Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial Multicenter Study[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].
The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial[Target-oriented infusion therapy in patients during myocardial revascularization].
The paper analyzes goal-oriented infusion therapy used during myocardial revascularization on the working heart. Forty-seven patients with coronary heart disease were examined. Group 1 (control) (n = 20) received standard infusion therapy (a combination of colloids and crystalloids (1:1) at a rate of 6-7 ml/kg/h, by being oriented to indices, such as heart rate, blood pressure, central venous pressure, and diuresis rate. ⋯ In this group, a volume load was done at the beginning of an operation until the maximum possible SV resulted from increased preload (global end-diastolic volume index). The goal of infusion therapy throughout the operation was to maintain these values of the latter index. Goal-oriented infusion therapy, the purpose of which was to determine and maintain the individual optimal values of preload, was found to minimize hemodynamic disorders at surgery and to reduce the frequency of use of cardiotonic agents and the duration of artificial ventilation.
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial[Thromboelastographic characteristics of different infusion therapy regimens in healthy bone marrow donors].
Infusion solutions are able to change the hemostatic system. Thromboelastography (TEG) is an integral technique to evaluate the hemostatic system. TEG was used to evaluate the effect of three infusion solutions (6% hydroxyexyethyl starch (HES) 200/0.5 - Hemohes; HES 130/0.4 - Voluven; modified gelatin solution - Gelofusin) on the hemostatic system in 36 bone marrow donors (healthy individuals). ⋯ Hemostatic changes were noted by the end of an operation in all groups; however, these were less pronounced when Voluven was administered. Thus, all colloid infusion solutions have varying effects on the hemostatic system, with a tendency toward both hypo- and hypercoagulation. According to TEG, HES 130/0.4 (Voluven) has a minimal effect on the hemostatic system.
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Anesteziol Reanimatol · Sep 2009
Comparative Study Clinical Trial[Experience in using normofundin and sterofundin solutions for the correction of hypernatremia].
The efficacy of Sterofundin, Normofundin, and physiological solutions in correcting hypernatremia and impaired acid-base balance was analyzed in patients with sellar region tumors. Twenty-one patients were enrolled in the study; three groups were formed. Physiological solution added by 4% of potassium chloride and 25% magnesium sulfate solution was used in Group 1 (n = 7). ⋯ The use of Normofundin is associated with a risk of a rapid and significant reduction in the level of sodium and that of physiological solution fails to correct hypernatremia. Metabolic alkalosis was typical for all the patients included into the study. Its effective correction was noted only when Sterofundin was used.
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Anesteziol Reanimatol · Sep 2009
Clinical Trial[Prospects for using hydroxyethyl starch in the complex of intensive care during interhospital transportation of critically ill patients with polytrauma].
The paper analyzes the results of a comparative study of different infusion therapy modalities in victims with polytrauma during transportation to a specialized traumatological center. A combination of crystalloids and dextrans was applied to a control group and hydroxyethyl starch (HES) 130/0.4 was used in a study group. The evaluation criteria were the maintenance of stable hemodynamic parameters during transportation; a negative effect on hemostatic parameters and a preventive effect against the development of multiple organ dysfunction during transportation. Infusion therapy using HES has an advantage by all the parameters estimated.