Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Obj'ectives. To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. Materials and methods. A multicenter observational clinical study “REspiratory Therapy for Acute Stroke” (RETAS) was conducted under the aegis of the “Federation of Anaesthesiologists and Reanimatologists” (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. Results. We found that initial hypoxemia in the 28-day period was associated with high mortality (in patients with 20 or more NIH scores) (p = 0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension (in patients with 20 or more NIH scores) (p = 0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIH scores) (p < 0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (p < 0.001). We found that the use of standard respiratory status monitoring scales (CPIS, LIS, etc.) was associated with a decrease in mortality (p < 0.001). Conclusions. We identified risk factors that increase mortality in patients with acute stroke with respiratory support: initial hypoxemia, lack of instrumental monitoring of ICP and monitoring of respiratory status according to standard scales, the use of hyperventilation, as well as volume-controlled ventilation.
The article studies the issues of nutritional support and its optimization for various types of energy deficiency in surgical patients with acute pancreatitis. The author presented the results of his own study, which included patients with moderate and severe acute pancreatitis. Patients are divided according to the type of energy deficiency (enzymatic, hypoxic, substrate, hypermetabolic). An algorithm for differential diagnosis of energy deficiency types and associated nutritional support is presented. The author achieved an effective individualized nutritional support for patients with acute pancreatitis.
Медицинское научное сообщество постоянно ищет возможные пути успешного лечения новой коронавирусной инфекции COVID-19. По мере накопления опыта и знаний по данной проблеме Федерация анестезиологов и реаниматологов России регулярно обновляет рекомендации по анестезиолого-реанимационному обеспечению пациентов с новой коронавирусной инфекцией COVID-19. Текущая, 4-я, редакция, как и предыдущие, претерпела значительные изменения и дополнения. Важные уточнения внесены в разделы по респираторной терапии, лекарственной терапии, тромбопрофилактике, особенностям ведения пациентов с сопутствующими заболеваниями.
Background. Analysis of distribution of Full Outline of UnResponsiveness (FOUR) Scale provided by F. M. Wijdicks at the Mayo Clinic in 2005 served as the basis for the initiation of the Federation of anesthesiologists of Russia study “FOUR-Rus” (NCT04018989 ClinicalTrails.gov). Objectives. To assess reproducibility and consistency when using the Russian-language version of the FOUR scale. Materials and methods. 260 patients were selected, aged 37 to 90 years with acute head injury, including: I60 - 39 (15 %), I61 - 86 (33 %), I63 - 130 (51 %), I67 - 4 (0,15 %) patients. Center № 1/2 - 159/101 patients. Age - sex composition, level of sedation and pain in the groups did not differ. For examinations in the centers, 2 ICU physicians and 1 neurologist were selected. Reproducibility and interdisciplinary consistency were assessed in pairs with Cronbach's alpha (a) internal consistency. Statistical analysis was performed using IBM SPSS Statistics Subscription. Conclusions. There are no differences in consistency and reproducibility between FOUR and GSC in stroke patients when used by resuscitators and neurologists in non-specialized ICU. The FOUR scale has maximum reproducibility and wider possibilities for assessing the level of consciousness.
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