[Influence of cerebral perfusion pressure and cardiac output on brain oxygenation and metabolism].

The article contains results of examination of correlation between systemic hemodynamic and brain oxygenation and metabolism in patients with intracranial hemorrhage. Cardiac index (CI) and cerebral perfusion pressure (CPP) levels were compared to brain oxygenation and metabolism in 8 patients with intracranial hemorrhage (137 measurements). CI alterations didn't influence on PbrO2, glucose level or lactate/pyruvate ratio in the brain interstitial fluid in patients with traumatic brain injury. CPP elevation led to cerebral metabolism improvement. Optimal metabolic state was mentioned in CPP > 80 mm Hg. CPP elevation led to PbrO2 increasing in patients with subarachnoid hemorrhage due to aneurism rupture. This phenomenon can be explained by damage mechanisms of cerebral blood flow autoregulation. In these cases CI elevation was accompanied by worsening of aerobic metabolism in theoretically intact regions and improving it in injured brain regions.

[Sepsis in patients with intracranial hemorrhage: incidence and influence on outcome].

The aim of the study is to analyze sepsis and septic shock incidence and their influence on the outcome in critically ill patients with intracranial hemorrhage. Sepsis incidence (33,7%) and septic shock incidence (18,6%) in the patients studied did not depend on intracranial hemorrhage etiology. Septic complications led to higher mortality which was 22,8% in patients with sepsis and 74,4% in patients with septic shock. Sepsis and septic shock risk factors are defined. The problem of sepsis and septic shock diagnosis in critically ill patients with intracranial hemorrhage are highlighted.

[Systemic hemodynamic disorders in critically ill patients with intracranial hemorrhages].

The paper analyzes systemic hemodynamic disorders in 45 victims of severe brain injury and patients with nontraumatic intracranial hemorrhages. The incidence of hypovolemia in patients with nontraumatic intracranial hemorrhages and victims of severe brain injury is 65.4% and 73.7%, respectively. Infusion therapy based on the estimation of routine hemodynamic parameters (blood pressure, heart rate, central venous pressure, daily fluid balance) could not prevent hypovolemia in the examinees and caused a high rate of sympathomimetic use in uncorrected volemic states.

[Effect of volemic status on brain oxygenation and metabolism in patients with intracranial hemorrhages].

The paper analyzes the impact of the volemic status and its correction on systemic hemodynamic parameters (transpulmonary thermodilution PiCCO plus technique), the value of intracranial pressure and the biochemical composition of brain interstitial fluid (tissue microdialysis) in the affected and conditionally intact hemisphere in 8 patients with intracranial hemorrhages and a reduced awakening level up to 4-8 scores by the Glasgow coma scale. It has been shown that in patients with significant metabolic disturbance in the involved hemisphere, hypovolemia correction using hydroxyethyl starch 130/0.4 is accompanied by activated oxidative phosphorylation and a lower lactate/pyruvate ratio, without changing the of blood pressure and increasing pulmonary extravascular water.

[Role of multicomponent neuromonitoring in the determination of intensive care tactics in a female patient with subarachnoidal hemorrhage due to cerebral arterial aneurysmal rupture].

The paper describes a case of aneurysmal subarachnoidal hemorrhage in a female patient during intensive care involving the whole set of the latest neuromonitoring parameters: intracranial and cerebral perfusion pressure, brain tissue oxygen tension and temperature, as well as a set of biochemical parameters studied by the tissue microdialysis technique. The high diagnostic value of the parameters that cannot be changed by any other neuromonitoring modalities is shown.

[Intracranial pressure, cerebral perfusion and metabolism in acute period of intracranial hemorrhage].

Estimation of the volume of cerebral lesion, reversibility of ischemia and prognosis of the disease determinate management tactics in patients with severe head injuries and non-traumatic intracranial hemorrhages. Data of multimodal neuromonitoring in patients with intracranial hemorrhage in the earlier stages of comatose period were analyzed in this paper. They included incracranial pressure, cerebral perfusion pressure, bulb oxymetry, brain oxygen tension, tissue microdialysis. Typical parameters for different types of neurological outcomes were defined.

[Effect of hemotransfusion on brain oxygenation and metabolism in patients with intracranial hemorrhages].

The paper analyzes the impact of anemia correction on the time course of changes in oxygen tension in the brain and on the biochemical composition of brain interstitial fluid (tissue microdialysis) in the affected and conditionally intact hemisphere in 8 patients with intracranial hemorrhages and a reduced awakening level up to 4-8 scores by the Glasgow coma scale. Anemia correction in patients with intracranial hemorrhage was shown to fail to change oxygen tension in the brain and to be followed by a reduction in lactate/pyruvate ratio in the involved cerebral hemisphere. Only in significant anemia (Hb < 7 g/dl), hemotransfusion elevated cerebral perfusion pressure, by increasing mean blood pressure.

[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].

The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.

[Tactics of infusion therapy in the acute period of intracranial hemorrhages].

The paper deals with the determination of infusion therapy tactics in critically ill patients with intracranial hemorrhages on the basis of invasive measurements of systemic hemodynamics. The routine hemodynamic parameters (blood and central venous pressures, heart rate) are noted to fail to assess the volemic status of the patients in full. Unlike the use of colloidal solutions, infusion therapy with physiological sodium chloride is not shown to correct systemic hemodynamics. It has been ascertained that in acute intracranial hemorrhages, infusion therapy with crystalloidal solutions leads to impaired pulmonary gas exchange and increased pulmonary extravascular fluid and the use of a combination of crystalloidal solutions and a colloidal agent in a 1:1 ratio can correct the volemic status of the patients and is not followed by lung dysfunctions.

[The first experience with simultaneous bilateral monitoring of brain oxygenation and metabolism in patients with intracranial hemorrhages].

The paper analyzes the first unique experience with simultaneous bilateral monitoring of oxygenation of the brain and the key parameters of its metabolism by microdialysis in 5 patients with acute neurosurgical abnormality. Monitoring of cerebral metabolism is shown to rapidly diagnose and correct intensive therapy tactics in the most seriously ill neurosurgically patients.

[Role of pectins in the complex treatment in patients in neurointensive care units]. / Znachenie pektinov v komplekse lechebnykh meropriiatii u neiroreanimatsionnykh bol'nykh.

Clinical and laboratory estimation of the efficacy of pectins in complex treatment of patients with intracranial hematoma was performed. It was shown that in the group of the patients treated with pectins vs the control group development of pyo-inflammatory infections was less frequent, the indices of the immunity status improved and a more rapid decrease of the intoxication and a more rapid normalization of the composition of various biotopes in the patients were observed.