RESUMEN
The number of elderly and senile patients who are in need of surgical care delivery is growing steadily year over year. This category of patients is characterized by comorbidity, polypragmasy and high prevalence of geriatric syndromes including loss of autonomy, malnutrition and cognitive impairments that increase the risk of developing perioperative complications. Management of these patients at all stages requires a comprehensive multidisciplinary approach. Nevertheless, there is no uniform understanding of solution of this problem at present. Determination of consensus on certain issues using the Delphi method will allow to gather and unite expert opinions. In this regard, the working group formulated the main points of management of elderly and senile patients before, during and after surgical treatment and conducted a cross-sectional analysis of experts' opinions.
Asunto(s)
Evaluación Geriátrica , Humanos , Anciano , Evaluación Geriátrica/métodos , Consenso , Anciano Frágil , Técnica Delphi , Fragilidad/complicaciones , Femenino , Masculino , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Grupo de Atención al Paciente/organización & administración , Atención Perioperativa/métodos , Atención Perioperativa/normas , Estudios TransversalesRESUMEN
The problematic treatment of infections caused by multiple-resistant Klebsiella, especially in ICU, is the leading cause of prolonged hospitalization and high mortality rates. The use of antibiotics for the prevention of infections is considered unreasonable as it may contribute to the selection of resistant bacteria. In this regard, the development of drugs that will be effective in preventing infection during various invasive procedures is extremely necessary. We have shown that the developed innovative antibacterial compound fluorothiazinone (FT) that suppresses the formation of biofilms is effective in the prevention of a model pneumonia caused by a multi-resistant clinical K. pneumoniae isolate. Prophylactic use followed by treatment with FT in mice with acute pneumonia modulates the local innate immune response without suppressing protective properties in the early stages of infection, while contributing to a decrease in the bacterial load in the organs and preventing lethal pathological changes in the lungs at later stages of K. pneumoniae infection. Further development of such antivirulence drugs and their use will reduce morbidity and mortality in nosocomial infections, as well as reduce the number of antibiotics used.
Asunto(s)
Infecciones por Klebsiella , Neumonía , Ratones , Animales , Klebsiella pneumoniae , Neumonía/tratamiento farmacológico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Biopelículas , Pulmón , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiologíaRESUMEN
The article presents a review of the literature on the use of a fundamentally new technique for prevention and treatment of cerebral edema. A drug glibenclamide, which is used to treat type 2 diabetes mellitus, is able to reduce cerebral edema and neuronal damage as evidenced by the results of preclinical trials in rodents and the first results of drug application in patients. The article describes the mechanism of glibenclamide action and discusses the potential for its application.
Asunto(s)
Edema Encefálico/tratamiento farmacológico , Gliburida/uso terapéutico , Animales , Edema Encefálico/prevención & control , Ensayos Clínicos como Asunto , Evaluación Preclínica de Medicamentos , Gliburida/administración & dosificación , Humanos , Presión Intracraneal/efectos de los fármacos , Resultado del TratamientoRESUMEN
The work is devoted to the analysis of modern trends of process of cognition in neurointensive care. In particular, considered the emergence and development of the method of "evidence-based medicine" in the treatment of patients with diseases and injuries of the brain. Demonstrated the positive features of the method. However, the authors are focused on the limitations of evidence-based approach, the main of which are the lack of an individualized treatment plan and the paucity of information obtained from materials of randomized controlled trials. The authors propose to combine the "evidence" data and the "classical style" of treatment, which involves individual clinical judgment based on knowledge of the pathophysiology and pathomorphology, intelligent use of technology, retrospective analysis of the beneficial and adverse effects of certain methods, creation of a special data bank of "natural" course of events, the development of individual prognostic model. The authors believe that the use of standards is more appropriate during acute illness and trauma, and the classic style is better for chronic situation.
Asunto(s)
Lesiones Encefálicas/terapia , Cuidados Críticos/métodos , Medicina Basada en la Evidencia/métodos , Lesiones Encefálicas/diagnóstico , Cuidados Críticos/tendencias , Medicina Basada en la Evidencia/normas , Humanos , Medicina de Precisión/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: To perform a multifactorial analysis of the association of the development of complications in neurologic intensive care unit patients in the early (on days 1-3) postoperative period and with surgical conditions, mechanical ventilation parameters, and risk factors. SUBJECT AND METHODS: The results of multislice spiral computed tomography (MSCT) of the chest and brain were analyzed in 80 patients (34 men and 46 women; mean age, 52 +/- 13 years). RESULTS: In the study patient group, the incidence of pulmonary edema and pneumonia was not found to depend on the type of neurosurgical intervention and that of an inhaled anesthetic. There was a significant (p < 0.05) relationship of the development of pulmonary edema to anesthesia duration exceeding 6 hours and an increase in the risk of lung pathology in the presence of extrapulmonary complications in patients with high body mass index. CONCLUSION: Some pulmonary complications in neurosurgical patients are potentially preventable. Early postoperative chest MSCT in neurosurgical patients is essential to timely diagnose lung pathology.
Asunto(s)
Enfermedades Pulmonares , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias , Tomografía Computarizada Espiral/métodos , Adulto , Enfermedades del Sistema Nervioso Central/diagnóstico por imagen , Enfermedades del Sistema Nervioso Central/cirugía , Diagnóstico Precoz , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/prevención & control , Masculino , Persona de Mediana Edad , Moscú/epidemiología , Procedimientos Neuroquirúrgicos/métodos , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The report describes two patients with lateral amyotrophic sclerosis complicated by respiratory insufficiency. Instead of long-term hospitalization to ICU the patients were kept at home, where prolonged mechanical ventilation was applied to them: in the first case - through tracheostomy tube, in the second - through mask. The use of prolonged home mechanical ventilation therapy instead of long-term hospitalization to ICU is discussed.
Asunto(s)
Esclerosis Amiotrófica Lateral/terapia , Servicios de Atención de Salud a Domicilio , Respiración Artificial , Anciano , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Federación de RusiaRESUMEN
In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.
Asunto(s)
Ecocardiografía Transesofágica , Fluidoterapia/métodos , Hemodinámica/fisiología , Traumatismo Múltiple/terapia , Ultrasonografía Doppler , Enfermedad Aguda , Adolescente , Adulto , Anciano , Volumen Sanguíneo/fisiología , Determinación del Volumen Sanguíneo/instrumentación , Determinación del Volumen Sanguíneo/métodos , Soluciones Cristaloides , Femenino , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Hipovolemia/etiología , Hipovolemia/prevención & control , Soluciones Isotónicas/administración & dosificación , Tiempo de Internación , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/fisiopatología , Sustitutos del Plasma/administración & dosificación , Índices de Gravedad del Trauma , Resultado del Tratamiento , Adulto JovenRESUMEN
The paper describes two clinical cases of aortic rupture of traumatic and nontraumatic genesis, which was difficult to diagnose due to evident neurological symptoms. The analysis of these cases and the data available in the literature leads to the conclusion that aortic rupture is not a nosological entity with a known fatal outcome. Timely diagnosis based on widely practiced up-to-date ultrasound and radiological methods allows one to perform surgical or endovascular treatment in good time, by showing good long-term outcomes.
Asunto(s)
Rotura de la Aorta/diagnóstico , Rotura de la Aorta/cirugía , Errores Diagnósticos , Infarto del Miocardio/diagnóstico , Adulto , Rotura de la Aorta/etiología , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Cognición/fisiología , Enfermedad Crítica , Emociones/fisiología , Adaptación Psicológica , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Enfermedad Crítica/psicología , Enfermedad Crítica/terapia , Delirio/etiología , Delirio/psicología , Delirio/terapia , Humanos , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Estrés Psicológico/terapiaRESUMEN
Based on the international and Russian guidelines, the paper describes standards, recommendations and options developed on the principles of evidence-based medicine for severe brain injury. It also presents a spectrum of recognition, management, and differential treatment of victims with severe brain and skull injury.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/cirugía , Guías de Práctica Clínica como Asunto/normas , Primeros Auxilios , Humanos , Federación de RusiaRESUMEN
Brain injury is one of the main causes of death in 20-40-year-old persons. The main causes of fatal outcomes are progressive edema and cerebral ischemia. The strategic task of intensive care in patients with severe brain injury, who are critically ill, is to prevent and treat secondary ischemic brain damages. The major secondary damaging factors include arterial hypotension, hypoxemia, hyper- and hypocapnia, hypoosmolality, and hyperglycemia. This paper presents the advisable treatment protocol for patients with brain injury, which has been developed and used in a neurosurgical intensive care unit of the N. V, Sklifosofsky Research Institute of Emergency Care. The protocol is based on international guidelines and the authors' own studies. It outlines the basic lines of monitoring and intensive care in patients with severe brain injury.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/terapia , HumanosRESUMEN
An original method of impedancemetry designed by the authors and applied in 88 cases of cerebral edema caused by brain aneurysm rupture (n = 23), by acute hemorragic stroke of hypertensive type (n = 13) and craniocerebral injury (n = 52) is described. Diagnostic value of the method, its safety and convenience for clinical practice are demonstrated.
Asunto(s)
Edema Encefálico/diagnóstico , Electrodiagnóstico/métodos , Adolescente , Adulto , Anciano , Edema Encefálico/fisiopatología , Niño , Diagnóstico Diferencial , Impedancia Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , SeguridadRESUMEN
Acute erosive lesions of upper parts of gastrointestinal tract with bleeding aggravate severe burn trauma, postoperative period after extensive surgeries and is the often component of polyorganic insufficiency syndrome. Gastric secretion in patients with severe burn trauma and neurotrauma was studied. Decrease of gastric secretory function due to central paresis of gastrointestinal tract and reflux of bile into stomach was seen in majority of patients with neurotrauma and acute gastric ulcers. On the contrary, in patients with burn shock increase of acid-secretory function of stomach was revealed. Schemes of prophylaxis and treatment of acute ulcers were developed. They included antacid therapy (for patients with increased secretion), regulators of motor-evacuatory function of stomach and intestine (for patients with paresis), drugs increased regenerative properties of mucosa, early enteral nutrition with balanced mixtures. This treatment in combination with hemostatic therapy and cure of main disease permitted to reduce number of gastroduodenal bleedings and lethality in these patients.
Asunto(s)
Enfermedad Crítica , Hemorragia Gastrointestinal/etiología , Quemaduras/complicaciones , Traumatismos Craneocerebrales/complicaciones , Ácido Gástrico/metabolismo , Hemorragia Gastrointestinal/fisiopatología , Hemorragia Gastrointestinal/prevención & control , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/fisiopatología , Úlcera Péptica/etiología , Úlcera Péptica/fisiopatología , Úlcera Péptica/prevención & control , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/fisiopatología , Úlcera Péptica Hemorrágica/prevención & controlAsunto(s)
Edema Encefálico/prevención & control , Isquemia Encefálica/prevención & control , Traumatismos Craneocerebrales/terapia , Cuidados Críticos/métodos , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Barrera Hematoencefálica/efectos de los fármacos , Barrera Hematoencefálica/fisiopatología , Edema Encefálico/etiología , Edema Encefálico/fisiopatología , Isquemia Encefálica/etiología , Isquemia Encefálica/fisiopatología , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/fisiopatología , Descompresión Quirúrgica , Diuréticos Osmóticos/uso terapéutico , Humanos , Presión Intracraneal/efectos de los fármacos , Presión Intracraneal/fisiología , Monitoreo Fisiológico , Respiración Artificial , Simpatomiméticos/uso terapéutico , Índices de Gravedad del TraumaRESUMEN
A success in treatment of acute ulcerations of the upper parts of the gastrointestinal tract in patients with a severe neurosurgical pathology can be achieved only with a complex approach to treatment of the intensive care patients. The application of antiulcerous medicines in combination with pyrokinetics and medicines improving the regeneratory ability of the gastrointestinal tract mucosa allowed to considerably decrease risk of the development of gastroduodenal bleedings against the background of erosive-ulcerous lesion of the mucosa. The endoscopic methods of arresting bleedings in such patients in combination with the correction of homeostasis by infusions and local hemostatic therapy in most cases result in reliable hemostasis of the upper parts of the gastrointestinal tract. The program of active measures is completed with the early enteral feeding with balanced nutritional mixtures.
Asunto(s)
Sistema Digestivo/patología , Úlcera/terapia , Enfermedad Aguda , Adulto , Antiulcerosos/uso terapéutico , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Membrana Mucosa/patología , Úlcera/tratamiento farmacológicoRESUMEN
The potentialities of cerebral oximetry in the para-infrared band as a means of neuromonitoring are assessed. The method is highly informative for selecting the treatment strategy during the acute period of craniocerebral injury and cerebrovascular diseases. Simultaneous analysis of intracranial pressure, central hemodynamics, and cerebral oximetry permits differentiation of mechanisms of intracranial hypertension and its compensation. Increase of rSO2 in increased intracranial pressure corresponds to brain hyperemia, its decrease to cerebral ischemia. A long trend of rSO2 changes is informative for disease prediction.
Asunto(s)
Encéfalo/irrigación sanguínea , Procedimientos Neuroquirúrgicos , Oximetría/métodos , Resucitación , Adulto , Arterias , Humanos , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/métodos , Oximetría/instrumentación , Oxígeno/sangre , Transductores , VenasRESUMEN
The assessment of ECG in patients with nontraumatic subarachnoid hemorrhages demonstrated 5 characteristic patterns of ECG change. They were shown to be secondary to cerebral pathology. Preoperative heart rhythm changes are not stable or life-threatening, whereas intraoperative arrhythmias, high-grade ventricular extrasystoles in particular, may prove fatal. Preoperative ECG changes, including "pseudoinfarction" ones, do not affect cardiac output or arterial blood pressure, so that no special treatment is required, nor is surgery contraindicated.
Asunto(s)
Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/diagnóstico , Adulto , Electrocardiografía , Humanos , Aneurisma Intracraneal/cirugía , Cuidados Intraoperatorios , Masculino , Monitoreo Fisiológico , Rotura Espontánea , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/cirugíaRESUMEN
Study of the ECG and central hemodynamics and the results of mathematical analysis of the heart rhythm in patients with rupture of arterial aneurysms in the pre- and postoperative period showed that the values of cardiovascular activity are prognostic signs of the outcome of surgical and nonoperative treatment. Postponement of operation on patients with arterial hypertension for 1-3 days from the onset of the disease may be fatal. Correction of increased systolic pressure and high cardiac output after the operation is inadmissible because they are favourable responses of the organism to the operative trauma. Moderate activation of the sympathetic and parasympathetic nervous system on the eve of the operation has a favourable effect on its outcome.
Asunto(s)
Sistema Cardiovascular/fisiopatología , Aneurisma Intracraneal/fisiopatología , Hemorragia Subaracnoidea/fisiopatología , Adulto , Electrocardiografía , Femenino , Frecuencia Cardíaca , Hemodinámica , Humanos , Aneurisma Intracraneal/mortalidad , Aneurisma Intracraneal/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Hemorragia Subaracnoidea/mortalidad , Hemorragia Subaracnoidea/cirugía , Factores de TiempoRESUMEN
With ECG of the patients with arterial brain aneurysms ruptures analyzed in the pre- and postsurgical periods, 5 characteristic types of changes could be identified. Functional (secondary) nature of ECG changes was established and their dependence on the severity of the patients' state, aneurysm localization, disease duration, presence of angiospasm and intracranial hematoma were evidenced. The increase in the markedness of ECG disorders did not correspond to hemodynamic impairment. ECG changes are no contraindications for urgent surgery of the aneurysm. Nevertheless, distinct ECG changes were noted which could serve as prognostic criteria for the fatal outcome of the surgery.