy of starter therapy was evaluated as recovery/improvement and no effect.Results. The infection was characterized by a severe course in 58.9 % of patients, with SOFA scores ranging from 1 to 16 points (mean 5.8 points). 88.2 % of patients had received prior antibiotics, most commonly carbapenems. CRKP infections occurred more frequently in older men with comorbidity. The clinical efficacy of initial antibiotic therapy was 41.2 %. In 47.1 % of cases, there was no effect, which required adjustment of therapy. Excluding patients in whom it was impossible to evaluate the effect, eradication was achieved in 33.3 % of patients. 64.6 % of patients were discharged or transferred to another hospital; 6 patients died between 5 and 41 days after diagnosis of CRKP infection. Fatal outcome was more frequent in women ( p=0.042), patients with higher comorbidity index (p=0.027), in case of sepsis and/or septic shock ( p=0.011), and in earlier detection of CRKP after hospitalization ( p<0.001).Conclusion. The efficacy of initial antibiotic therapy after detection of CRKP infection has been shown to be associated with patient survival and reduced risk of mortality with an odds ratio of 3.5. We also identified risk factors for mortality in CRKP infection: comorbidity, sepsis, duration of hospitalization and female gender.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"578 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446398","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 : 2024-02-20DOI: 10.24884/2078-5658-2024-21-1-6-16
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 an infusion of a succinate-containing drug during the intraoperative period of vascular surgery.Materials and methods. The study involved 120 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1 %) who underwent elective vascular surgery. Patients were randomly divided into two groups. Patients of group 1 received intraoperative infusion of succinate-containing drug at a dose of succinate 0.35 [0.26–0.40] mg/kg/min– 1. Group II was a control group. In the perioperative period, the occurrence of perioperative CVC, the blood level of the N-terminal segment of natriuretic B-type prohormone (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed.Results. Perioperative CVC was registered in 11 (18.3 %) patients of group I and in 11 (18.3 %) patients of group II (p = 1.0). The level of NT-proBNP in patients of group I and group II was 207 [160–300] pg/ml and 229 [150.6–298.9] pg/ml (p = 0.817) before surgery, 234.2 [155.9–356] and 277 [177.7–404] pg/ml ( p = 0.207) after surgery and 240.5[149.3–306] and 235.5 [133–495.1] pg/ml ( p = 0.979) before discharge from the hospital. An increased level of cTnI after surgery was recorded in 4 (6.7 %) patients of group I and in 1 (1.7 %) patient ( p = 0.364) of group II.Conclusion. Intraoperative infusion of succinate-containing drug does not affect the occurrence of CVC in patients with high cardiac risk during vascular surgery. The succinate-containing drug does not affect the preoperative level of NT-proBNP and cTnI.
{"title":"The effectiveness of succinate cardioprotection during vascular surgery in high cardiac risk patients","authors":"I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky","doi":"10.24884/2078-5658-2024-21-1-6-16","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-1-6-16","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 an infusion of a succinate-containing drug during the intraoperative period of vascular surgery.Materials and methods. The study involved 120 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1 %) who underwent elective vascular surgery. Patients were randomly divided into two groups. Patients of group 1 received intraoperative infusion of succinate-containing drug at a dose of succinate 0.35 [0.26–0.40] mg/kg/min– 1. Group II was a control group. In the perioperative period, the occurrence of perioperative CVC, the blood level of the N-terminal segment of natriuretic B-type prohormone (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed.Results. Perioperative CVC was registered in 11 (18.3 %) patients of group I and in 11 (18.3 %) patients of group II (p = 1.0). The level of NT-proBNP in patients of group I and group II was 207 [160–300] pg/ml and 229 [150.6–298.9] pg/ml (p = 0.817) before surgery, 234.2 [155.9–356] and 277 [177.7–404] pg/ml ( p = 0.207) after surgery and 240.5[149.3–306] and 235.5 [133–495.1] pg/ml ( p = 0.979) before discharge from the hospital. An increased level of cTnI after surgery was recorded in 4 (6.7 %) patients of group I and in 1 (1.7 %) patient ( p = 0.364) of group II.Conclusion. Intraoperative infusion of succinate-containing drug does not affect the occurrence of CVC in patients with high cardiac risk during vascular surgery. The succinate-containing drug does not affect the preoperative level of NT-proBNP and cTnI.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"1072 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140445908","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 : 2023-12-17DOI: 10.24884/2078-5658-2023-20-6-106-115
D. Balakhnin, I. I. Chermnykh, A. Ivkin, E. Grigoryev, D. Shukevich
Acute kidney injury (AKI) associated with cardiac surgery in children is one of the most frequent complications of the postoperative period appearing due to various perioperative factors. Generally accepted criteria for the diagnosis of AKI, on the one hand, may underestimate the frequency of development of this complication, on the other hand, require verification for use in the pediatric population. The application of kidney injury markers in pediatric practice is associated with a number of difficulties. For example, the high variability of the concentration of markers depending on age complicates the interpretation of the result, and maternal molecules can circulate in the blood of newborns. At the same time, in the cardiac surgery practice, the greatest impact of the measurement of kidney injury markers in children has been noted, which allows significantly accelerate the diagnosis of this complication and the starting of its therapy.
{"title":"The problem of the diagnosis of acute kidney injury in children operated under the conditions of artificial circulation","authors":"D. Balakhnin, I. I. Chermnykh, A. Ivkin, E. Grigoryev, D. Shukevich","doi":"10.24884/2078-5658-2023-20-6-106-115","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-106-115","url":null,"abstract":"Acute kidney injury (AKI) associated with cardiac surgery in children is one of the most frequent complications of the postoperative period appearing due to various perioperative factors. Generally accepted criteria for the diagnosis of AKI, on the one hand, may underestimate the frequency of development of this complication, on the other hand, require verification for use in the pediatric population. The application of kidney injury markers in pediatric practice is associated with a number of difficulties. For example, the high variability of the concentration of markers depending on age complicates the interpretation of the result, and maternal molecules can circulate in the blood of newborns. At the same time, in the cardiac surgery practice, the greatest impact of the measurement of kidney injury markers in children has been noted, which allows significantly accelerate the diagnosis of this complication and the starting of its therapy.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"34 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176568","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 : 2023-12-17DOI: 10.24884/2078-5658-2023-20-6-90-96
L. M. Tsentsiper, A. Motienko, I. Terekhov, D. Levonevskiy, K. Samochernykh, A. N. Kondratyev
Paroxysmal sympathetic hyperactivity syndrome is a frequent complication of acute severe brain injury, so with severe traumatic brain injury, it develops in 30 % of patients. Despite a large number of publications, the issues of diagnosis, prevention and treatment of this syndrome remain unresolved. To date, the assessment of the syndrome of paroxysmal sympathetic hyperactivity takes, with proper training of the doctor, from 8 to 15 minutes, taking into account the calculation of points using a calculator. With the digitalization of this process, a single assessment will take about 2–3 minutes to enter the indicators. In this case, the calculation will occur automatically. Subsequently, when using «wearable gadgets for measurement», the process of filling in indicators can also occur automatically. The application allows to register and store basic data about users who can have three roles: patients, specialist doctors, administrators. The creation of a database of patients with sympathetic hyperactivity syndrome will significantly improve diagnostic methods and assess the adequacy of therapy. Medical data is only useful if it can be turned into meaningful information. This requires high-quality data sets, uninterrupted communication between IT systems, and standard data formats that can be processed by humans and machines.
{"title":"A digital solution for determining the severity of paroxysmal sympathetic hyperactivity syndrome in patients with brain injury","authors":"L. M. Tsentsiper, A. Motienko, I. Terekhov, D. Levonevskiy, K. Samochernykh, A. N. Kondratyev","doi":"10.24884/2078-5658-2023-20-6-90-96","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-90-96","url":null,"abstract":"Paroxysmal sympathetic hyperactivity syndrome is a frequent complication of acute severe brain injury, so with severe traumatic brain injury, it develops in 30 % of patients. Despite a large number of publications, the issues of diagnosis, prevention and treatment of this syndrome remain unresolved. To date, the assessment of the syndrome of paroxysmal sympathetic hyperactivity takes, with proper training of the doctor, from 8 to 15 minutes, taking into account the calculation of points using a calculator. With the digitalization of this process, a single assessment will take about 2–3 minutes to enter the indicators. In this case, the calculation will occur automatically. Subsequently, when using «wearable gadgets for measurement», the process of filling in indicators can also occur automatically. The application allows to register and store basic data about users who can have three roles: patients, specialist doctors, administrators. The creation of a database of patients with sympathetic hyperactivity syndrome will significantly improve diagnostic methods and assess the adequacy of therapy. Medical data is only useful if it can be turned into meaningful information. This requires high-quality data sets, uninterrupted communication between IT systems, and standard data formats that can be processed by humans and machines.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"19 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176586","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 : 2023-12-17DOI: 10.24884/2078-5658-2023-20-6-97-105
I. Lisitsa, Y. Aleksandrovich, A. N. Zav’yalova, O. V. Lisovskii, S. A. Razumov
The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.
{"title":"Dysphagia in pediatric intensive care unit patients (review)","authors":"I. Lisitsa, Y. Aleksandrovich, A. N. Zav’yalova, O. V. Lisovskii, S. A. Razumov","doi":"10.24884/2078-5658-2023-20-6-97-105","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-97-105","url":null,"abstract":"The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"41 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176372","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 : 2023-12-17DOI: 10.24884/2078-5658-2023-20-6-80-89
D. A. Averyanov, K. N. Khrapov
Fluoroscopy guided epidural injection is often used to treat radicular pain in the lumbar spine. Risk and effectiveness data vary depending on injection routes and underlying pathology. There are several options for accessing the epidural space in the lumbosacral spine to perform an analgesic injection – caudal, interlaminar and transforaminal. Transforaminal epidural injection is currently the most studied and widespread in the foreign practice of treating chronic pain. A brief overview describes transforaminal accesses to the epidural space of the lumbar spine and needles used for this purpose, lists possible adverse events and complications, and also provides a detailed illustrated description of supraneural transforaminal access.
{"title":"Supraneural transforaminal epidural injection in the treatment of radiculopathy in the lumbar spine – a brief descriptive overview and technique of manipulation","authors":"D. A. Averyanov, K. N. Khrapov","doi":"10.24884/2078-5658-2023-20-6-80-89","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-80-89","url":null,"abstract":"Fluoroscopy guided epidural injection is often used to treat radicular pain in the lumbar spine. Risk and effectiveness data vary depending on injection routes and underlying pathology. There are several options for accessing the epidural space in the lumbosacral spine to perform an analgesic injection – caudal, interlaminar and transforaminal. Transforaminal epidural injection is currently the most studied and widespread in the foreign practice of treating chronic pain. A brief overview describes transforaminal accesses to the epidural space of the lumbar spine and needles used for this purpose, lists possible adverse events and complications, and also provides a detailed illustrated description of supraneural transforaminal access.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"237 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176547","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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