Annals of pulmonary and critical care medicine最新文献

{"title":"Immune status in chronic critical illness: a systematic review","authors":"L. Berikashvili, A. V. Geize, R. Kornelyuk, G. Plotnikov","doi":"10.21320/1818-474x-2023-1-133-144","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-1-133-144","url":null,"abstract":"INTRODUCTION: Currently, there is an increase in the number of patients who are classified as chronically critically ill patients. OBJECTIVE: The review is aimed at studying the indicators of the immune status of chronically critically ill patients. MATERIALS AND METHODS: PubMed and Google Scholar were used to identify relevant articles. The following 3 searches were performed: “chronically critically ill patients AND immune”, “chronic critical illness AND immune”, “persistent inflammation, immunosuppression, and catabolism syndrome AND immune”. The literature review was limited from 2012 to August 2022. The inclusion criteria were as follows: (1) patients with chronic critical illness (CCI) or persistent inflammation, immunosuppression and catabolism syndrome (PICS); (2) comparison groups are at least one of the specified — patients undergoing rapid recovery, healthy volunteers; (3) parameters of the immune status, inflammation and catabolism are the study endpoints; (4) original articles. To assess the validity of the results, a risk of bias assessment was performed for each study included in the analysis. The risk of bias in non-randomised studies of exposures (ROBINS-E) tool was used. The Delphi method was executed in two rounds by three researchers to assess bias. RESULTS: Chronically critically ill patients with the immunosuppressive status have reduced levels of HLA-DR and ALC and elevated sPD-L1 and IL-10 levels. The results of the studies were rated at ‘high’ and ‘moderate’ risk of reporting bias. Their findings should be considered as low-quality results. CONCLUSIONS: Chronic critical illness is a poorly understood condition that periodically occurs in patients in the ICU. The immune status of chronically critically ill patients is a debatable issue, as the current data are insufficient to draw a definitive conclusion. Based on the systematic review, further prospective trials are required to study the immune status of chronically critically ill patients.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78685820","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":"Perioperative management of adult patients with concomitant diabetes mellitus: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (second revision)","authors":"I. Zabolotskikh, Y. Malyshev, P. Dunts, K. M. Lebedinskii, I. Leiderman, М. I. Neimark, Т. М. Semenikhina, A. Yaroshetskiy","doi":"10.21320/1818-474x-2023-1-14-33","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-1-14-33","url":null,"abstract":"Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was 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 opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73721728","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 use of mesenchymal stem cells in the treatment of severe forms of new coronavirus infection COVID-19: a prospective observational study","authors":"A. Dzyadzko, S. Krivenko, A. V. Syradouey, N. I. Dedylya, P. S. Prylutski, E. A. Prymakova, A. A. Symanovich, E. Nazarova, K. Petrovskaya, V. Smolnikova, I. A. Romanova","doi":"10.21320/1818-474x-2023-1-71-82","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-1-71-82","url":null,"abstract":"INTRODUCTION: One of the promising treatments for COVID-19 aimed at correcting the immune response and reducing the level of pro-inflammatory cytokines is the use of mesenchymal stem cells (MSCs). There is evidence that MSCs, due to various mechanisms, are able to suppress the cytokine storm in patients with COVID-19. Thus, the use of MSCs can contribute to the suppression of inflammation and the regulation of immune homeostasis in patients with severe COVID-19. OBJECTIVE: Evaluation of the effect of mesenchymal stem cell (MSC) therapy on the course of severe forms of novel coronavirus infection, accompanied by “cytokine storm”. MATERIALS AND METHODS: A prospective single-center study included 39 patients treated for coronavirus infection on the basis of the intensive care unit and, after randomization, randomly divided into control (n = 16) and study groups (n = 23). An assessment of clinical, laboratory parameters in both groups and a cytokine profile in the study group was carried out. Outcomes were compared, the incidence of complications and clinical and laboratory parameters in both groups, and the cytokine profile in the study group. RESULTS: The use of MSCs in patients with severe forms of COVID-19 affected the outcomes of the disease, the duration of stay on mechanical ventilation, the course of acute respiratory distress syndrome (ARDS) (an increase in the oxygenation index in patients of the study group by 5, 7 days from administration in comparison with the control group). CONCLUSIONS: In patients treated with MSCs, there was a significant decrease in a number of pro-inflammatory cytokines.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"225 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78470237","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":"Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study","authors":"Alexandr M. Ronenson, Y. Raspopin, E. Shifman, A. V. Kulikov, A. M. I. A. M. Ioscovich","doi":"10.21320/1818-474x-2023-1-34-42","DOIUrl":"https://doi.org/10.21320/1818-474x-2023-1-34-42","url":null,"abstract":"INTRODUCTION: Continuous monitoring of the hemostasis system during postpartum hemorrhage is an essential aspect of intensive care. Rotational thromboelastometry (ROTEM) provides rapid and differentiated detection of hemostasis system disorders. OBJECTIVE: To evaluate the effect of implementing the rotational thromboelastometry on the need for blood transfusion in massive postpartum hemorrhage in the practice of perinatal centers. MATERIALS AND METHODS: A retrospective cohort multicenter study was conducted in two perinatal centers. The BEFORE group included females with massive postpartum hemorrhage (PPH) (> 30 % of circulating blood volume (CBV) or > 2 L) within 2 years prior to ROTEM implementation in tertiary care hospitals; the AFTER group included females with massive postpartum hemorrhage within 2 years after ROTEM implementation. The primary endpoint of the study was a comparative evaluation of the frequency of fresh frozen plasma (FFP) transfusion for hemostasis correction in massive PPH before and after ROTEM implementation as an urgent method for coagulopathy diagnosis. RESULTS: A total of 97 patients were included in the study: 48 in the BEFORE group and 49 in the AFTER group. A significant relative risk (RR) of reduced frequency of FFP transfusion RR = 0.53 (0.32, 0.85; p = 0.009) with NNT = 3.6 after implementation of ROTEM into clinical practice was found. The frequency of cryoprecipitate transfusion increased. Analysis of cases of PPH over 50 % of the CBV (PPH in the BEFORE and AFTER groups 68.2 ± 12.4 and 72.3 ± 35.9, respectively, p = 0.673) showed a twofold significant risk of reducing the number of parturient women requiring FFP transfusion: RR = 0.5 (0.25, 0.99); p = 0.049), with NNT = 2. CONCLUSION: Rapid information on the status of the hemostasis system can reduce unnecessary FFP transfusion. Introducing the ROTEM method into the clinical practice of obstetric hospitals will improve the outcomes of intensive care for one of the most challenging categories of patients — postpartum women with massive postpartum hemorrhage.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85538966","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":"Family-centered care for social and psycho-emotional satisfaction of the child and his/her family in pediatric ICU: a multicenter questionnaire study","authors":"V. Lazarev, K. Vartanova, E. Tarakanova, A. Klyuev, M. Kopytov, T. Zaguzova, I. Ryzhenenkova, G. Nasyrova, I. Samolina","doi":"10.21320/1818-474x-2022-3-94-101","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-3-94-101","url":null,"abstract":"INTRODUCTION. The problem of parents and children staying together in intensive care units (ICU) is solved from a categorical ban in the past, to exceptional loyalty at the present time, when it is allowed to stay with the patient of his beloved pets. OBJECTIVES. To study the social and psycho-emotional aspects of the joint stay of parents with a child in the intensive care unit as an indicator of satisfaction with the medical care. MATERIALS AND METHODS. Hospitals with a commitment to a family centered care (FCC) were included in the study. Data collection was carried out on the basis of questionnaires (n = 471), when filling out which the respondent had to choose one of the submitted answers with a score from 1 to 5 (the highest), or in some cases submit their own version. The data were analyses by descriptive. RESULTS. Respondents rated 4 (4-5) the conditions of stay in the ICU, concerning: its location in a medical institution; the purpose of the premises of the department and the quality of their sanitary and hygienic cleaning; diagnostics, treatment, care; communication and psycho-emotional support by medical staff. The nature of the assistance provided by family members to the patient: sanitary and hygienic care (87.9 %), feeding (86.4 %), monitoring of medical equipment (50.9 %), assistance to medical staff in transporting the patient (53.5 %). The level of training of parents in caring for a child in the ICU upon admission is 3 (3-4), and upon transfer from the department 4 (4-4). CONCLUSIONS. The joint stay of parents with children in the ICU does not bring a negative psycho-emotional burden for them in communicating with medical staff, allows parents to obtain and improve their knowledge and skills in child care, to provide assistance in this. The problem of FCC requires further study.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84982563","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":"Legal aspects of assessing the quality of medical care","authors":"E. Netesin, V. Gorbachev, N. Utkin","doi":"10.21320/1818-474x-2022-1-141-148","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-1-141-148","url":null,"abstract":"The analysis of adverse outcomes of medical care allows to identify the causes and eliminate the possibility of their further recurrence, and contributes to the accumulation of practical experience. Objectives. To determine the degree of correlation of examinations of the quality of medical care conducted by medical organizations, insurance companies and investigating authorities, and to assess the validity of using the expression “defect in the provision of medical care”. Materials and methods. The main research method was the analysis of the conclusions of the Commission for the Study of Lethal Outcomes (CSLO), acts of inspections of the quality examination conducted by insurance companies and the conclusions of forensic medical examinations for the frequency of use of the expression “defect in the provision of medical care”, “medical error”, “shortcomings in the provision of medical help”. The data was obtained from the results of a study of 24 CSLO protocols, 15 acts of quality examination inspections conducted by insurance companies and 12 forensic medical examination reports. In all cases, the studied documents were associated with adverse outcomes of medical care, with the participation of anesthesiologists-resuscitators. Results. When analyzing these documents, it was found that the expression “defect in the provision of medical care” is more often found in the conclusions of forensic medical examinations - 91.7 %. When examining the quality of medical care, this term is found in only 13.3 % and in the protocols of CSLO in 54.2 %, and “deficiencies in the provision of medical care” - і n 41.6 %. Conclusions. The analysis revealed that in the documents reflecting the quality of care, there is a terminology that is different in meaning and content, which does not allow to objectively reflect the degree of the admitted deficiency and its іmpact on the outcome of the disease.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89551972","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":"Regional methods of anesthesia in labor pain relief: a systematic review","authors":"O.A. Makcharin, E. Lebedeva, N. V. Kochubeinik","doi":"10.21320/1818-474x-2022-4-55-65","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-55-65","url":null,"abstract":"INTRODUCTION: Today epidural anesthesia is the “golden standard” of anesthesia. But what can we do if the application of an epidural catheter is contraindicated? The use of narcotic analgesics can hardly be deemed a worthy alternative. OBJECTIVE: To identify alternative regional methods of anesthesia in labour pain relief. MATERIALS AND METHODS: We have performed a systematic review of literature in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline principles. The bibliographic search was conducted in January-March 2022. The search was performed in the MEDLINE, EMBASE, eLibrary.ru, Cochrane Library databases. The search keywords were: anesthesia of childbirth, pudendal block, paracervical block, paravertebral block, quadratic lumbar muscle (QLB) block, erector spinae plane block (ESPB). We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. RESULTS: We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. We identified six randomized controlled trials related to the subject matter, but the endpoints were heterogeneous preventing a statistical analysis; therefore, we performed a qualitative review of the literature. Works dedicated to paravertebral and paracervial blocks showed sufficient effectiveness of anesthesia for the second period of labor. Good results of anesthesia of the second period of labor were also described with the use of ESPB and bilateral QLB. Nevertheless, it is impossible to draw statistically significant conclusions on the use of ESPB and QLB due to the small sample. Articles devoted to the use of pudendal block in labour revealed its low effectiveness. CONCLUSIONS: The described results show that paravertebral, ESPB and QLB blocks can be used as alternative regional methods of anesthesia in labour. However, further research is required to assess the effectiveness of their use in childbirth.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90289910","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":"Thrombocytopenia in the ICU before and during the pandemic of the new coronavirus infection COVID-19: a comparative retrospective cohort study","authors":"E. Bulanova, S. E. Rabotinsky, P. Degtyarev, D. O. Sinyavkin, A. Bulanov","doi":"10.21320/1818-474x-2022-4-66-73","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-66-73","url":null,"abstract":"INTRODUCTION: Thrombocytopenia is common in critically ill patients. Its development is associated with a high risk of bleeding and other complications, including adverse outcomes. ОBJECTIVE: To analyze the incidence, severity, predictive significance of thrombocytopenia in critically ill patients before and during coronavirus infection. MATERIALS AND METHODS: The observational study included patients from intensive care units of a multidisciplinary hospital at different periods: before the COVID-19 and during the period when the hospital was operating as a COVID hospital. Patients from all intensive care units, excluding the hematology unit, were analyzed. RESULTS: Non-infectious period. Among 314 patients, 91 cases of thrombocytopenia were identified, representing 29 %. Severe thrombocytopenia among them was noted in 35 % (n = 32). The main etiological causes: performing extracorporeal procedures, liver disease, ischemic stroke, acute coronary syndrome. The infectious period. Thrombocytopenia occurred more frequently than in non-COVID patients (in 209 of 396 patients - 52.8 %) and was more uniform in severity. The most frequent cause of thrombocytopenia was a combination of sepsis, acute liver injury, performance of extracorporeal procedures and specific drug therapy of COVID-19 infection. CONCLUSIONS: According to our data, thrombocytopenia in the intensive care units of a multidisciplinary hospital (non-infectious period) occurred in one-third of critically ill patients. COVID 19 infection demonstrated an i ncreased incidence of thrombocytopenia in critical patients (in the presented study up to half of the patients). Severe thrombocytopenia is more common in patients of non-infectious period (35 % vs 20 %). In patients with coronavirus infection, thrombocytopenia was more frequently associated with a bleeding clinic (6.2 % vs 2.2 %), with less prognostic value as a criterion for adverse outcome: the presence of thrombocytopenia increased the risk of death by 5.5 times (95 % CI 2.97910.031) in noninfectious and by 1.54 times (95 % CI 1.3-1.82) in COVID-19 infection.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81463987","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":"Prognosis of adenosine triphosphate infusion for anticonvulsants efficacy in patients with intensive cancer pain: a prospective observational study","authors":"A. Karelov, A. A. Ryazankina, V. A. Semkichev","doi":"10.21320/1818-474x-2022-4-135-143","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-135-143","url":null,"abstract":"INTRODUCTION: Pain is a common symptom in cancer patients even when analgesics were given. OBJECTIVE: To assess the prognostic value of intravenous infusion of non-selective purine receptors agonist adenosine triphosphate for effectiveness of anticonvulsant gabapentin in cancer patients with moderate and severe pain who received non-selective inhibitor of cyclooxygenase plus weak opioid tramadol. MATERIALS AND METHODS: Thirty-four cancer patients with intensive pain were scheduled for the study. The intravenous infusion of adenosine triphosphate 35-45 mg • kg-1 • min-1 was performed within the period from 100 to 160 minutes. Then all patients were taken gabapentin (900 mg in three times daily). Pain was estimated 30 minutes before infusion, 30 minutes after infusion, and after taking 900 mg/day gabapentin for 4 days. Moreover, we studied prognostic significance of adenosine triphosphate infusion for the effectiveness of gabapentin administration. RESULTS: We revealed significant reduction of pain intensity after adenosine triphosphate infusion (Z = 4.0; р < 0.0001 - Wilcoxon signed rank test). The same result was obtained after taking of gabapentin for 4 days (Z = 4.9; р < 0.0001 - Wilcoxon signed rank test). Moreover, we found statistically moderate correlation link (t(N - 2) = 3.94; closeness correlation = 0.57; р < 0.0004 - Spearman’s rank correlation coefficient) between pain intensity value after adenosine triphosphate infusion and taking of gabapentin. Regression analysis demonstrated satisfactory predictive ability of the resulting model (R2 = 0.55 (corrected R2 = 0.53); F = 38.74; р < 0.0001). CONCLUSIONS: 1. Intravenous infusion of adenosine triphosphate may has significance for prognosis of taking anticonvulsant gabapentin effectiveness in cancer patients with moderate and severe pain who received non-selective cyclooxygenase inhibitor plus weak opioid tramadol. 2. Intravenous infusion of adenosine triphosphate or taking anticonvulsant gabapentin may significantly reduce pain intensity in cancer patients who had weak effect of administration of non-selective inhibitor of cyclooxygenase plus weak opioid tramadol.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84317540","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":"Dynamics of the baroreflex sensitivity during combined anesthesia with sevoflurane or propofol: a randomized trial","authors":"N. Trembach, Y. Malyshev, V. V. Golubtsov, I.A. Trembach, I. Zabolotskikh","doi":"10.21320/1818-474x-2022-4-44-54","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-44-54","url":null,"abstract":"INTRODUCTION: A significant number of complications is still a serious problem in abdominal surgery. It is known that patients with low baroreflex sensitivity are more prone to hemodynamic instability during general anesthesia, which allows them to be identified as a risk group. OBJECTIVE: To evaluate the dynamics of baroreflex sensitivity (BRS) during major abdominal surgery in patients with different risk of critical incidents under combined anesthesia with propofol or sevoflurane. MATERIALS AND METHODS: A randomized study was conducted in 160 patients (80 high-risk and 80 low-risk patients), who were randomized into subgroups according to the type of anesthesia (propofol or sevoflurane) to assess the effect of the type of anesthesia critical incidents and baroreflex dynamics. RESULTS: After the induction there was a trend towards a decrease in BRS, while in subgroups with initially low values of BRS, it decreased below 3 ms/mmHg. After the end of operation and 6 hours after ex-tubation, there were no significant changes in comparison with intraoperative values. Evaluation of BRS after 24 hours showed that BRS in all subgroups was significantly higher than at previous time points, but did not return to baseline values. At 6 hours postoperatively, in low-risk patients, BRS values were below 3 ms/mmHg in 12.5 % with propofol, and in 10 % with sevoflurane, in high-risk patients - in 45 % and 42.5 % of cases, respectively. At 24 hours, in the low-risk group, only two patients in the propofol anesthesia group and one in the sevoflurane anesthesia subgroup experienced this dysfunction. CONCLUSIONS: Both anesthesia with propofol and anesthesia with sevoflurane lead to a decrease in the sensitivity of the arterial baroreflex, which is not fully restored 24 hours after the end of the operation. High-risk patients with initially reduced baroreflex sensitivity show more frequent postoperative baroreflex dysfunction.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87902328","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}