V. I. Ershov, I. Leyderman, A. Belkin, V. Gorbachev, A. Gritsan, K. M. Lebedinskii, S. Petrikov, D. N. Protsenko, A. A. Solodov, A. V. Shchegolev, A. A. Borzdyko, A. S. Dobrynin, V. Silkin, I. Zabolotskikh
{"title":"Protein-energy malnutrition prevalence and influence on complications and outcome of severe stroke, requiring mechanical ventilation: a multicenter prospective observational trial","authors":"V. I. Ershov, I. Leyderman, A. Belkin, V. Gorbachev, A. Gritsan, K. M. Lebedinskii, S. Petrikov, D. N. Protsenko, A. A. Solodov, A. V. Shchegolev, A. A. Borzdyko, A. S. Dobrynin, V. Silkin, I. Zabolotskikh","doi":"10.21320/1818-474x-2024-1-58-68","DOIUrl":"https://doi.org/10.21320/1818-474x-2024-1-58-68","url":null,"abstract":"INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.","PeriodicalId":518729,"journal":{"name":"Annals of Critical Care","volume":"171 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140530414","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}
I. Zabolotskikh, S. V. Sinkov, A. Bulanov, N. A. Vorobyova, A. A. Eremenko, A. Kuzovlev, A. V. Kulikov, K. M. Lebedinskii, A. S. Popov, E. V. Roitman
{"title":"Perioperative management of patients with hemostatic system disorders. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the National Association of Specialists in Thrombosis, Clinical Hemostasiology and Hemorheology","authors":"I. Zabolotskikh, S. V. Sinkov, A. Bulanov, N. A. Vorobyova, A. A. Eremenko, A. Kuzovlev, A. V. Kulikov, K. M. Lebedinskii, A. S. Popov, E. V. Roitman","doi":"10.21320/1818-474x-2024-1-7-46","DOIUrl":"https://doi.org/10.21320/1818-474x-2024-1-7-46","url":null,"abstract":"Perioperative coagulation disorders pose a serious risk of life-threatening complications. The article presents methodological recommendations of the Federation of Anesthesiologists and reanimatologists of Russian Federation for the perioperative management of patients with disorders of the hemostatic system, which summarizes aspects of both diagnosis and assessment, and intensive care of congenital and acquired disorders of the coagulation system in the perioperative period. The literature search focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. The principles of perioperative management of disseminated intravascular coagulation syndrome, hepatic, uremic, traumatic, septic coagulopathy, acquired thrombocytopenia and trobocytopathies, antiphospholipid syndrome, hemophilia A and B, von Willebrand disease and other pathologies are described. For each recommendation, the level of certainty of the evidence and the level of strength of the evidence are presented. The recommendations were developed by experts in the field of perioperative patient management for anesthesiologists and intensive care physicians as a help in making clinical decisions; the final decision for a particular patient is made by the attending physician.","PeriodicalId":518729,"journal":{"name":"Annals of Critical Care","volume":"74 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140530393","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}
R. Lakhin, A. S. Kusai, E. A. Usoltsev, K. Tsygankov, V. V. Shustrov
{"title":"Catheterization of the internal jugular vein and subclavian/axillary vein under ultrasound control in the wounded with hemorrhagic shock due to combat trauma: a retrospective cohort study","authors":"R. Lakhin, A. S. Kusai, E. A. Usoltsev, K. Tsygankov, V. V. Shustrov","doi":"10.21320/1818-474x-2024-1-113-123","DOIUrl":"https://doi.org/10.21320/1818-474x-2024-1-113-123","url":null,"abstract":"INTRODUCTION: Catheterization of central veins using ultrasound navigation increases the rate of successful catheterizations and reduces the number of complications. The use of ultrasound navigation can improve the efficiency and safety of catheterization in conditions where central vein puncture is difficult. OBJECTIVE: Comparison of the readiness of the internal jugular vein and the subclavian vein/axillary vein for puncture, the effectiveness and safety of their catheterization using ultrasound navigation in patients with hemorrhagic shock. MATERIALS AND METHODS: A retrospective study of the medical data of 146 victims who required puncture and catheterization of vessels under the control of ultrasound navigation was performed. In all victims, using ultrasound, the readiness of the vessels for puncture was visually assessed by the compression and collapse of the vein at the moment of slight superficial pressure with the sensor. RESULTS: Assessment of the vessel's readiness for catheterization showed that, at all degrees of shock, the readiness of the subclavian vein/axillary vein for catheterization was higher than that of the internal jugular vein. Analysis of all central venous catheterizations performed showed that they were completed on the first attempt, but during the attempt it was necessary to redirect, sometimes tighten and advance the needle again. The data obtained showed statistical differences in patients with II and III degrees of shock (p = 0.001). CONCLUSIONS: Against the background of infusion therapy through a peripheral venous catheter for all degrees of shock, readiness for puncture and catheterization of the subclavian vein/axillary vein was higher compared to the internal jugular vein. Such tactics for shocks of degree II and III result in fewer needle passes.","PeriodicalId":518729,"journal":{"name":"Annals of Critical Care","volume":"168 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140530415","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}