[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)¼: a comparative analysis of the outcomes of stroke]. / Rossiiskoe mnogotsentrovoe observatsionnoe klinicheskoe issledovanie «Registr respiratornoi terapii u patsientov s ONMK (RETAS)¼: sravnitel'naya kharakteristika iskhodov insul'ta.

OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. RESULTS: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

[PROGNOSTIC SIGNIFICANCE OF CHANGES OF BLOOD GLUCOSE LEVEL IN PATIENTS WITH THORACOABDOMINAL INJURIES.]

Background Currently, one of the causes of high morbidity and mortality is injuries. Predict the outcome of injuries - it is an important task of the treating physician. Trauma is a stress factor so to predict the outcome, you can use markers of stress, the most accessible ofwhich is blood glucose. THE AIM: to reveal the dynamics of the relationship between blood glucose levels and the outlook for the life ofpatients with thoracoabdominal injuries. MATERIALS AND METHODS: A retrospective analysis of medical records of hospitalized patients were divided into two groups, depending on the outlook for the life of (favorable or unfavorable), and each of the groups - into two subgroups according to the presence or absence of signs of intoxication at admission. The subgroups were calculated and compared the mean blood glucose levels at different hours of hospital treatment. RESULTS: It was found that the average blood glucose levels at various hours of hospital stay were significantly higher in patients with poor outcome. The most noticeable was the difference in the first days of hospital treatment. Signs of intoxication was associated with lower values of glucose and a tendency to hypoglycaemia. In addition, among patients with high blood glucose ( 8 mg / dL) was observed over deaths in the first day of hospital stay. CONCLUSION: High blood glucose levels ( 8,0 mmol / L) in the first day of hospital treatment is a predictor ofpoor outcome in patients with thoracoabdominal injuries.

[PERIOPERATIVE CARE FOR PATIENTS WITH UNDERLYING ARTERIAL HYPERTENSION (CLINICAL GUIDELINES)].

These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

[THE EFFICACY AND SAFETY OF DEXMEDETOMIDINE FOR SEDATION OF PATIENTS DURING PROLONGED MECHANICAL VENTILATION IN INTENSIVE CARE UNITS (RUSSIAN MULTICENTER STUDY RESULTS)].

A multicenter prospective study investigated the efficacy and safety dexmedetomidine of sedation in 103 patients during long-term (> 12 h) mechanical ventilation and in cases of delirium. Protocol of sedation included intravenous infusions of dexmedetomidine 1.4/kg/h and administering of analgesic drugs, and if necessary--sedative drugs (propofol, midazolam). Group 1 included 69 patients in whom dexmedetomidine sedation was performed for prolonged mechanical ventilation. Group 2 consisted of 34 patients in whom dexmedetomidine was used due to development of delirious state. Dexmedetomi- dine was used as an infusion of 0.7 mg/kg for 1 hour with further correction of dosage. We recorded a level of sedation by RASS, the need for the appointment of other drugs with sedative effects, the duration of mechanical ventilation, length of ICU stay. The infusion of dexmedetomidine can provide a target level of sedation for RASS from 0 to -3 at 80-90% of patients with surgical and therapeutic profile who underwent prolonged mechanical ventilation. The frequency of adverse events appeared due to the development of bradycardia, hypotension. In the use of dexmedetomidine bolus injection should be avoided.

[Improvement of higher medical education via the system of quality specialist training].

Development of the system of management of quality specialist training in the Kraysnoysrsk State Medical Academy allowed to optimize administration and academic process, create conditions for introduction of innovative technologies in educational, research, and clinico-diagnostic activities for the purpose of their standardization and realization of managerial decisions. The new system promotes organization of administrative and educational work of the Academy in line with leading trends of regional development, stimulates creativity and strategic planning.

[Diagnostics and correction of thrombohemorrhagic impairments in patients with purulent-septic complications in obstetrics and gynecology]. / Diagnostika i korrektsiia trombogemorragicheskikh narushenii u bol'nykh s gnoino-septicheskimi oslozhneniiami v akushersko-ginekologicheskoi praktike.

The clinical course of thrombohemorrhagic complications was studied in 56 patients, aged 18 to 38, with sepsis, which developed due to obstetric and gynecologic processes on days 1, 3, 5, 7 and 10 after surgery. The patients were treated, 1999-2003, at the obstetric intensive-care and consultation center, MUZA Maternity Hospital No. 1, Krasnoyarsk. The coagulation, anti-coagulation and fibrinolytic chains of the coagulation cascade and vascular-thrombotic hemostasis were dynamically evaluated. Thrombohemorrhagic complications in severe sepsis and septic shock manifested themselves as hypercoagulation stage in 52% of observations. The hemostasis correction does not only require the elimination of changes in the hemocoagulation system but also the intensive care of the present systemic dysfunctions.

[An analysis of using the graphic monitoring of ventilation for an optimal choice of respiratory management parameters in patients with acute respiratory distress syndrome]. / Graficheskii monitoring ventiliatsii pri vybore optimal'nykh parametrov respiratornoi podderzhki u patsientov s ostrym respiratornym distress-sindromom.

The potentialities of graphic ventilation monitoring (graphic monitor "Servo Screen 390", Siemens Elema, Sweden) were analyzed for optimizing the respiratory management parameters in 48 obstetric and gynecology patients with acute respiratory distress syndrome (ARDS). The ventilation loops and curves, ALV parameters, mechanical lung properties, gas blood composition and gas indices were dynamically evaluated during examination stages. The graphic ventilation monitoring, when used for respiratory management in patients with ARDS, provides for optimizing, in the real time mode, the PEEP and Vt levels, which is in line with the AVL "safety" concept.