Purpose: evaluation of the clinical significance of parametric monitoring of the effectiveness of intensive care and rehabilitation based on the analysis of the functional state of the autonomous nervous system in patients with brain damage of different genesis.Materials and methods. The study included 66 patients on day 20—50 after the traumatic brain injury; anoxic damage; and stroke consequences. The isolation of clinical groups and subsequent analysis of clinical status is based on the analysis of the functional state of the autonomic nervous system based on the dynamics of the heart rate variability (HRV) parameters. Findings obtained in studies of 500 patients in the postoperative period with a 5-minute HRV were tested as normal and abnormal ANS parameters [1]. Parasympathetic hyperactivity was measured within the limits for SDNN (standard deviation of all normal-to-normal R-R intervals) > 41.5 ms; for rMSSD (root-meansquare of the successive normal sinus R-R interval difference) > 42.4 ms; for pNN50% (the percentage of interval differences in successive NN intervals greater than 50 ms (NN50) / total number of NN intervals) > 8.1%; for SI (Baevsky stress index, in normalized units) < 80 n. u.; for TP (total power of variance of all NN intervals) > 2000 ms2. Sympathetic hyperactivity was determined within the limits for following parameters: SDNN, < 4.54 ms; rMSSD, < 2.25 ms; pNN50%, < 0.109%; SI, > 900 n. u.; TP < 200 ms2. Normal HRV parameters were selected within the limits of the values for: SDNN [13.31-41.4ms]; rMSSD [5.78—42.3 ms]; pNN50% [0.110—8.1%]; SI [80—900 nu]; for TP [200—2000 ms2]. To verify the parasympathetic or sympathetic hyperactivity within these limits, 3 of 5 parameters were chosen [1].Results. Based on the dynamics of the HRV parameters before the intensive care and on days 30—60 of the intensive therapy and rehabilitation of patients with traumatic and non-traumatic brain injuries, 5 main clinical groups of patients were identified. Group 1 (n=27) consisted of patients with normal parameters of the ANS functional activity (both at the time of admission to the hospital and on the 30—60th day of the intensive therapy and rehabilitation). Group 2 (n=9) included patients with the baseline sympathetic hyperactivity of the ANS at admission to the intensive care unit and normal functional activity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 3 (n=8) included patients with baseline normal functional state of the ANS and the signs of sympathetic hyperactivity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 4 (n=15) consisted of patients with signs of sympathetic hyperactivity of the ANS both initially and on the 30—60th day of the intensive care and rehabilitation. Group 5 (n=7) included patients with signs of parasympathetic hyperactivity of the ANS (according to the parameters of HRV) both at baseline, at admission to the intensive care unit, and on the 30—60th day of the intensive care and rehabilitation.Conclusion: The normalization of HRV parameters is accompanied by patients’ recovery from the vegetative state and coma to minimal consciousness or normal consciousness; the index of disability rate decreases, the social reintegration grows, according to the DRS scale (M. Rappaport, 1982); dependence on mechanical ventilation reduces, and the muscle tone normalizes.
In recent years, EEG spectral analysis has become increasingly popular due to the development of computer technologies. Among the methods of spectral analysis, various variants of the window Fourier transform are most often used, taking into account the non-stationary nature of the EEG signal. In this article, the spectral composition of the sleep EEG of 32 patients with impaired consciousness was studied using a discrete Fourier transform with Windows in the form of elongated spheroidal sequences. The classification of the received gipropischeprom patients with CHF on the dynamics of the spectral composition of the detected correlation characteristic changes in the spectral composition of sleep EEG with the level of consciousness and the etiology of the disease
AIM: To determine the possibility of using analgonociception monitoring (analgesia nociception index, ANI) to assess the need for postoperative analgesia in patients with prolonged impairment of consciousness. MATERIAL AND METHODS: This pilot prospective randomized study enrolled 34 consecutive patients with chronic impairment of consciousness (vegetative state/minimal state of consciousness) who underwent neurosurgical interventions. Randomization was made by the envelope method for the grouping of the patients: study group (SG, n=17), received anesthesia with intravenous paracetamol 1000 mg according to ANI in the postoperative period; control group (CG, n=17), without additional anesthesia in the postoperative period. Patients with arrhythmias were excluded. The groups are comparable in terms of the main clinical parameters (all parameters p 0.05). The ANI (MetroDoloris device, France) was recorded at 1, 4, 8, 12, and 24 h after surgery. The valuation was based on the revised scale for assessing pain in a coma, i.e., Nociception Coma ScaleRevised (NCS-R) [7], after 4, 12, and 24 h. RESULTS: An intragroup comparison of the changes in ANI during postoperative day 1 showed an adequate level of pain relief (60.1 [55.362.5]), whereas in the group without postoperative analgesia with paracetamol, by 4 h after the operation, ANI dropped to the lower limit (46.3 [40.251.9]). In an intergroup comparison in the first 8 h after surgery, ANI was significantly higher than in the group without anesthesia (p=0.04) and had values of 55, which indicates the absence of pronounced vegetative reactions indicating the presence of pain. From 12 oclock, the values are leveled out, not going beyond the limits of indicators of inadequate anesthesia (p=0.69). When assessing nociception on the NCR-R scale during the postoperative day in both groups, a tendency to the appearance of weak autonomic responses was observed (6 [5; 8] in SG and 6 [5; 7] in CS, respectively), which did not differ significantly. The presence of pain 4 h after surgery was confirmed by increased levels of cortisol and salivary alpha-amylase in patients without postoperative analgesia (p=0.03). CONCLUSION: No generally recognized and available evidence-based instrumental methods are available for the assessment of pain intensity in patients with chronic impairment of consciousness. There is no single position of the professional community on the need for postoperative analgesia in such patients. Further studies to evaluate the effectiveness of using the ANI Metro Doloris monitoring system with a significant number of observations will lead to the determination of adequate perioperative analgesia regimens in patients with various forms of prolonged impairment of consciousness.
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