Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Nov 2004
Clinical Trial Controlled Clinical Trial[Kinetic therapy for acute respiratory distress syndrome].
The authors evaluated the clinical and physiological effects of kinetic therapy (KT) in the treatment of acute respiratory distress syndrome (ARDS). Forty-six patients with ARDS underwent successive postural positioning in accordance with two regimens: 1) lateral, prone, contralateral, supine positions; 2) prone, lateral, contralateral, supine positions. The criterion for changing each position was the change in monitoring indices: SpO2, PaO2, and thoracopulmonary compliance (C). ⋯ KT regimen 1 was found to be more effective than KT regimen 2. Propofol sedation enhanced the efficiency of KT. The latter reduced death rates in patients with ARDS.
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Anesteziol Reanimatol · Nov 2004
Comparative Study[Choice of the parameters of artificial ventilation in patients with acute respiratory distress syndrome].
The paper presents the results of use of two modes of controlled artificial ventilation (ALV) in adult patients with acute respiratory distress syndrome of various genesis: 1) ALV with its controlled volume, the descending pattern of inspiratory flow, the limitation of respiratory volume in the airways (RV, 6-8 ml/kg; Ptr.peak < 30 cm H2O), 2) ALV with its controlled volume, the orthogonal pattern of inspiratory flow (RV, 12-15 ml/kg, Ptr.peak > 35 cm H2O). It also shows the advantages and disadvantages of these respiratory procedures in this group of patients.
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Anesteziol Reanimatol · Nov 2004
Comparative Study[Lesions of the vascular endothelium and impairments of haemostatic coagulation in patients with severe craniocerebral trauma].
Malfunctions of central hemostasis chains, activation of blood coagulation systems and decreased antithrombogenic potentials of vascular walls are typical of craniocerebral trauma at exacerbation. It provokes the onset of the DIC-syndrome in 98.8% of examinees; the below signs are observed in such condition: decreased platelet resistance of vascular walls, increased aggregation activity of platelets, activated coagulation chain of hemostasis and increased blood viscosity. The prognostically unfavorable criteria of coagulopathy in acute craniocerebral trauma are as follows: pathological response of the vascular wall to transitory ischemia observed concurrently with a reduced dynamic FW activity; a persistently low and/or decreased dynamic AT-III activity; decreased fibrinolytic activities of plasma and platelet counts; and persistently higher concentrations and/or higher dynamic concentrations of fibrinogen and soluble fibrin mono-measured complexes (according to coagulation tests). Hemostasis should be corrected with respect to the above hemostasiologic syndromes.
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Anesteziol Reanimatol · Nov 2004
Comparative Study[The specific features of lipid metabolism and changes in the plasma activity of transaminases in patients with sepsis].
A parallel study of changes in the activity of transaminases and the parameters of lipid metabolism was conducted in patients with sepsis or septic shock, receiving renal replacement therapy. The multiple baseline increase in the activity of gamma-glutamyltranspeptidase was observed in about 50% of the patients and the elevated level of triglycerides and very low density-lipoprotein cholesterol in all the examinees. ⋯ In the absence of the baseline multiple increased activity of gamma-glutamyltranspeptidase, there was a good clinical outcome provided that there were positive changes in triglycerides and very low-density lipoprotein cholesterol during therapy and its probability was about 33%. It is concluded that the activity of gamma-glutamyltranspeptidase and the concentration of triglycerides and very low-density lipoprotein cholesterol may be used to evaluate the efficiency of treatment and as predictors of the outcome of treatment in patients with sepsis and septic shock.