Annals of pulmonary and critical care medicine最新文献

{"title":"Perioperative management of elderly and senile patients. Recommendations","authors":"I. Zabolotskikh, E. Gorobets, E. Grigoryev, Y. Kotovskaya, K. M. Lebedinskii, T. Musaeva, E. Mkhitaryan, A. Ovechkin, V. S. Ostapenko, A. V. Rozanov, N. Runikhina, O. Tkacheva, N. Trembach, V. Khoronenko, M. Cherdak","doi":"10.21320/1818-474x-2022-3-7-26","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-3-7-26","url":null,"abstract":"Perioperative management of elderly patients remains one of the most difficult tasks of modern anesthesiology. Compared with younger patients, people over 60 years of age have a higher risk of developing adverse postoperative outcomes, as a result of age-related decline in physiological functions, the presence of several concomitant diseases, polypragmasia, cognitive dysfunction and specific geriatric syndromes, such as frailty. More than 25 % of this category of people have several chronic diseases of the cardiovascular, nervous, endocrine, hematopoietic, musculoskeletal systems, respiratory, digestive and other systems. In the process of aging, there is also a decrease and some perversion of metabolic processes, a decrease in the reactivity of the body. All of the above, along with the surgical intervention, increases the risk of postoperative complications and perioperative mortality. The recommendations present the definition of the category of elderly and senile patients, provide information about age-related changes in their body that affect anesthesia and intensive care. The main clinical syndromes and symptoms useful in predicting the unfavorable course of the perioperative period are indicated, including frailty, nutritional insufficiency, sarcopenia and cognitive dysfunction. Methods for assessing functional activity and the risk of falls are given separately. Attention is paid to the causes, diagnosis, prevention and treatment of delirium, cardiovascular, respiratory complications. The principles of choosing the method of anesthesia and management of the perioperative period in elderly and senile patients, depending on the features of і nterventions and concomitant pathology, are described.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85822151","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":"Effect of assisted lung ventilation on the level of serum biomarkers of lung injury after robot-assisted surgery: a prospective randomized study","authors":"A. A. Klimov, A.A. Chotchaeva, M. Pankratova, V. Subbotin","doi":"10.21320/1818-474x-2022-3-82-93","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-3-82-93","url":null,"abstract":"INTRODUCTION. It is uncertain whether assisted lung ventilation versus pressure control-volume guaranteed ventilation reduces ventilation-induced pulmonary injury and inflammation during anaesthesia for robotic surgery. OBJECTIVES. To compare Pressure support ventilation Pro (PSVpro) with moderate neuromuscular block (NMB) with protective pressure control-volume guaranteed ventilation (PCV-VG) with intensive neuromuscular block during anaesthesia for robotics abdominal surgery respect to biomarkers levels of lung injury and inflammation. MATERIALS AND METHODS. Design: randomized clinical trial. 35 patients scheduled for elective robotic radical prostatectomy under general anesthesia were randomized into two groups. Group 1 - moderate and shallow NMB (TOF 1-4, TOF ratio T4/T1 < 40 %o) and pressure support ventilation - PSVpro (n = 19), Group 2 - intensive NMB (TOF 0, PTC < 2) and protective pressure control-volume guaranteed ventilation - PCV-VG (n = 16). The primary outcome was the changes in serum levels of inflammation biomarkers (Tumor necrosis factor α (TNF-α), Interleukin-6 (IL-6) and Interleukin-6 (IL-8)) and lung injury biomarker (Surfactant Protein D (SP-D)) 1 hour after the end of surgery. RESULTS. The levels of serum IL-6, IL-8, TNF-α and SP-D, before and after surgery were 2.1 (1.125-16.215), 30.9 (12.85-50.7); 10.6 (8.04-14.75), 13 (8.585-21.25); 4 (4-4.035), 4 (4-4); 66.2 (39.2-91.1), 65.4 (57-109.6) in the Group 1 and 2.20 (1.55-5.33), 26.15 (18.175-42.875); 10.45 (8.6425-16.35), 19.15 (9.77-31.35); 4 (4-4.815), 4 (4-4); 60.65 (49.56-106.73), 63.20 (56.5-106.65) in the Group 2 respectively. Changes in serum biomarkers levels were not significantly different between the two ventilation strategies. CONCLUSIONS. Pressure support ventilation Pro with moderate neuromuscular block compare to protective mandatory lung ventilation with intense neuromuscular block does not affect changes in serum levels of biomarkers for inflammation and lung injury IL-6, IL-8, SP-D and TNF-α in patients undergoing elective robotic prostatectomy.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86387623","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":"Changes in the pituitary-adrenal system for extracorporal membrane oxygenation: prospective study","authors":"N. Altshuler, M. Kutcyi, N. M. Kruglyakov, K. Gubarev, G. I. Bagzhanov, K. Popugaev","doi":"10.21320/1818-474x-2022-3-69-81","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-3-69-81","url":null,"abstract":"INTRODUCTION. At the moment, assessing adrenal dysfunction in patients in critical condition and ways to correct this function with hormone replacement therapy are extremely difficult. OBJECTIVE. Analysis of changes in the dynamics of adrenocorticotropic hormone (ACTH) and cortisol levels in blood plasma during extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS. The prospective study was performed in intensive care unit (47 patients on ECMO). After connecting ECMO (D0), (D1-D3-D5-D7-D9), and until the completion of ECMO, assessment of cortisol and ACTH levels was carried out. RESULTS. The median level of cortisol in blood plasma was higher in the deceased patients on the third day (D3) (p = 0.05), D7 (p = 0.03); D13 (p = 0.05) and the last day of observation (p = 0.001), respectively. The level of ACTH in the blood of deceased patients was higher immediately on the day of ECMO initiation (D0) and on day 3 (D3) of observation: D0 (p = 0.018); D3 (p = 0.04), respectively. Analysis of the ROC curve showed that cortisol levels show a sensitivity of 71 % and a specificity of 89 % to an adverse outcome during ECMO. DISCUSSION. The life-saving ECMO technique, in critical conditions, is associated with a high risk of increasing of complications, including potentially lethal ones. Critical illness-related corticosteroid insufficiency (CIRCI) clinically manifests itself as inadequate adrenal activity, taking into account the augmentation of the disease severity. This activity is expressed in the form of a decrease in production and/or resistance to endogenous cortisol, as confirmed by the study. Consideration of CIRCI during the usage of ECMO reflects more objectively the violation of the pituitary-adrenal system. CONCLUSIONS. 1. CIRCI is detected in patients during ECMO. 2. High plasma cortisol levels are the predictor of an adverse outcome. 3. The level of ACTH in blood plasma is higher in patients with adverse outcomes. 4. High levels of cortisol in plasma are not a criterion for making the decision to initiate hydrocortisone therapy.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83526731","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":"A family-centered care for the professional activities of medical staff in pediatric ICU: a multicenter questionnaire study","authors":"V. V. Lazarev, K. Vartanova, E. Tarakanova, A. Klyuev, M. Kopytov, T. Zaguzova, I. Ryzhenenkova, G. Nasyrova, I. Samolina, I. D. Panov","doi":"10.21320/1818-474x-2022-4-74-82","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-74-82","url":null,"abstract":"INTRODUCTION: Medical staff limits often the presence of parents in ICU with their children, citing the fact that parents can bring serious difficulties to the work of the department. OBJECTIVE: To evaluate social and psycho-emotional aspects of joint stay of a family member (parents) with a patient (child) in ICU from the viewpoint of the medical stuff. MATERIALS AND METHODS: The study included hospitals, which followed the principles of a family centered care (FCC) approach in the treatment of patients (median and quartiles years - 4.00 (2.00; 10.00)). The 417 questionnaires were analyzed. The data were subjected to descriptive analysis. RESULTS: Respondents assessed the working conditions and the level of their wages not higher than satisfactory in more than 30 % of the answers. In the spectrum of assistance provided by family members to a patient in the ICU, the medical staff indicated 89 % and 91.5 % respectively sanitary and hygienic care, 82 % and 81.9 % - feeding him, 32 % and 47.1 % - assistance in transportation patient. The first level of preparation of parents for caring for a patient in the ICU was 3 (2; 3) - doctors and 3 (2; 3) - nurses, and when the patient was transferred from the ICU - 4 (3; 4) and 3 (3; 4) respectively. Claims in the opinion of the medical staff from patients and parents were due to their underestimation of the complexity of the situation with the patient (58 % and 48.6 %), the characteristics of patients (33 % and 36.3 %) and their parents (48 % and 39.8 %), insufficient awareness of the patient‘s health status (nurses - 23.2 %). CONCLUSIONS: The FCC in the ICU does not introduce significant psycho-emotional and labor loads in the professional activities of medical staff and creates positive conditions for increasing the level of knowledge and skills of parents in caring for their children.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"42 9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82861326","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":"Ultrasound-guided lung lesion index as a predictor of treatment outcomes: cohort study of 388 patients with coronavirus infection","authors":"R. E. Lakhin, E. A. Zhirnova, A. Shchegolev, I. Zheleznyak, I. Menkov, A. A. Chugunov","doi":"10.21320/1818-474x-2022-3-45-56","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-3-45-56","url":null,"abstract":"INTRODUCTION. Currently there are a lot of articles of lung ultrasound (LUS) in COVID-19 both in the diagnosis and in the prognosis of the disease. OBJECTIVE. Evaluation of the relationship between the ultrasound-guided lung lesion index (UIL) with the volume of lung involvement determined by computed tomography (CT) and disease outcomes in patients with COVID-19. MATERIALS AND METHODS. A prospective observational cohort clinical study included 388 patients aged 18-75 years; diagnosed with pneumonia with COVID-19 or suspected COVID-19. Lung ultrasound was performed according to the 16-zone “Russian Protocol” within 24 hours after CT scan of the chest organs. RESULTS. The median lung lesion volume on CT was 55 (35-74) % and UIL was 46 (28-60) points. UIL had a strong direct correlation of 0.873 (95 % CI 0.842-0.897, p < 0.01) with the change in the volume of lung involvement determined by CT and the inverse with the SpO2/FiO2 index - 0.850 (95 % CI 0.827-0.871, p < 0.01). Mortality was 56 patients (14.4 %) (p = 0.018). The optimal cut-off point for ROC analysis in predicting mortality was 55 points and had a sensitivity of 97.6 % and a specificity of 73.9 % with an area under the curve of 0.896 (95 % CI 0.861-0.931). Kaplan- Meier analysis on the entire data set (n = 388) demonstrated a survival rate of 97.6 % in the group with a UIL score less than 55 points and 62 % in the group with a UIL score more than 55 points. Differences between groups were statistically significant (Log Rank test p < 0.001; Breslow test p < 0.001). As a result, multivariate Cox regression analysis, using the stepwise exclusion method, only UIL remained a significant predictor of adverse outcome (p < 0.01). CONCLUSIONS. UIL determined by 16-zone “Russian protocol” correlated with severity of respiratory failure and volume of lung injury and was a predictor of adverse prognosis of disease outcome.","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":"87711542","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":"Features of energy and protein supply in patients with sepsis: a retrospective observational study","authors":"V. Luft, S. Shlyapnikov, A. Demko, A. V. Lapitsky, I. M. Batyrshin, G. Pichugina, P. Dubikaytis, A.I. Zolotukhin","doi":"10.21320/1818-474x-2022-4-101-110","DOIUrl":"https://doi.org/10.21320/1818-474x-2022-4-101-110","url":null,"abstract":"INTRODUCTION: Sepsis remains an actual problem of modern medicine. Among other treatment options, timely prescribed optimal nutritional-metabolic support is one of the priority methods of intensive treatment for this category of patients. OBJECTIVE: To study the severity of metabolic dysfunction in sepsis and determine the parameters of optimal substrate supply for this category of patients. MATERIALS AND METHODS: The study included 166 patients with sepsis. We studied the severity of systemic metabolic dysfunction and the impact of various options for energy and protein supply on the course of the disease and its outcome. Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic evaluation of indicators of indirect calorimetry, actual losses of nitrogen and nitrogen balance. RESULTS: Actual energy expenditure in sepsis reaches its maximum values by the 5-6th day of the disease (33.5 ± 1.8 kcal/kg/day or 2366 ± 126 kcal/day). The average energy consumption in sepsis is 2226 ± 96 kcal/day or 30.9 ± 1.4 kcal/kg/day. Energy supply in sepsis less than 25 kcal/kg/day leads to a significant increase in mortality. Protein losses in sepsis reach their maximum values by the 5-6th day of the disease (1.93 ± 0.12 g/kg/day). The average loss of protein in sepsis is 1.68 ± 0.06 g/kg/day. Protein provision of this category of patients with more than 1.5 g/kg/day contributes to a significant decrease in mortality, relative to patients receiving less protein per day. CONCLUSIONS: Energy supply in the range of 25-35 kcal/kg/day, as well as protein supply of more than 1.5 g/kg/day, significantly contribute to better survival of patients with sepsis.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86681053","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":"Nutritional support and rehabilitation in intensive care units for elderly and senile patients. Review","authors":"I. Pasechnik, A.I. Zakrevsky","doi":"10.21320/1818-474x-2021-2-94-102","DOIUrl":"https://doi.org/10.21320/1818-474x-2021-2-94-102","url":null,"abstract":"","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79869544","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":"Criminal cases against doctors - anesthesiologists-reseanimators under articles: 109, 118, 238, 290, 293 of the criminal code of the Russian Federation: observational study","authors":"V. Gorbachev, E. Netesin, V. I. Gorbacheva, S. Sumin, N. Utkin","doi":"10.21320/1818-474x-2021-3-80-87","DOIUrl":"https://doi.org/10.21320/1818-474x-2021-3-80-87","url":null,"abstract":"","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81316248","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":"Possibilities of transesophageal echocardiography for assessing the volemic status of patients during direct myocardial revascularization operations on the beating heart: a review","authors":"O.A. Batigyan, E. Lebedeva, D. Martynov","doi":"10.21320/1818-474x-2021-4-88-97","DOIUrl":"https://doi.org/10.21320/1818-474x-2021-4-88-97","url":null,"abstract":"Introduction. Uncertainty about approaches to optimizing monitoring and tactics of hemodynamic correction today directly affects the effectiveness of interventions. This problem is especially pronounced in the case of patients with high cardiac risk, as well as in the case of rapidly developing intraoperative hemodynamic disorders, which are a specific feature of some cardiac surgical interventions, such as myocardial revascularization operations on a beating heart. In such a situation, the key factor for the success of the operation is the coordination of the work of the surgeon and the anesthesiologist. Objectives. To determine the main approaches to monitoring and assessing the volemic status of a patient during direct myocardial revascularization operations on a working heart and to evaluate the possibility of transesophageal echocardiography as such a monitoring tool. Materials and methods. The search was carried out in the electronic databases PubMed, Scopus, Web of Science Core Collection; the analysis was carried out based on works published in the period from 2001 to 2021. Results. The resulting material, which includes validated peer-reviewed studies, randomized clinical trials, major systematic reviews and meta-analyzes, provides an overview of global experience in optimizing fluid loading and its characteristics in cardiac surgery patients. According to the analyzed data, there is no consensus among specialists on the above issues, and many important factors remain outside the framework of everyday clinical practice. For high-quality interaction, a combination of highly informative monitoring and proven tactics of conducting perioperative infusion therapy in response to the dynamically changing condition of the patient is required. Conclusions. To develop unified criteria for hemodynamic correction in each individual situation, it is necessary to assess the volemic status in patients who undergo myocardial revascularization on a beating heart in real time. In this vein, transpesophageal echocardiography is presented by the authors as the tool of choice for optimizing monitoring during off-pump coronary artery bypass graft surgery.","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78958595","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":"Some features of intraoperative infusion-transfusion therapy when performing cytoreductive operations with the use of hyperthermic intraperitoneal chemotherapy in patients with ovarian cancer: retrospective cohort study","authors":"D. Morikov, A. Shelekhov, V. Gorbachev, V. Dvornichenko, A. Pavlov, S. Radostev","doi":"10.21320/1818-474x-2021-3-126-132","DOIUrl":"https://doi.org/10.21320/1818-474x-2021-3-126-132","url":null,"abstract":"","PeriodicalId":93261,"journal":{"name":"Annals of pulmonary and critical care medicine","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76321311","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}