[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.

[Changes in lipid and carbohydrate metabolism in patients with severe sepsis of different etiology].

UNLABELLED: Different origin (heterogeneity) of sepsis is a key stone in many discussions regarding options for the course and outcome, despite the general rules of development of the pathogenic mechanisms. PURPOSE OF THE STUDY: To compare data of systemic inflammation (CRP, PCT, IL-8, IL-6, IL-4, TNF-alpha) and markers of endothelial dysfunction (NO, lactate, D-dimers), also lipid (cholesterol, triglycerides, HDL, LDL, VLDL) and carbohydrate metabolism between the two groups of patients with severe intra-abdominal infection (n = 109) and severe sepsis of other etiologies (n = 53). RESULTS: We found out a significant difference between the groups in serum levels of the CRP, IL-4 and cholesterol at all stages of the study. During severe abdominal sepsis was accompanied by a significantly higher level of cholesterol, LDL and VLDL, as well as higher values of glycaemia. Patients with sepsis other etiology showed a lighter and more dynamic course of the disease was significantly lower 28-day mortality.

[Perfusion-metabolic interaction in acute cerebral insufficiency. ACIPS study Part I. Cerebral blood flow evaluation].

Basic physiological position that metabolic requirements of brain determine perfusion characteristics of cerebral blood flow underlies the definition of syndrome of acute cerebral insufficiency. So there is a perfusion-metabolic interaction (PMI) in brain tissue at every moment. Based on this paradigm we should synchronize measurement of these components in intensive care practice. The goal of ACIPS study (Acute Cerebral Injury Protection System) is creating methodology of monitoring PMI and treatment algorithm based on this monitoring. In this article we present data that volume cerebral blood flow can be assessed by summing volume bloodflows on brachiocephalic vessels measured with triplex ultrasound. Such results are comparable with CT-perfusion results. Both methods can be used interchangeably if difference in -0.6-11.8 ml/kg/min isn't clinical significant.

[Characteristics of septic shock in obstetrics].

Peculiarities of septic shock in obstetrics are considered in this article. Traits of pregnant woman organism concerning infectious process, etiology and risk factors, modern criteria of heavy sepsis diagnosis and septic shock are discussed. It is pointed out that septic process system manifestations considerably outstrips local manifestations of purulent process in a uterus and it is necessary to take into account modern markers and criteria when making decision on initial infection center sanitization. The modern protocol of septic shock initial intensive therapy where are defined not only modern methods of treatment, but also time of their implementation, and the basic principles of pyosepsis caused maternity mortality decrease.

[Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study].

Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. The results of individual studies serve as the basis for refusing the use of synthetic colloid agents in the therapy of severe sepsis. The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.

[Changes in lipid metabolic parameters in patients with severe sepsis].

The vital importance of systemic inflammatory reactions in developing a critical condition of any etiology is generally accepted at the present developmental stage of reanimatology and intensive care. The metabolic component remains a less studied part of a complex of the universal pathophysiological changes that characterize a critical condition. Lipid metabolic changes in sepsis are less investigated. Some publications indicate a role of fatty acids in regulating a systemic inflammatory reaction and in maintaining the balance of pro- and anti-inflammatory reactions in the development of a systemic inflammatory reaction. Others show their role in endothelial damage. The latter are of great interest due to the fact that lipolysis occurs just on the endothelium with the involvement of lipases. The purpose of this study was to reveal lipid metabolic changes and to define an association between the lipid metabolic parameters and the severity of a systemic inflammatory reaction in patients with severe sepsis, as well as their possible impact on the outcome of the critical condition.

[Modes of infusion provision of myocardial revascularization on the working heart].

The paper deals with the study of the impact of liberal (traditional) and conservative (restrictive) infusion strategy on oxygen transport, central hemodynamics, and vascular tone during myocardial revascularization on the working heart. Two patient groups intraoperatively received different infusion volumes under the control of central hemodynamic parameters by a PICCO PLUS system (Pulsion, Germany) and oxygen transport. There were no significant differences in the major parameters between the groups. However, after applying the conservative strategy, postoperative pulmonary compliance and artificial ventilation duration were less than those after liberal infusion strategy. Based on the findings, it is concluded that the restrictive infusion strategy is restrictive during myocardial revascularization on the working heart.

[Effect of various colloidal solutions on pulmonary oxygenizing function in patients with acute lung lesion].

The effects of 6% hydroxyethyl starch and 10% albumin solution on the parameters of central hemodynamics and pulmonary extravascular water were studied in acute lung lesion. The patients were divided into 2 groups that did not significantly differ by the baseline severity of a condition (APACHE II and Murray scales). Groups 1 and 2 patients were transfused 6% hydroxyethyl starch and 10% albumin solution, respectively. The "PICCO PLUS" system was used to determine the parameters of central hemodynamics, pulmonary extravascular water, and oxygenation before and after infusion of the test colloidal solutions. Unlike 10% albumin solution, 6% hydroxyethyl starch was found to significantly increase preload parameters, without deteriorating pulmonary oxygenizing function due to the accumulation of extravascular liquid.

[Choice of temperature extracorporeal circulation regimen during prosthetic repair of the aortic valve].

Hypo- and normothermal perfusions were compared during prosthetic repair in two patient groups matched by demographic indices, baseline severity, surgical intervention volume, anesthetic regimen, extracorporeal procedure, and cardioplegia mode. The findings suggest that there are no significant differences in the changes in central hemodynamic parameters and oxygen transport during hypo- and normothermal perfusion. During extracorporeal circulation, hypothermia is an additional stressor that causes the strain of compensatory mechanisms in the postoperative period. This leads to a more significant hyperglycemia, increases the usage of adrenomimetics, and prolongs the time of artificial ventilation. Thus, normothermal perfusion is a more preferable option of intraoperative protection during prosthetic repair of the aortic valve.

[Multicentre study of comparative efficacy of meropenem and combined regimens for empirical antibacterial therapy of severe nosocomial infections: results of clinical and pharmacoeconomic analysis].

Adequacy and effectiveness of empirical antibacterial therapy of severe nosocomial infections with meropenem vs. combined regimens of antibacterial therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial therapy of severe nosocomial infections was performed: meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and fluoroquinolones in combination with aminoglycosides and/or metronidazole. Patients with recorded diagnosis of nosocomial pneumonia (including the ventilator-associated one) or abdominal infection with the signs of severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded nosocomial infection were included into the final estimate of the therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with meropenem and in the treatment of 73 patients the standard antibacterial therapy was used. In the group of the patients treated with meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of meropenem and the standard therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of meropenem the probability of recovery from nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control. Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial therapy with the use of meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial therapy (33.9%). The cost-effectiveness coefficient with the use of meropenem was 2.2 times lower vs. the control. Therefore, the empirical therapy of severe nosocomial infections with meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).

[The efficacy of using blood-saving technologies in operations on the heart and aorta]. / Effektivnost' ispol'zovaniia krovosberegaiushchikh tekhnologii pri operatsiiakh na serdtse i aorte.

Application of blood-saving methods during open-heart and aorta surgeries is discussed as exemplified by 86 patients. Platelet-rich plasma was prepared before surgery and infused during heart valve replacement, which decreased the postoperative blood loss 1.5 times. Reinfusion of patient's blood during aortocoronary shunting decreased the need in fluid replacement by 67% and utilization of the Cell Saver device in surgery on the aorta decreased the needed amount of donor blood by 50%.

[A scale for estimating multiple organ dysfunction in surgical patients]. / Skala otsenki poliorgannoi disfunktsii u khirurgicheskikh bol'nykh.

A scale is proposed for estimating the severity of multiple organ dysfunction in surgical patients and its changes in the course of treatment. The scale was tried in 37 patients after abdominal operations. Estimations performed by means of the scale ore revealed good correlation with the patient's clinical status. Routine parameters are used in the scale, which facilitates its utilization in any surgical intensive care. The scale helps evaluate the severity of each system damage.

[Effects of induction propofol mono-narcosis on the central and cerebral hemodynamics]. / Vliianie vvodnogo mononarkoza propofolom na tsentral'nuiu i tserebral'nuiu gemodinamiku.

Changes in the central hemodynamics were followed up by echocardiography and the linear velocity of the bloodflow by transcranial dopplerography in 15 patients with ASA classes I-II during induction bolus anesthesia with propofol in a dose 2.7 mg/kg without opioids. The diastolic and mean arterial pressure decreased by 12.3 and 15.4 %, respectively, the rate of cardiac contractions by 7.8%, cardiac index by 13.4%, and the resistive index on the radial and middle cerebral arteries by 13.4 and 10.2%, respectively, after administration of the above dose of propofol. The reaction to intubation of the trachea was the minimal, consisting in an increase of the mean and systolic arterial pressure by 22.2 and 22.7%, respectively, and of diastolic by 16.1%. The rest parameters were as initially. The linear velocity of the bloodflow in the middle cerebral artery did not reliably change. Hence, the central hemodynamic parameters are stable on condition that the deficit in the central bloodflow during induction anesthesia with propofol in a dose of 2.7 mg/kg is compensated for, adequate protection from intubation stress is provided, and autoregulation of the cerebral bloodflow is preserved.

[Artificial ventilation of the lungs in respiratory failure caused by lesions of the peripheral neuron]. / IVL pri dykhatel'noi nedostatochnosti, obuslovlennoi porazheniem perifericheskogo neirona.

A case with 155-day artificial ventilation of the lungs (AVL) in a patient with the poliencephalomyelitic form of tick-borne encephalitis is described. AVL was conducted through tracheostoma by the Puritan-Bennett 720ae device in the CMU mode for 26 days, then in the SIMU + PS accessory mode for 7 days, and in the CPAP + PS mode for 155 days. Despite the recovery of spontaneous respiration, vital capacity of the lungs did not normalize (1.1 liter) and the involvement at the level of the spine and the nuclei of the craniocerebral nerves was not corrected. The compensation was evidently due to training the diaphragm and the respiratory muscles and joining the accessory muscles.

[The use of endolymphatic antibacterial therapy to prevent suppurative complications after heart operations under artificial blood circulation]. / Primenenie éndolimfaticheskoi antibakterial'noi terapii s tsel'iu profilaktiki gnoinykh oslozhnenii posle operatsii na serdtse v usloviiakh iskusstvennogo krovoobrashcheniia.

Under study were results of antibacterial therapy used in 40 patients with rheumatic heart diseases operated upon under conditions of artificial blood circulation. A conclusion is made that preventive endolymphatic infusion of antibiotics is expedient.

[Clinical use of tramadol in lithotripsy compared with buprenorphine]. / Klinicheskoe ispol'zovanie tramadola pri litotripsii v sravnenii s buprenorfinom.

The comparison was made of analgetic action of tramadol and buprenorphine+diazepam in extracorporeal impulse lithotripsy. Opiate agonist-antagonist buprenorphine can provide high-quality analgesia in a drastic lowering of sHbO2. Nonnarcotic analgetic tramadol does not depress external respiration and provides adequate analgesia.

[Protection of the myocardium during prolonged surgery of the heart valves]. / Zashchita miokarda pri dlitel'nykh operatsiiakh na klapanakh serdtsa.

The comparative analysis of the effectiveness of the use of blood and crystalloid cardioplegia in valve prosthetics with prolonged clamping of the aorta was carried out. The use of blood cardioplegia is preferable, especially in patients with low functional myocardial reserve.