Vestnik intensivnoi terapii最新文献

{"title":"Dynamics of organ dysfunction and inflammation markers in patients with septic shock during multimodal hemocorrection: a multicenter, randomized, controlled study","authors":"S. I. Rey, V. V. Kulabukhov, A. Yu. Popov, O. V. Nikitina, G. A. Berdnikov, T. G. Kim, S. V. Masolitin, M. A. Magomedov, O. V. Ignatenko, N. P. Krotenko, A. N. Marysheva, N. I. Chaus, L. V. Okhinko, M. S. Mendibaev, A. G. Chumachenko, A. V. Grechko, Vladimir M. Pisarev","doi":"10.21320/1818-474x-2023-4-60-71","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-4-60-71","url":null,"abstract":"INTRODUCTION: Septic shock is the most serious complication in intensive care that associates with significant mortality. Extracorporeal hemocorrection may improve treatment of patients with septic shock. OBJECTIVE: Evaluation of the effect of hemocorrection with the multimodal adsorbent device Efferon LPS on the dynamics of organ dysfunction and inflammation markers in patients with septic shock. MATERIALS AND METHODS: A multicenter randomized controlled study was conducted in four clinical organizations in the city of Moscow from March 2021 to May 2022. The study included 58 patients (29 men and 29 women) with septic shock. Randomization was performed in a ratio of 2:1 (hemoperfusion: control). Within 24 hours of enrollment in the study, selective hemoperfusion procedures were performed or standard therapy was used. Hemosorption using Efferon LPS was performed twice, with an interval of 24.5 (23.3–26.0) hours. RESULTS: The use of the multimodal selective hemosorbent Efferon LPS significantly reduced the severity of multiple organ failure (MOF) in patients with septic shock from 7 to 3 points on the SOFA scale after 72 hours by improving hemodynamics, respiratory and renal function. In contrast to the control group, in the Efferon LPS group, the levels of CRP, PCT and IL-6 significantly decreased in 72 hours. The severity of MOF significantly correlated with the level of CRP and PCT (Spearman’s r = 0.346 and r = 0.444, respectively). The duration of hospitalization in survived patients was 16.1 days and 30.1 days in the Efferon LPS and control group, respectively (p = 0.032). The need for a renal replacement therapy (RRT) in survivors by the 3rd day was significantly reduced only in the Efferon LPS group — from 73.7 to 33.3 %. CONCLUSIONS: The use of the selective hemosorbent Efferon LPS resulted in significant decreases the hallmarks of systemic inflammation, MOF and requirements for RRT in patients with septic shock.","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"58 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136068742","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}

{"title":"Cyclosporine A therapy in patients with COVID-19 and failure of immunosuppression therapy: a retrospective cohort propensity-score matched analysis","authors":"Z. M. Merzhoeva, A. I. Yaroshetskiy, S. A. Savko, A. P. Krasnoshchekova, Irina A. Mandel, N. A. Tsareva, N. V. Trushenko, G. S. Nuralieva, S. N. Avdeev","doi":"10.21320/1818-474x-2023-4-125-138","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-4-125-138","url":null,"abstract":"INTRODUCTION: Therapy of COVID-19 patients with progressive lung damage after the use of glucocorticosteroids (GCS) and interleukin-6 inhibitors (IIL-6) has not yet been developed. OBJECTIVE: Assessment of the effectiveness of cyclosporine A in patients with COVID-19 with progression of lung damage and hypoxemic acute respiratory failure, who received therapy with GCS and IIL-6. MATERIALS AND METHODS: A retrospective cohort propensity-score matched analysis (n = 98). Cyclosporine A was prescribed in the first 72–96 hours after IIL-6 administration when the patient's condition worsened. The patients of comparison group corresponded to the study group, but did not receive cyclosporine A therapy. The primary end point was in-hospital mortality. Secondary endpoints — duration of hospitalization, number of patients admitted to the intensive care unit (ICU), need for respiratory support. RESULTS: Mortality was 12 (22) % in the cyclosporine group and 27 (61) % in the comparison group, р = 0.001 (hazard ratio [HR] 2.00 (1.12–3.48), р = 0.018), ICU admission rate 14 (26) % vs 29 (66) %, р = 0.001, respectively. In the cyclosporine group on day 7 CT-4, there were 26 % of patients vs 52 % in the control group, р = 0.014, the need for respiratory support (37 % vs 63.6 %, р = 0.011); saturation 88 % (82–93) vs 80 % (70–86), р = 0.001, respectively. The need for respiratory support at day 11 after IIL-6 increased the likelihood of death (HR 7.10 (2.5–20), р = 0.001). Risk factors for death: age over 57.5 years, body mass index over 30 kg/m2, hemoglobin oxygen saturation below 85.5 % on the day of IIL-6 application. Duration of hospitalization was 18.5 (14–24) days vs 18 (12–24) days, р = 0.778. CONCLUSIONS: Cyclosporine A in addition to GCS and IIL-6 for COVID-19 therapy may reduce mortality, ICU admissions, and respiratory support requirements.","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"138 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136069755","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}

{"title":"The combined use of erythropoietin and iron preparations for the management of postpartum anemia: a systematic review and meta-analysis","authors":"Natalya A. Barkovskaya, E. M. Shifman, D. N. Protsenko","doi":"10.21320/1818-474x-2023-4-72-89","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-4-72-89","url":null,"abstract":"INTRODUCTION: There are limited data on the effectiveness of erythropoietin in combination with oral ferrotherapy for the management of postpartum anemia. OBJECTIVE: To evaluate the efficacy of erythropoietin in combination with oral iron compared with oral ferrotherapy in puerperas with postpartum haemorrhage. MATERIALS AND METHODS: MEDLINE, Scopus, EBSCOhost and 5 other databases (January 1980 to February 2023) were searched for articles on the use of oral iron in combination with and without erythropoietin for the treatment of post-hemorrhagic anemia in puerperas. Primary outcomes: hemoglobin level, hemoglobin increase, hematocrit, number of blood transfusions, secondary outcomes: ferritin level, serum iron, lactation capacity. The analysis was carried out in accordance with the PRISMA guidelines, 2020. RESULTS: 4 studies were analyzed, 198 women were included. When using erythropoietin in combination with oral ferrotherapy, the cumulative value of the increase in hemoglobin concentration after 5 days, 2 weeks of treatment was significantly higher compared with the control group (mean difference [MD]: 11.83 g/L, 95% CI 4.43–19.23; р = 0.002, MD 10.13 g/L, 95% CI 4.97–15.29; р = 0.0001), respectively. The cumulative mean hemoglobin concentration after 40 days of treatment was significantly higher in the erythropoietin group (MD 11.00 g/L, 95% CI 1.70–20.30; р = 0.02). The cumulative mean hematocrit after 2 weeks of treatment was significantly higher in the erythropoietin group (MD 3.35 %, 95% CI 0.31–6.39; р = 0.03). The use of erythropoietin in combination with oral iron reduces the likelihood of blood transfusion (relative risk 0.12, 95% CI 0.02–0.95; р = 0.04). CONCLUSIONS: A faster hematological response was shown with the combined use of erythropoietin with oral ferrotherapy compared with monotherapy with iron preparations in the management of postpartum anemia. Further studies with sufficient sample sizes are required.","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"92 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136069765","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}

{"title":"Levosimendan: current and possible areas of clinical application: A review","authors":"Vladimir A. Boboshko, E. I. Zibareva, V. V. Lomivorotov","doi":"10.21320/1818-474x-2023-3-122-136","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-3-122-136","url":null,"abstract":"Levosimendan belongs to the class of calcium sensitizers, which exhibits its positive inotropic effects by increasing the affinity of troponin from the myocardium to calcium without additional myocardial oxygen demand, what favorably distinguishes it from catecholamines and their negative effects (myocardial ischemia, arrhythmias, vasoconstriction, hyperglycemia). In 2000, the drug was first used for the short-term treatment of decompensated chronic heart failure. After more than 20 years, the clinical use of levosimendan has covered a wide area among patients with pathology of the cardiovascular system and its use has gone far beyond the primary indications. To date, the drug has been studied in more than 200 randomized trials in patients with various clinical profiles: acute decompensation of chronic heart failure, progressive heart failure, acute myocardial infarction, cardiogenic shock, therapy of low cardiac output syndrome in cardiac surgery, perioperative use in pediatric cardiac surgery, septic shock, pulmonary hypertension, right ventricular failure, Takotsubo cardiomyopathy, patients with mechanical circulatory support devices. This review highlights the pharmacological features of the drug and key randomized clinical trials on the use of levosimendan in various categories of patients, in addition to officially recommended indications. The article also provides a brief overview of current and planned randomized trials.","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135602503","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}

{"title":"Modified Delphi analysis of the clinical guideline “Sedation of patients in the departments of anesthesiology, intensive care and intensive care”","authors":"Роман Евгеньевич Лахин, А. А. Андреенко, А. В. Власенко, Д. В. Мартынов, В. В. Лазарев, А. М. Овезов, В. И. Горбачев, И. Н. Лейдерман, А. А. Белкин, В. В. Фишер, В. В. Ломиворотов, В. В. Кузьков, Е. М. Шифман, Е. В. Григорьев, А. С. Попов, М. А. Магомедов, А. И. Ярошецкий","doi":"10.21320/1818-474x-2023-2-45-54","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-2-45-54","url":null,"abstract":"INTRODUCTION: Approaches to sedation in the departments of anesthesiology, intensive care and intensive care have changed over the past 20 years. In 2020, the guidelines “Sedation of patients in the departments of anesthesiology, intensive care and intensive care” were placed in the rubric of clinical recommendations. OBJECTIVE: To contribute to improving the quality of planned updating of recommendations with the help of a modified Delphi analysis of the provisions and quality criteria of the current version of the document published in the rubricator of clinical recommendations of the Ministry of Health of the Russian Federation. MATERIALS AND METHODS: We used a modified Delphi method with two rounds of questionnaires to develop a consensus. The agreement of specialists was reached in three stages: preparatory, discussions and the development of a consensus conclusion. To conduct the assessment, a questionnaire was created consisting of 3 blocks: assessment of the provisions of the clinical recommendation; assessment of the quality criteria of the clinical recommendation and an overall assessment of the clinical recommendation. The assessment was made on the basis of the Likert scale. Median, fashion and weighted average score were calculated. If, when evaluating the provisions and quality criteria of a clinical recommendation, the median value or mode of any provision was less than 7, the weighted average score was less than 70 %; the median value or mode of quality criteria is less than 7.5, the weighted average score is less than 75 %, then this provision (quality criterion) should be recommended for processing. RESULTS: The assessment of the provisions and criteria was carried out in the first round of discussion. At the second round of discussion, comments and recommendations were finally developed for the developers of the methodological recommendation. Consensus was reached during two rounds of modified Delphi analysis. As a result of the analysis, 16 out of 21 provisions and 5 out of 6 quality criteria were agreed, the rest required processing. CONCLUSIONS: As a result of an independent assessment by experts, 5 provisions and 1 quality criterion were recommended for processing. Comments and recommendations on all these provisions and quality criteria of the methodological recommendation “Sedation of patients in the departments of anesthesiology, intensive care and intensive care” were also agreed.","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135911774","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}

{"title":"Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018)","authors":"A. A. Andreenko, E. Dolbneva, V. Stamov","doi":"10.21320/1818-474X-2019-2-7-7-31","DOIUrl":"https://doi.org/10.21320/1818-474X-2019-2-7-7-31","url":null,"abstract":"В обзоре представлены клинические рекомендации Федерации анестезиологов и реаниматологов, пересмотренные в 2018 г. В основу рекомендаций положен обзор публикаций и современные международные руководства Общества по проблемам трудных дыхательных путей (DAS, 2015), Американского общества анестезиологов (ASA, 2013), Европейского общества анестезиологов (ESA, 2018). Ситуации «трудных дыхательных путей» (ТДП) встречаются в современной анестезиологической практике относительно нечасто, но в случае невозможности обеспечения адекватной оксигенации пациентов они приводят к постгипоксическому повреждению головного мозга или остановке кровообращения. Современные требования к безопасности пациентов во время анестезии определяют необходимость проведения тщательной оценки пациентов перед операцией, выявления прогностических признаков трудной вентиляции через лицевую маску или надгортанные воздуховоды, трудной ларингоскопии и интубации, трудной крикотиреотомии. В результате обследования анестезиолог обязан сформулировать основной и резервный планы действий, подготовить необходимое оборудование, привлечь в случае необходимости специалистов. В рекомендациях представлены доказательные данные об эффективности современных устройств для вентиляции и интубации трахеи (ИТ). Предложены алгоритмы принятия решения и действий в различных ситуациях при прогнозируемых и непрогнозируемых ТДП у пациентов с различным риском аспирации. Также предложен алгоритм подготовки, прогнозирования возможных осложнений и выполнения экстубации трахеи. Представленные в обзоре рекомендации направлены на достижение цели — повышение безопасности пациентов во время Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018)","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47227805","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}

{"title":"Comment on the article of A.V. Butrov et al. “Change of the temperature balance of the brain in various types of general anesthesia”","authors":"A. Lubnin","doi":"10.21320/1818-474x-2018-4-89","DOIUrl":"https://doi.org/10.21320/1818-474x-2018-4-89","url":null,"abstract":"","PeriodicalId":34876,"journal":{"name":"Vestnik intensivnoi terapii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43091905","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}