RESUMEN
UNLABELLED: Optimization of respiratory support and prevention of ventilator-associate lung injure are the most important problems of neonatal resuscitation and intensive care. THE AIM OF THE STUDY: To improve the results of intensive care for respiratory failure in preterm infants by optimizing respiratory support on the basis of the analysis of the biomechanical characteristics of the lungs and blood gas. MATERIALS AND METHODS: The study included 138 infants with birth weight 1500g (1300-1740g) and a gestational age of 30.5 (29-32) weeks in need of mechanical ventilation. Apgar score at one minute was equal to 5.0 (4.0-6.0) points, and the fifth--7.0 (6.0-7.0) points. Biomechanical properties of light investigated the dynamic lung compliance, aerodynamic upper airway resistance, the coefficient of hyperextension, the time constant and the coefficient of RVR, reflecting the patient's spontaneous breathing pattern were evaluated. RESULTS: It was found that the most significant biomechanical characteristics of lungs, reflecting the severity of the respiratory failure are the dynamic compliance, aerodynamic airway resistance, coefficient C20/C, and the time constant. Correlation between the index of oxygenation, clinical assessment of the severity of respiratory failure and the duration of control mechanical ventilation was demonstrated. CONCLUSION: Rate of hyperextension and time constant are expressed by the correlation with the level of the oxygenation index, which allows them to be used for screening evaluation of severity critically ill patients during admission to the neonatal intensive care unit.
Asunto(s)
Pulmón/fisiopatología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Índice de Severidad de la Enfermedad , Puntaje de Apgar , Análisis de los Gases de la Sangre , Femenino , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Masculino , Oxígeno/sangre , Respiración Artificial/efectos adversos , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/sangre , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Factores de TiempoRESUMEN
Some features of temperature homeostasis regulation during the intraoperative period and methods of its correction with a balanced fluid therapy are described. The possibility of using infusion of antihypoxants and amino acid solutions to maintain optimum body temperature during the perioperative period is considered. The study was performed on a group of 107 children of various age, which underwent a surgery of thoracic or abdominal cavity. All operations were performed with total intravenous anesthesia and artificial pulmonary ventilation. In order to correct intraoperative hypothermia, sodium chloride 0.9% solution, mafusol, infezol-40, and reamberin were used. Results showed that reamberin produced a significant positive effect on the indices of peripheral body temperature. This allows reamberin to be recommended for widespread use in clinical practice in order to prevent and eliminate intraoperative hypothermia.
Asunto(s)
Regulación de la Temperatura Corporal/fisiología , Fluidoterapia/métodos , Hipotermia/prevención & control , Complicaciones Intraoperatorias/prevención & control , Meglumina/análogos & derivados , Succinatos/uso terapéutico , Abdomen/cirugía , Adolescente , Anestesia General , Anestesia Intravenosa , Niño , Preescolar , Femenino , Humanos , Lactante , Cuidados Intraoperatorios , Periodo Intraoperatorio , Masculino , Meglumina/uso terapéuticoRESUMEN
The research is devoted to the assessment of the impact of the method of anesthesia on the psychoneurological status of a newborn during surgical delivery. It is revealed that subarachnoid anesthesia does not adversely affect the central nervous system of a newborn and is one of the best options for anesthetic management during surgical delivery because it provides a sufficient level of analgesia and is of a greatest safety for mother and child.
Asunto(s)
Enfermedades del Prematuro/terapia , Cuidado Intensivo Neonatal/métodos , Respiración con Presión Positiva/métodos , Alveolos Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/fisiopatología , Masculino , Alveolos Pulmonares/fisiopatología , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Resultado del TratamientoRESUMEN
The publication is devoted to the case of the successful application of alveolus mobilization maneuver in infants with respiratory distress syndrome and demonstrates the high clinical efficacy of this method of respiratory support, not only during expressed hypoxemia, but also during hypercapnic respiratory failure.
Asunto(s)
Anestesia Intravenosa/métodos , Anestesia Obstétrica/métodos , Anestesia Raquidea/métodos , Cesárea , Sistema Nervioso/efectos de los fármacos , Adaptación Fisiológica/fisiología , Adulto , Anestesia Intravenosa/efectos adversos , Anestesia Obstétrica/efectos adversos , Anestesia Raquidea/efectos adversos , Puntaje de Apgar , Glucemia/análisis , Femenino , Sangre Fetal/química , Edad Gestacional , Humanos , Hidrocortisona/sangre , Recién Nacido , Sistema Nervioso/crecimiento & desarrollo , Examen Neurológico , Pruebas Neuropsicológicas , Embarazo , Estrés Psicológico/sangre , Estrés Psicológico/etiología , Factores de TiempoRESUMEN
A prospective randomized study was conducted to evaluate the efficiency of two intravenous anesthesia modes in children during traumatological operations. Anesthesia induction and maintenance were carried out via intravenous injection of ketamine (2 mg/kg/hr) and propofol (4 mg/kg/hr) in Group 1 children and via that of propofol (4 mg/kg/ hr) and fentanyl (3 microg/kg/hr) in Group 2. The mean duration of operations was 43.6 +/- 27.8 and 29.6 +/- 17.8 min in Groups 1 and 2, respectively. No complications were observed in Group 1; short-term apnea was seen in 2 (7.6%) children during initial anesthesia in Group 2. The children of this group were also found to have lower respiration rate. Both drug combinations were ascertained to provide a sufficient anesthesia depth in non-intubated, spontaneously breathing children, but the use of a combination of propofol + ketamine (Group 1) produced no negative impact on hemodynamics and external respiration parameters, which allowed this combination to be recommended for short-term surgical interventions.
Asunto(s)
Anestesia Intravenosa/métodos , Anestésicos Intravenosos/uso terapéutico , Fentanilo/uso terapéutico , Ketamina/uso terapéutico , Propofol/uso terapéutico , Heridas y Lesiones/cirugía , Adolescente , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/efectos adversos , Niño , Preescolar , Quimioterapia Combinada , Femenino , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Intubación Intratraqueal , Ketamina/administración & dosificación , Ketamina/efectos adversos , Masculino , Monitoreo Intraoperatorio , Procedimientos Ortopédicos/métodos , Propofol/administración & dosificación , Propofol/efectos adversos , Estudios Prospectivos , Respiración/efectos de los fármacos , Factores de Tiempo , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
The fetal inflammatory response syndrome (FIRS) is one of the causes of multiple organ dysfunction (MOD) in critically ill newborn infants. The paper shows a role of interleukin-8 (IL-8) in the development of FIRS and MOD in neonates a correlation between the concentration of IL-8 and the number of organs involved in the pathological process and demonstrates the leading role of endothelial dysfunction in the pathogenesis of the pathological processes concerned.
Asunto(s)
Interleucina-8/sangre , Insuficiencia Multiorgánica/sangre , Complicaciones del Embarazo/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/embriología , Biomarcadores/sangre , Endotelio Vascular/inmunología , Femenino , Sangre Fetal/inmunología , Edad Gestacional , Humanos , Recién Nacido , Insuficiencia Multiorgánica/embriología , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/inmunología , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/inmunologíaRESUMEN
The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 regional centers in Europe, Central and South America, Africa, and Asia, which are organized in 2006-2007 in Saint Petersburg by the Association and Society of Anesthesiologists and all the Anesthesiology Departments of the city are given. Today's geography of FEEA, dedicated to ESA diploma (DESA) exam training, is expanding in Russia.
Asunto(s)
Anestesiología/educación , Sociedades Médicas , Europa (Continente) , Federación de RusiaRESUMEN
Different monitoring modes are used to estimate the depth of anesthesia. Electroencephalography (EEG) is employed as a method of an electrophysiological study of brain function both during anesthesia and at the neuroresuscitative stage and changes in the peripheral vascular bed are evaluated by means of the perfusion index (PI). The purpose of the study was to comparatively analyze the use of EEG readings and PI at different stages of surgery and in coma of various etiologies. Thirty female patients aged 30-70 years (Group 1) operated on under general anesthesia were examined. Group 2 consisted of 14 intensive care unit patients of both sexes and different ages (range, 3 to 60 years) who had depressed consciousness to the comatose level. The association established between the changes in EEG reading and PI in the perioperative period allows estimation of the depth and adequacy of anesthesia, by analyzing the changes in both EEG and PI. Unlike central hemodynamic parameters, PI shows an earlier response to nociception. Group 2 patients had also synchronous changes in EEG and PI characteristics in various clinical conditions.
Asunto(s)
Anestesia General , Coma/fisiopatología , Electroencefalografía , Monitoreo Intraoperatorio/métodos , Oximetría , Atención Perioperativa/métodos , Adulto , Anciano , Coma/etiología , Coma/psicología , Femenino , Humanos , Persona de Mediana Edad , FotopletismografíaRESUMEN
The aim of this study was to estimate the validity of pediatric severity rating scales at general pediatric intensive care units. This was a prospective, observational multicenter study that was performed from November 1, 2007, to January 31, 2008. The end points were the estimation of the severity of disease, by using the PRISM, PIM II, RELOD scores, and 28-day survival. The investigation covered 226 patients whose mean age was 4.1 +/- 0.3 years. Twelve (5.3%) patients died during the study. The Medcalc computer program was employed for statistical analysis. The area under the receiver operating curve (ROC) was 0.623 +/- 0.116 for PRISM (p = 0.289); 0641 +/- 0.116 for PELOD (p = 0.224); 0.833 +/- 0.096 for PIM II (p < 0.001). The calibration of scores according to the intervals of mortality risk (Hosmer-Lemeshov test) showed that the observed and predicted mortality rates were similar for PIM II scores (chi2 = 8.23; p = 0.084) and were different for PRISM scores (chi2 = 203.5; p < 0.001) and PELOD ones (chi2 = 26.16; p < 0.001). Thus, the PIM II scores showed the best validity. PRISM and PELOD can be used to estimate the severity of disease in individual subgroups of high mortality-risk patients.
Asunto(s)
Unidades de Cuidado Intensivo Pediátrico/normas , Índice de Severidad de la Enfermedad , Adolescente , Niño , Mortalidad del Niño/tendencias , Preescolar , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Lactante , Mortalidad Infantil/tendencias , Masculino , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Federación de Rusia , Estudios de Validación como AsuntoRESUMEN
The paper describes the major tasks, functions, and structure of intensive care consulting centers (ICCC), gives the variables characterizing the activities of ICCC, analyzes their impact on infantile mortality rates in a large region, by using the Leningrad Region as an example, and shows it necessary to set up an ICCC in all regions of the Russian Federation.
Asunto(s)
Mortalidad Infantil/tendencias , Unidades de Cuidado Intensivo Neonatal/normas , Cuidado Intensivo Neonatal/métodos , Derivación y Consulta/normas , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/tendencias , Cuidado Intensivo Neonatal/organización & administración , Cuidado Intensivo Neonatal/normas , Cuidado Intensivo Neonatal/estadística & datos numéricos , Derivación y Consulta/organización & administración , Derivación y Consulta/estadística & datos numéricos , Derivación y Consulta/tendencias , Federación de Rusia/epidemiologíaRESUMEN
Postoperative pain is one of the most serious problems in patients who have undergone surgical interventions. The paper analyzes the efficiency of various postoperative analgesia regimens in children and shows the high efficiency of paracetamol as a component of combined anesthesia in the postoperative period.
Asunto(s)
Acetaminofén/uso terapéutico , Analgesia/métodos , Analgésicos no Narcóticos/uso terapéutico , Dolor Postoperatorio/prevención & control , Acetaminofén/administración & dosificación , Adolescente , Analgésicos no Narcóticos/administración & dosificación , Anestesia Epidural/métodos , Niño , Preescolar , Quimioterapia Combinada , Femenino , Humanos , Masculino , Dimensión del Dolor , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
Respiratory distress syndrome (RDS) is one of the principal causes of death in very and extremely low birth weight neonatal infants. Surfactant replacement therapy is the treatment of choice today. The paper analyzes the impact of different periods of Curosurf administration on the outcome of disease and shows it necessary to administer surfactants in this group of patient as soon as possible.
Asunto(s)
Recién Nacido de Bajo Peso , Enfermedades del Recién Nacido/prevención & control , Surfactantes Pulmonares/administración & dosificación , Esquema de Medicación , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo/crecimiento & desarrollo , Recién Nacido de Bajo Peso/crecimiento & desarrollo , Recién Nacido , Surfactantes Pulmonares/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
The present paper outlines the basic idea on multiple organ dysfunctions in the newborn. The major clinical manifestations of multiple organ dysfunctions (MOD) have been studied and are described. The basic systems most susceptible to MOD are determined, and the critical stages of neonality when the development of MOD is extremely high are identified.
Asunto(s)
Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Índice de Severidad de la Enfermedad , Femenino , Edad Gestacional , Humanos , Recién Nacido , MasculinoRESUMEN
The role of selenium in man is diverse. In particular, selenium is a cofactor of the major antioxidative enzyme glutathione peroxidase, which inhibits free radical oxidation reactions and restores the normal vital functions of cells and organs. This study deals with selenium metabolism in severe brain injury and its correction modes.
Asunto(s)
Antioxidantes/metabolismo , Traumatismos Craneocerebrales , Eritrocitos/metabolismo , Traumatismo Múltiple , Selenio , Niño , Traumatismos Craneocerebrales/sangre , Traumatismos Craneocerebrales/metabolismo , Traumatismos Craneocerebrales/orina , Femenino , Humanos , Cinética , Peroxidación de Lípido , Masculino , Traumatismo Múltiple/sangre , Traumatismo Múltiple/metabolismo , Traumatismo Múltiple/orina , Selenio/sangre , Selenio/metabolismo , Selenio/orina , Índice de Severidad de la EnfermedadRESUMEN
The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 centers being located in Europe, Central and South Americas, Africa, and Asia, are described in the article. The first FEEA seminars in Russia were organized in St. Petersburg in 2006-2007 by the Association and Society of Anesthesiologists and by all the anesthesiology departments of the city. Today's geography of FEEA seminars dedicated to European Society of Anesthesiology diploma exam training is expanding in Russia.
Asunto(s)
Anestesiología/educación , Sociedades Médicas , Europa (Continente) , Federación de RusiaRESUMEN
The agents containing succinic and fumaric acids were used to control body temperature during an operation. Elective surgical interventions into small pelvic organs were made in 22 females aged 28-55 years, who were divided into 2 groups. In group 1 (n = 11), the agents containing succinic and fumaric acids were used and infusion therapy that did not differ from Group 2 (n = 11) in all other respects. The level of metabolism, temperature in the rectum and big toe, and other parameters were estimated. Administration of the drugs containing carboxylic acids of the Krebs cycle was shown to lead to the activatization of metabolism, the maintenance of core temperature, by increasing peripheral body temperature at surgery.
Asunto(s)
Regulación de la Temperatura Corporal/efectos de los fármacos , Fumaratos/administración & dosificación , Hipotermia/prevención & control , Cuidados Intraoperatorios/métodos , Ácido Succínico/administración & dosificación , Adulto , Femenino , Humanos , Persona de Mediana Edad , Pelvis/cirugíaRESUMEN
Twenty-five full-term neonates with severe posthypoxic syndrome, including 9 (36%) with prior acute moderate asphyxia, 8 (32%) with acute asphyxia, and 8 (32%) with associated acute asphyxia, were examined. The severity of posthypoxia and the efficiency of its treatment were evaluated, by studying cerebral and systemic hemodynamics. In children with moderate and severe asphyxia, artificial ventilation contributed to normalization of acid-base balance and infusion of dopamine in a dose of up to 5 microg/kg x min could achieve adequate cardiac output. In children with associated severe asphyxia, infusion of dopamine in a dose of 5.5-10 microg/kg x min, which failed to improve cerebral perfusion pressure, was required to maintain the optimal cardiac output. This situation requires additional cerebral protective therapy aimed at lowering intracranial pressure.
Asunto(s)
Asfixia Neonatal/diagnóstico , Asfixia Neonatal/terapia , Circulación Cerebrovascular , Cuidados Críticos/métodos , Equilibrio Ácido-Base , Asfixia Neonatal/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Dopamina/uso terapéutico , Femenino , Humanos , Recién Nacido , Presión Intracraneal , Masculino , Respiración Artificial , SíndromeRESUMEN
Changes in the products of lipid peroxidation (LPO) and the antioxidative system (AOS) were studied in 94 children aged 3 to 15 years with severe brain injury (BI) on days 1, 3-5, and 7-10. The contents of dienic conjugates and malonic dialdehyde and the level of induced peroxide hemolysis and peroxide resistance of red blood cells in the plasma were determined. Children with severe BI were found to have activated LPO processes and decreased AOS activity, the most significant changes occurring within 24 hours of injury. The increased activity of peroxide processes was attended by reverse AOS changes. In children, the time course of changes in the parameters of LPO and AOS differs from that in adults since there is no phase of excessive LPO activation due to the exhaustion of AOS reserves.
Asunto(s)
Traumatismos Craneocerebrales/metabolismo , Radicales Libres/metabolismo , Niño , Traumatismos Craneocerebrales/sangre , Eritrocitos/metabolismo , Femenino , Hemólisis , Humanos , Peróxidos Lipídicos/sangre , Masculino , Factores de Tiempo , Índices de Gravedad del TraumaRESUMEN
The impact of spinal anesthesia on cardiac rhythm variability was studied in 36 children aged 13-17 years who had been operated on for urological, orthopedic, and vascular diseases. The findings were compared with the results obtained in 83 children with the same pathology at the age of 7-15 years, who had been operated under general anesthesia. A spectral cardiac sinus rhythm analysis demonstrated a steady state of stress-limiting systems during spinal block. Unlike general anesthesia, spinal anesthesia was ascertained to reduce the likelihood of intraoperative arrhythmias, by producing an adequate analgesic effect.