Pub Date : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-35-42
V. Bazylev, K. T. Shcheglova, N. N. Artemyev, A. I. Magilevets, A. A. Shikhranov, M. V. Kokashkin, N. E. Makogonchuk, D. A. Bofanov
Relevance. The choice of perfusion strategy is vital for the protection of internal organs during surgery. In several studies of recent years, as well as by us, a strategy of sustained total all region (STAR) perfusion (selective brain, heart and lower body perfusion) has been proposed, allowing to avoid ischemic and reperfusion injuries of internal organs.The objective was to evaluate the benefits of STAR perfusion during reconstruction of the aortic arch in children.Materials and methods. The prospective study included 15 patients who underwent aortic arch reconstruction using a strategy of simultaneous selective brain, heart and lower body perfusion (STAR perfusion) in the period from June 2022 to May 2023. The average age at the time of surgery was 1.3 months (95 % CI (confidence interval) 6.0–16.0), the average body weight was 3.4 kg (95 % CI 2.7–4.1).Results. Сhanges of the tissue oximetry index, measured at two points, did not fall below reference ranges at any stage of the operation. The greatest mean value of lactate concentration during the operation was 2.8 ± 1.0 mmol/l, recovery of the indicator was noted after 6 hours – 1.9 ± 0.9 mmol/l. Kidney function evaluation – the rate of diuresis and creatinine levels did not exceed reference levels. The average treatment time in the intensive care unit was 7.7 ± 4.3 days (95 % CI 4.5 10.9), in the hospital – 15.4 ± 5.8 days (95 % CI 11.4–19.4). There were no deaths among those operated using the new perfusion strategy.Conclusion. The use of the strategy of Sustained Total All Region (STAR) perfusion in case of reconstruction of the aortic arch in newborn, infants and young children is safe and advanced, since it avoids ischemia of internal organs and reduces the risk of post-ischemic complications.
{"title":"Experience in applying the strategy of simultaneous selective perfusion of the brain, heart and lower body in reconstruction of the aortic arch in infants","authors":"V. Bazylev, K. T. Shcheglova, N. N. Artemyev, A. I. Magilevets, A. A. Shikhranov, M. V. Kokashkin, N. E. Makogonchuk, D. A. Bofanov","doi":"10.24884/2078-5658-2023-20-6-35-42","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-35-42","url":null,"abstract":"Relevance. The choice of perfusion strategy is vital for the protection of internal organs during surgery. In several studies of recent years, as well as by us, a strategy of sustained total all region (STAR) perfusion (selective brain, heart and lower body perfusion) has been proposed, allowing to avoid ischemic and reperfusion injuries of internal organs.The objective was to evaluate the benefits of STAR perfusion during reconstruction of the aortic arch in children.Materials and methods. The prospective study included 15 patients who underwent aortic arch reconstruction using a strategy of simultaneous selective brain, heart and lower body perfusion (STAR perfusion) in the period from June 2022 to May 2023. The average age at the time of surgery was 1.3 months (95 % CI (confidence interval) 6.0–16.0), the average body weight was 3.4 kg (95 % CI 2.7–4.1).Results. Сhanges of the tissue oximetry index, measured at two points, did not fall below reference ranges at any stage of the operation. The greatest mean value of lactate concentration during the operation was 2.8 ± 1.0 mmol/l, recovery of the indicator was noted after 6 hours – 1.9 ± 0.9 mmol/l. Kidney function evaluation – the rate of diuresis and creatinine levels did not exceed reference levels. The average treatment time in the intensive care unit was 7.7 ± 4.3 days (95 % CI 4.5 10.9), in the hospital – 15.4 ± 5.8 days (95 % CI 11.4–19.4). There were no deaths among those operated using the new perfusion strategy.Conclusion. The use of the strategy of Sustained Total All Region (STAR) perfusion in case of reconstruction of the aortic arch in newborn, infants and young children is safe and advanced, since it avoids ischemia of internal organs and reduces the risk of post-ischemic complications.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"1239 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176991","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-43-51
V. Ziamko, A. Dzyadzko, A. Shcherba, S. Y. Pushkin, E. V. Arshintseva, V. N. Grushin
The objective was to study the effect of drug «Oxyphtem»1 on liver morphometric parameters in a systemic inflammatory response.Materials and methods. The experimental study was carried out on male Wistar rats (n = 26). The rats of the experimental group were injected with drug «Oxyphtem» intravenously once. Daily observation was carried out during14 days. Rats were taken out of the experiment on the 15th day under light ether anesthesia. Liver samples were fixed in 10 % neutral formalin in phosphate buffer for 24 hours. Histological preparations were studied using the Measure Pixels image analysis computer program based on a Leica 2000 light microscope.Results. In the intact group of rats, no violations of the liver parenchyma were detected: hepatocytes had clear boundaries, the lamellar structure was preserved and sinusoidal capillaries were not dilated. With the development of the systemic inflammatory response in the liver of rats of the control group, expansion and blood filling of the central veins and sinusoids, violation of the structure of the liver plates, and perinuclear edema of hepatocytes were noted. In the experimental group of rats with the use of drug «Oxyphtem», the preservation of the structure of the liver plates was observed, binuclear hepatocytes were found, and the sinusoids were not expanded. We hypothesize that hepatocyte proliferation and the increase in binuclear hepatic cells were indicative of the regenerative response to systemic inflammatory damage and metabolic demand.Conclusion. The use of drug «Oxyphtem» under conditions of the experimental systemic inflammatory response increases reparative regeneration and adaptation of the liver.
{"title":"Influence of perfluoroorganic emulsion on morphometric parameters of the liver in a systemic inflammatory response (experimental study)","authors":"V. Ziamko, A. Dzyadzko, A. Shcherba, S. Y. Pushkin, E. V. Arshintseva, V. N. Grushin","doi":"10.24884/2078-5658-2023-20-6-43-51","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-43-51","url":null,"abstract":"The objective was to study the effect of drug «Oxyphtem»1 on liver morphometric parameters in a systemic inflammatory response.Materials and methods. The experimental study was carried out on male Wistar rats (n = 26). The rats of the experimental group were injected with drug «Oxyphtem» intravenously once. Daily observation was carried out during14 days. Rats were taken out of the experiment on the 15th day under light ether anesthesia. Liver samples were fixed in 10 % neutral formalin in phosphate buffer for 24 hours. Histological preparations were studied using the Measure Pixels image analysis computer program based on a Leica 2000 light microscope.Results. In the intact group of rats, no violations of the liver parenchyma were detected: hepatocytes had clear boundaries, the lamellar structure was preserved and sinusoidal capillaries were not dilated. With the development of the systemic inflammatory response in the liver of rats of the control group, expansion and blood filling of the central veins and sinusoids, violation of the structure of the liver plates, and perinuclear edema of hepatocytes were noted. In the experimental group of rats with the use of drug «Oxyphtem», the preservation of the structure of the liver plates was observed, binuclear hepatocytes were found, and the sinusoids were not expanded. We hypothesize that hepatocyte proliferation and the increase in binuclear hepatic cells were indicative of the regenerative response to systemic inflammatory damage and metabolic demand.Conclusion. The use of drug «Oxyphtem» under conditions of the experimental systemic inflammatory response increases reparative regeneration and adaptation of the liver.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"821 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139177055","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-74-79
D. N. Kazarinov, M. Kirov
Atmospheric electricity damage as a result of lightning strike is a relatively rare condition in intensive care medicine, however it can be accompanied by high mortality and serious complications in the majority of survived patients.The objective was to demonstrate a clinical case of lightning injury and discussion of diagnostic and treatment aspects in this condition.Materials and Methods. 18-yr old patient was delivered to hospital after lightning strike. She lost consciousness, there was no breathing for a short time, and the witnesses provided artificial respiration and external cardiac compressions. On admission, the signs of shock were present in parallel with dopamine infusion, the skin was pale-grey and cold, with traces of thermal damage according to the type of contact with metal of various localization on the neck, scalp, front surface of the chest and abdominal wall, in the groin, on the left foot. The patient was hospitalized to ICU, therapeutic and diagnostic measures were started. We revealed decompensated lactic acidosis, biochemical signs of myocardial and muscle damage. The infusion therapy, analgesics, antibiotics, proton pump inhibitors, anticoagulants were administered. During the therapy in the first 6 hours, the signs of shock were attenuated, in 4 days, the patient was transferred to traumatological department in a stable state. After the transfer from the ICU, hearing decline as well as pain and sensory disturbances in the left foot are persisting.Conclusion. An integrated approach is required in the diagnosis, treatment, and rehabilitation of patients with lightning injury.
{"title":"Clinical case of lightning injury","authors":"D. N. Kazarinov, M. Kirov","doi":"10.24884/2078-5658-2023-20-6-74-79","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-74-79","url":null,"abstract":"Atmospheric electricity damage as a result of lightning strike is a relatively rare condition in intensive care medicine, however it can be accompanied by high mortality and serious complications in the majority of survived patients.The objective was to demonstrate a clinical case of lightning injury and discussion of diagnostic and treatment aspects in this condition.Materials and Methods. 18-yr old patient was delivered to hospital after lightning strike. She lost consciousness, there was no breathing for a short time, and the witnesses provided artificial respiration and external cardiac compressions. On admission, the signs of shock were present in parallel with dopamine infusion, the skin was pale-grey and cold, with traces of thermal damage according to the type of contact with metal of various localization on the neck, scalp, front surface of the chest and abdominal wall, in the groin, on the left foot. The patient was hospitalized to ICU, therapeutic and diagnostic measures were started. We revealed decompensated lactic acidosis, biochemical signs of myocardial and muscle damage. The infusion therapy, analgesics, antibiotics, proton pump inhibitors, anticoagulants were administered. During the therapy in the first 6 hours, the signs of shock were attenuated, in 4 days, the patient was transferred to traumatological department in a stable state. After the transfer from the ICU, hearing decline as well as pain and sensory disturbances in the left foot are persisting.Conclusion. An integrated approach is required in the diagnosis, treatment, and rehabilitation of patients with lightning injury.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"1147 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176939","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-58-66
A. V. Shchegolev, R. Lakhin, A. A. Nikulin, S. G. Meshchaninova, V. F. Bezhenar
The objective was to identify prognostic criteria for unfavorable outcome in pregnant women with severe and extremely severe forms of COVID-19 and to build a model for predicting clinical outcome.Materials and methods. The cohort single-center retrospective study was conducted, which included 83 patients who were treated in the intensive care unit (ICU) from January 1 to December 31, 2021. Of these, 13 patients had an unfavorable outcome – death, and 70 patients with a successful outcome – recovery. The differences in the main clinical and laboratory parameters of patients of both groups during hospitalization in the ICU and on the 3rd day of treatment (Δ – delta) were analyzed.Results. The Cox regression analysis identified laboratory parameters, the difference of which (Δ) on admission to the ICU and on the 3rd day of treatment is associated with the development of the unfavorable outcome (death). These indicators were used as variables in a linear regression equation. The equation for calculating the prognostic index met the criteria of a statistically significant model (sensitivity 84.6 %, specificity 85.7 %, area under the operating characteristic curve (AUROC – Area Under Receiver Operator Curve) – 0.959 (95 % confidence interval [95 % CI] 0.918 – 1.0).Conclusion. The calculation of the prognostic index can be an additional clinical tool that allows one to predict the development of an unfavorable outcome, concentrate the work of a multidisciplinary team, attract additional reserves of a medical institution and/or evacuate such patients to high-level hospitals.
{"title":"Prediction of adverse clinical outcomes in pregnant women with severe and extremely severe forms of coronavirus infection","authors":"A. V. Shchegolev, R. Lakhin, A. A. Nikulin, S. G. Meshchaninova, V. F. Bezhenar","doi":"10.24884/2078-5658-2023-20-6-58-66","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-58-66","url":null,"abstract":"The objective was to identify prognostic criteria for unfavorable outcome in pregnant women with severe and extremely severe forms of COVID-19 and to build a model for predicting clinical outcome.Materials and methods. The cohort single-center retrospective study was conducted, which included 83 patients who were treated in the intensive care unit (ICU) from January 1 to December 31, 2021. Of these, 13 patients had an unfavorable outcome – death, and 70 patients with a successful outcome – recovery. The differences in the main clinical and laboratory parameters of patients of both groups during hospitalization in the ICU and on the 3rd day of treatment (Δ – delta) were analyzed.Results. The Cox regression analysis identified laboratory parameters, the difference of which (Δ) on admission to the ICU and on the 3rd day of treatment is associated with the development of the unfavorable outcome (death). These indicators were used as variables in a linear regression equation. The equation for calculating the prognostic index met the criteria of a statistically significant model (sensitivity 84.6 %, specificity 85.7 %, area under the operating characteristic curve (AUROC – Area Under Receiver Operator Curve) – 0.959 (95 % confidence interval [95 % CI] 0.918 – 1.0).Conclusion. The calculation of the prognostic index can be an additional clinical tool that allows one to predict the development of an unfavorable outcome, concentrate the work of a multidisciplinary team, attract additional reserves of a medical institution and/or evacuate such patients to high-level hospitals.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"219 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176907","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-28-34
A. R. Avidzba, V. A. Saskin, A. V. Kudryavtsev, M. Kirov
Introduction. Reperfusion (both pharmacological and interventional) is the cornerstone of acute ischemic stroke (AIS) management. Currently, there are only limited data in the scientific literature regarding the influence of systemic hemodynamic parameters on the recanalization status and complications of AIS.The objective of our study was to assess the relationship between the systemic hemodynamic parameters in the early postreperfusion period and the outcomes of AIS.Materials and methods. For retrospective analysis, data of 292 patients who received intravenous thrombolysis (IVT) at the Arkhangelsk Regional Stroke Center between 2010 and 2021 were collected. The main endpoints were functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH). The success of reperfusion was defined as the neurological improvement by 4 or more points of the NIHSS score within the first 24 hours after the start of IVT.Results. The relationship between mean systolic blood pressure (SBP) during the first 24 hours of IVT and functional recovery was obtained: B = 0.016 (β = 0.096) [95 % CI 0.000 – 0.031] (р = 0.49). The relationship between maximal SBP during the first day of IVT and functional recovery was also determined: B = 0.009 (β = 0.102) [95 % CI 0.001 – 0.018] (p = 0.037). The sICH occurred in nine cases, all of them were in the group without achieving successful reperfusion.Conclusion. The baseline levels of SBP ≥ 160 mm Hg at hospital admission in patients with AIS followed by IVT are accompanied by worse functional outcome and greater odds of death. The neurological improvement with significant decline in the NIHSS score during the first 24 hours after IVT is associated with a decreased risk of sICH.
{"title":"The influence of systolic arterial pressure in the first day after systemic thrombolysis on ischemic stroke outcomes and complication rate: a retrospective single-center study","authors":"A. R. Avidzba, V. A. Saskin, A. V. Kudryavtsev, M. Kirov","doi":"10.24884/2078-5658-2023-20-6-28-34","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-28-34","url":null,"abstract":"Introduction. Reperfusion (both pharmacological and interventional) is the cornerstone of acute ischemic stroke (AIS) management. Currently, there are only limited data in the scientific literature regarding the influence of systemic hemodynamic parameters on the recanalization status and complications of AIS.The objective of our study was to assess the relationship between the systemic hemodynamic parameters in the early postreperfusion period and the outcomes of AIS.Materials and methods. For retrospective analysis, data of 292 patients who received intravenous thrombolysis (IVT) at the Arkhangelsk Regional Stroke Center between 2010 and 2021 were collected. The main endpoints were functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH). The success of reperfusion was defined as the neurological improvement by 4 or more points of the NIHSS score within the first 24 hours after the start of IVT.Results. The relationship between mean systolic blood pressure (SBP) during the first 24 hours of IVT and functional recovery was obtained: B = 0.016 (β = 0.096) [95 % CI 0.000 – 0.031] (р = 0.49). The relationship between maximal SBP during the first day of IVT and functional recovery was also determined: B = 0.009 (β = 0.102) [95 % CI 0.001 – 0.018] (p = 0.037). The sICH occurred in nine cases, all of them were in the group without achieving successful reperfusion.Conclusion. The baseline levels of SBP ≥ 160 mm Hg at hospital admission in patients with AIS followed by IVT are accompanied by worse functional outcome and greater odds of death. The neurological improvement with significant decline in the NIHSS score during the first 24 hours after IVT is associated with a decreased risk of sICH.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"322 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139177203","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-52-57
M. N. Isfahani, F. B. Borojeni, F. Pakravan, B. Masoumi
The presence of the patient’s family at their bedside during cardiopulmonary resuscitation (CPR) is one of the challenging issues that has been frequently taken into consideration. Considering the importance of this topic. The objective of the present study was conducted to determine the attitude of the CPR team members and the patient’s companions toward the presence of the patient’s first-degree relatives during CPR.Materials and methods. The descriptive-analytical cross-sectional study was conducted on 100 CPR team members of two University Hospitals and 120 near relatives of patients undergoing CPR in 2021. The data were collected by the researcher-made questionnaire and depression, anxiety, stress scale (DASS) during CPR. The collected data were analyzed by SPSS (version 22) statistical software.Results. From the perspective of both the CPR team members and the patient’s companions, the highest mean response was related to the fact that it would be better for the patient to agree on the presence or absence of their family before hospitalization and whether they have favorable conditions. The attitude toward the presence of the patient’s family during CPR was statistically significantly associated with the companions’ gender (p < 0.05) and with the experience of work and participation in CPR of the CPR team members (p < 0.05).Conclusion. Taking into account the different opinions of the CPR team members and the patient’s relatives about the presence of family during resuscitation, additional studies with a large sample size should be carried out.
{"title":"The attitude of the resuscitation team members and the patient’s companions toward the presence of the patient’s first-degree relatives during cardiopulmonary resuscitation in the emergency departments","authors":"M. N. Isfahani, F. B. Borojeni, F. Pakravan, B. Masoumi","doi":"10.24884/2078-5658-2023-20-6-52-57","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-52-57","url":null,"abstract":"The presence of the patient’s family at their bedside during cardiopulmonary resuscitation (CPR) is one of the challenging issues that has been frequently taken into consideration. Considering the importance of this topic. The objective of the present study was conducted to determine the attitude of the CPR team members and the patient’s companions toward the presence of the patient’s first-degree relatives during CPR.Materials and methods. The descriptive-analytical cross-sectional study was conducted on 100 CPR team members of two University Hospitals and 120 near relatives of patients undergoing CPR in 2021. The data were collected by the researcher-made questionnaire and depression, anxiety, stress scale (DASS) during CPR. The collected data were analyzed by SPSS (version 22) statistical software.Results. From the perspective of both the CPR team members and the patient’s companions, the highest mean response was related to the fact that it would be better for the patient to agree on the presence or absence of their family before hospitalization and whether they have favorable conditions. The attitude toward the presence of the patient’s family during CPR was statistically significantly associated with the companions’ gender (p < 0.05) and with the experience of work and participation in CPR of the CPR team members (p < 0.05).Conclusion. Taking into account the different opinions of the CPR team members and the patient’s relatives about the presence of family during resuscitation, additional studies with a large sample size should be carried out.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"209 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176917","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 : 2023-12-16DOI: 10.24884/2078-5658-2023-20-6-67-73
A. Sytov, P. Kononets, A. Shin, E. E. Budargin, V. Bugaev, I. Y. Grishenkin
The objective was to demonstrate a clinical case of iatrogenic injury of the trachea, which, despite its large size (length 65, width up to 25 mm), wastreated conservatively and, thus, avoided risks for the patient associated with the need for technically complex surgical intervention.Materials and methods. A 65-year-old patient diagnosed with peripheral cancer of the lower lobe of the left lung pT2aN0M0 stage IB, who routinely underwent thoracoscopic left lower lobectomy with mediastinal lymph node dissection. During anesthesia, tracheal intubation with a double-lumen tube of the R. Shaw type was carried out with technical difficulties; during intubation, a defect in the posterior wall of the trachea in its membranous part was formed. The defect was diagnosed on the first postoperative day.Results. Despite the large size of the tracheal defect, the patient had no symptoms of respiratory failure, and there were also no signs of mediastinitis or damage to the esophagus, which almost completely covered the resulting hole in the posterior wall of the trachea. Such circumstances made it possible to avoid a potentially dangerous and complex surgical intervention, carry out conservative therapy and wait for the resulting defect to heal through granulation tissue. Enhanced antimicrobial therapy was carried out; in order to sanitize the tracheobronchial tree and monitor healing, fiber-optic bronchoscopy was performed, which made it possible to clearly demonstrate both the damage itself and the stages of its healing.Conclusions. The described case clearly demonstrates the potential for healing of even very extensive tracheal wall defects with conservative therapy. However, it is important to note that success in this clinical case was the result of a combination of circumstances – only the membranous part of the trachea was damaged; the defect was almost completely covered by the intact esophagus, which reduced the risk of developing mediastinitis and prevented the development of severe pneumomediastinum and subcutaneous emphysema. There were no signs of respiratory failure. The patient was transferred from the intensive care unit on the 13th day of the postoperative period, discharged from the hospital on the 22nd day.
{"title":"Conservative treatment of iatrogenic tracheal rupture (clinical case)","authors":"A. Sytov, P. Kononets, A. Shin, E. E. Budargin, V. Bugaev, I. Y. Grishenkin","doi":"10.24884/2078-5658-2023-20-6-67-73","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-67-73","url":null,"abstract":"The objective was to demonstrate a clinical case of iatrogenic injury of the trachea, which, despite its large size (length 65, width up to 25 mm), wastreated conservatively and, thus, avoided risks for the patient associated with the need for technically complex surgical intervention.Materials and methods. A 65-year-old patient diagnosed with peripheral cancer of the lower lobe of the left lung pT2aN0M0 stage IB, who routinely underwent thoracoscopic left lower lobectomy with mediastinal lymph node dissection. During anesthesia, tracheal intubation with a double-lumen tube of the R. Shaw type was carried out with technical difficulties; during intubation, a defect in the posterior wall of the trachea in its membranous part was formed. The defect was diagnosed on the first postoperative day.Results. Despite the large size of the tracheal defect, the patient had no symptoms of respiratory failure, and there were also no signs of mediastinitis or damage to the esophagus, which almost completely covered the resulting hole in the posterior wall of the trachea. Such circumstances made it possible to avoid a potentially dangerous and complex surgical intervention, carry out conservative therapy and wait for the resulting defect to heal through granulation tissue. Enhanced antimicrobial therapy was carried out; in order to sanitize the tracheobronchial tree and monitor healing, fiber-optic bronchoscopy was performed, which made it possible to clearly demonstrate both the damage itself and the stages of its healing.Conclusions. The described case clearly demonstrates the potential for healing of even very extensive tracheal wall defects with conservative therapy. However, it is important to note that success in this clinical case was the result of a combination of circumstances – only the membranous part of the trachea was damaged; the defect was almost completely covered by the intact esophagus, which reduced the risk of developing mediastinitis and prevented the development of severe pneumomediastinum and subcutaneous emphysema. There were no signs of respiratory failure. The patient was transferred from the intensive care unit on the 13th day of the postoperative period, discharged from the hospital on the 22nd day.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"311 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139177253","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 : 2023-12-15DOI: 10.24884/2078-5658-2023-20-6-12-18
V. I. Sakharov, P. Mironov, A. A. Tсandekov, V. Rudnov
Introduction. The problem of an adequate assessment of the prognosis of the outcome of severe community-acquired pneumonia (CAP) is particularly difficult if it is caused by an unusual pathogen for it, in particular Klebsiella pneumoniae.The objective was to develop the approach for predicting the survival of a heterogeneous population of patients with CAP caused by Klebsiella pneumoniae using statistical approaches based on artificial neural networks.Materials and methods. The design is a retrospective, multicenter, controlled, non-randomized study. Inclusion criteria: clinical, laboratory and radiological diagnosis of CAP associated with Klebsiella pneumoniae with a SOFA score of 2 or more points. The development included 100 patients. 50 died. The prognostic significance of the SOFA, APACHE II, PSI/PORT, Glasgow and Charlson comorbidity index, procalciotonin, C-reactive protein scales was evaluated. The data obtained were evaluated in the StatPlus 7 and Pycharm GPT programs.Results. None of the stated scales has shown its significance. There were no statistically significant differences between the surviving and deceased patients in terms of the level of biomarkers studied. In this regard, we have compiled a logistic regression equation for assessing the prognosis based on a combination of the SOFA score, the Charlson index and the procalcitonin level.Conclusion. In assessing the prognosis of outcome in patients with CAP caused by Klebsiella pneumoniae, it is advisable to use a combination of data from the SOFA score, Charlson comorbidity index and procalciotonin levels. Threshold critical values are SOFA score of more than 4 points, Charlson comorbidity index of more than 7 points, procalciotonin level of more than 2 ng/ml.
{"title":"Assessment of the prognosis of the outcome of severe community-acquired pneumonia caused by Klebsiella pneumoniae","authors":"V. I. Sakharov, P. Mironov, A. A. Tсandekov, V. Rudnov","doi":"10.24884/2078-5658-2023-20-6-12-18","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-12-18","url":null,"abstract":"Introduction. The problem of an adequate assessment of the prognosis of the outcome of severe community-acquired pneumonia (CAP) is particularly difficult if it is caused by an unusual pathogen for it, in particular Klebsiella pneumoniae.The objective was to develop the approach for predicting the survival of a heterogeneous population of patients with CAP caused by Klebsiella pneumoniae using statistical approaches based on artificial neural networks.Materials and methods. The design is a retrospective, multicenter, controlled, non-randomized study. Inclusion criteria: clinical, laboratory and radiological diagnosis of CAP associated with Klebsiella pneumoniae with a SOFA score of 2 or more points. The development included 100 patients. 50 died. The prognostic significance of the SOFA, APACHE II, PSI/PORT, Glasgow and Charlson comorbidity index, procalciotonin, C-reactive protein scales was evaluated. The data obtained were evaluated in the StatPlus 7 and Pycharm GPT programs.Results. None of the stated scales has shown its significance. There were no statistically significant differences between the surviving and deceased patients in terms of the level of biomarkers studied. In this regard, we have compiled a logistic regression equation for assessing the prognosis based on a combination of the SOFA score, the Charlson index and the procalcitonin level.Conclusion. In assessing the prognosis of outcome in patients with CAP caused by Klebsiella pneumoniae, it is advisable to use a combination of data from the SOFA score, Charlson comorbidity index and procalciotonin levels. Threshold critical values are SOFA score of more than 4 points, Charlson comorbidity index of more than 7 points, procalciotonin level of more than 2 ng/ml.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"83 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139178696","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 : 2023-12-15DOI: 10.24884/2078-5658-2023-20-6-19-27
N. Lesteva, N. Dryagina, A. Kondratiev
The objective was to study the degree of deviations of laboratory parameters of the systemic inflammatory response syndrome (SIRS) under the conditions of modulation of the reactions of the sympathetic nervous system by various α-2-adrenergic receptors during neurosurgical interventions for the removal of the brain tumor of subtentorial localizationMaterials and methods. The laboratory data of 179 patients operated for the brain tumor of subtentorial localization were analyzed. The operations were performed under conditions of total intravenous anesthesia. The patients were divided into two groups depending on the α-2-adrenergic agonist used in the structure of the anesthetic aid: clonidine was used in the first group, dexmedetomidine was used in the second group. Laboratory tests included analysis of the levels of cytokines (IL-8, IL-6, IL-10, TNF-α), CRP, fibrinogen. Blood sampling for the study was carried out in five stages: 1 – one day before the operation, 2 – on the day of the operation before the introductory anesthesia, 3 – after the induction anesthesia, 4 – after removal of the tumor (at the stage of hemostasis); 5 – on the first day after surgery.Results. The dynamics of laboratory parameters were similar in both study groups and reflected the manifestations of the systemic inflammatory response of the body to intracranial intervention. The levels of pro-inflammatory cytokines IL-6, IL-8, TNF-α, and C-reactive protein (CRP) increased in the fourth and fifth stages of the study. The increase in the level of IL-6 and fibrinogen in the fifth stage of the study in the second group was more significant, which was explained by the less pronounced anti-inflammatory effect of dexmedetomidine compared to clonidine.Conclusions. Changes in laboratory parameters of SIRS as the reaction to surgical intervention on the brain were transient. Under conditions of total intravenous anesthesia with the use of α-2-adrenergic agonists, modulation of the inflammatory response was demonstrated, which ensured adequate consistency of the inflammatory process.
{"title":"Dynamics of laboratory markers of systemic inflammation in neurosurgical operations using α-2-adrenoagonists","authors":"N. Lesteva, N. Dryagina, A. Kondratiev","doi":"10.24884/2078-5658-2023-20-6-19-27","DOIUrl":"https://doi.org/10.24884/2078-5658-2023-20-6-19-27","url":null,"abstract":"The objective was to study the degree of deviations of laboratory parameters of the systemic inflammatory response syndrome (SIRS) under the conditions of modulation of the reactions of the sympathetic nervous system by various α-2-adrenergic receptors during neurosurgical interventions for the removal of the brain tumor of subtentorial localizationMaterials and methods. The laboratory data of 179 patients operated for the brain tumor of subtentorial localization were analyzed. The operations were performed under conditions of total intravenous anesthesia. The patients were divided into two groups depending on the α-2-adrenergic agonist used in the structure of the anesthetic aid: clonidine was used in the first group, dexmedetomidine was used in the second group. Laboratory tests included analysis of the levels of cytokines (IL-8, IL-6, IL-10, TNF-α), CRP, fibrinogen. Blood sampling for the study was carried out in five stages: 1 – one day before the operation, 2 – on the day of the operation before the introductory anesthesia, 3 – after the induction anesthesia, 4 – after removal of the tumor (at the stage of hemostasis); 5 – on the first day after surgery.Results. The dynamics of laboratory parameters were similar in both study groups and reflected the manifestations of the systemic inflammatory response of the body to intracranial intervention. The levels of pro-inflammatory cytokines IL-6, IL-8, TNF-α, and C-reactive protein (CRP) increased in the fourth and fifth stages of the study. The increase in the level of IL-6 and fibrinogen in the fifth stage of the study in the second group was more significant, which was explained by the less pronounced anti-inflammatory effect of dexmedetomidine compared to clonidine.Conclusions. Changes in laboratory parameters of SIRS as the reaction to surgical intervention on the brain were transient. Under conditions of total intravenous anesthesia with the use of α-2-adrenergic agonists, modulation of the inflammatory response was demonstrated, which ensured adequate consistency of the inflammatory process.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139177289","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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