[The application of the tracheostomy technique in neuroresuscitation].

The objective of the present study was to compare the frequency of complications associated with percutaneous dilatational tracheostomy by the method of Griggs and conventional surgical tracheostomy. The retrospective analysis of 120 critically ill patients maintained by mechanical ventilation and neurorehabilitated following tracheostomies was carried out. The two groups of the patients were matched for the age and severity of their clinical conditions. No difference was documented between the frequencies of complications after the treatment using the two surgical strategies. It is concluded that both percutaneous dilatational tracheostomy and conventional surgical tracheostomy may be recommended for the use in clinical practice.

[Prognostic criteria for tracheostomy in the neuroresuscitation unit].

UNLABELLED: The aim is to specify prognostic criteria for tracheostomy on the basis of long-term (more than 14 days) ALV and prolonged (more than 14 days) trachea canmulation. MATERIALS AND METHODS: Retrospectively were analyzed the medical history of 120 difficult patients with tracheostomy, who spent in ICU more than 72 hours. Was executed multiple logistic regression analysis. RESULTS: In patients with consciousness level of 8 or less points on the Glasgow coma scale and subarachnoid hemorrhage, detected on CT scan of the brain, increases the chances for prolonged ALV versus patients without these signs in 3.93 times. In patients with constrained basal cisterns, detected on CT scan of the brain and to the consciousness level of 8 or less points on the Glasgow coma scale versus patients without these signs increases the chances of the prolonged trachea cannulation in 5 times. CONCLUSION: Prognostic criteria for tracheostomy in patients in neuroresuscitation unit are: criteria for prolonged ALV: level of 8 or less points on the Glasgow coma scale and subarachnoid hemorrhage and criteria for prolonged trachea cannulation: constrained basal cisterns, detected on CT scan of the brain and to the consciousness level of 8 or less points on the Glasgow coma scale.

[Effect of an original enteral feeding protocol on clinical outcome indicators in patients with acute cerebral damage of vascular and traumatic genesis].

The prospective randomized controlled study enrolled 58 patients diagnosed as having brain injury and hemorrhagic stroke. Enteral feeding was started within the first 24 hours after admission to an intensive care unit (ICU); a control group (n = 28) was given an isocalorie formula while a study group (n = 28) received a combination of a hypercalorie formula and a fiber-containing formula. In the study group, the intestine was stimulated with erythromycin within the first 3 days. Glasgow coma scale (GCS) and APACHE II scores, the degree of a systemic inflammatory response (SIR) and multiple organ failure (MOF), serum albumin and glucose levels, energy expenditure and balance, and nitrogen excretion and balance were estimated on day 10. Treatment results on day 30, length of ICU stay, AV duration, mortality, and use of blood preparations were compared. On study day 10, nitrogen and energy balances and the pattern of signs of SIR and MOF were significantly better and fresh frozen plasma and albumin solutions were used less in the study group than in the control one. There were differences in APACHE II and GCS scores, energy expenditure and nitrogen loss, plasma albumin and glucose concentrations, mortality, and volume of used packed red blood cells. The original enteric feeding protocol based on the use of dietary fiber-fortified hypercalorie diets in combination with the new method of gastric motility stimulation makes it possible to reduce the accumulation of deficiency of energy and plastic substrates, to alleviate the manifestations of SIR and MOF and to decrease the consumption of blood components and preparations.