Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.
Purpose of the study: a comparative assessment of safety and quality of respiratory support carried out using the ASV mode vs. conventional protocol, in which ventilation parameters are set by an ICU physician during early postoperative period in cardiosurgical patients.Materials and methods. The modes of a respiratory support included automated ASV ventilation (40 patients) versus conventional ventilation (38 patients) managed by 8 ICU physicians were compared in a cohort of cardiosurgical patients in a randomized controlled study.The comparison included ventilation parameters, all efforts of physicians to adjust ventilator settings and time it took, duration of respiratory support in ICU, incidence of adverse events in the course of weaning, total time in ICU and hospital, postoperative complications and mortality.Results. There was no reliable difference in the duration of postoperative trachea intubation, which was equal to 267±76 minutes (the ASV group) and 271±80 minutes (the control group).The number of manual adjustments, which was 2 vs. 4 (P<0.00001), and the time spent by a clinical physician near a ventilator, which was 99±35 seconds vs. 166±70 seconds, were reliably lower in the ASV group (P=0.00001).The time between restoration of patient’s own respiratory activity and transfer to the assisted breathing mode was longer in the control group and amounted to 30 (0–90) min. while in the smart mode, the transfer took place immediately after restoration (P=0.004969).When ASV was used, the driving pressure was reliably lower during all phases of respiratory support: ΔP 7.2±1.6 vs. 9.3±2.1 cm H2O, (P=0.000001); there was no reliable difference in the tidal volume: 7.0 (6–8.5) (ASV) vs. 7 (6–10) ml/kg/ideal body mass (the control group).Conclusion. ASV represents a lung-protective ventilation that reduces physician’s time cost and medical staff efforts in ALV management without compromising patient’s safety and respiratory support quality.
Simdax 2.5 mg/ml concentrate for solution for infusion. 2. Qualitative aNd QuaNtitative ComPoSitioN Each ml of concentrate contains 2.5 mg of levosimendan. One 5 ml vial contains 12.5 mg of levosimendan. One 10 ml vial contains 25 mg of levosimendan. For a full list of excipients, see section 6.1.
The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was February 01, 2021. To develop the recommendations for the Guidelines, were used documents directly describing the features of the management of patients with NCI COVID-19 (guidelines - 34; randomized clinical trials and Cochrane Reviews - 13; observational and comparative studies - 107; other documents, notes and comments - 64), and documents describing anesthesia and intensive care in the general population of patients. Compared to the previous 4th version of the guidelines, the recommendations in 8 sections have been corrected; new subsections “Chronic kidney disease”, “Rehabilitation treatment of patients with COVID-19 in the intensive care unit”, “Routing of patients with COVID-19 to the stages of rehabilitation” were created; revised 1 Appendix, additionally developed 7 Appendices; the section “Quality criteria” has been supplemented. The provisions of the current version of the guidelines highlight the specifics of anesthesia, intensive care, rehabilitation, resuscitation measures, manipulation, transportation, prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis, drug interactions are described. The features of management of pregnant women, children of different age groups, patients with concomitant diseases, the principles of the formation of stocks of drugs and consumables are considered.
The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was June 29, 2020. To develop the Guidelines for the recommendations, were used documents that directly describing the features of the management of patients with coronavirus disease COVID-19 (guidelines and guidelines - 16; randomized clinical trials and Cochrane Reviews - 8; observational and comparative studies - 77; other documents, notes and comments - 54) and describing anesthetic and resuscitation support in the general population of patients. The provisions of the recommendations highlight the specifics of anesthesia, intensive care, resuscitation, manipulation, and prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis are described. The features of the management of pregnant women, children of different age, patients with concomitant diseases, issues of transportation of patients are considered.
Цель исследования-оценка частоты развития, причин, структуры и исходов острой дыхательной недостаточности (ОДН) у больных после операций на сердце и аорте. Материал и методы. Ретроспективное исследование проведено среди 3972 пациентов после плановых кардиохирургических операций, выполненных в РНЦХ им. акад. Б.В. Петровского в 2013-2017 гг. Критерии включения: устойчивое снижение оксигенирующей функции легких (РаO 2 /FiO 2 <300 мм рт.ст.) в послеоперационном периоде, требующее проведения искусственной вентиляции или неинвазивной масочной вентиляции легких в течение не менее 1 суток. Результаты. ОДН развилась в 138 (3,5%) случаях. Наиболее часто она наблюдалась при операциях на аорте-57 (11,2%) из 508 больных. При остальных операциях частота ОДН колебалась от 1 до 3,5%. Операции аортокоронарного шунтирования без искусственного кровообращения сопровождаются меньшей частотой ОДН, чем с искусственным кровообращением-1,6% против 3,5% (р=0,0469). В структуре ОДН первое место занимает острый респираторный дистресс-синдром (ОРДС)-37 (26,8%) больных. Вторичную ОДН на фоне неврологических осложнений наблюдали у 25 (18,1%) больных. Обострение хронической обструктивной болезни легких и бронхиальной астмы зарегистрировано у 23 (16,1%) пациентов, парез диафрагмы-у 15 (11,7%). У 15 (10,8%) пациентов ОДН вызвала пневмония, у 12 (8,7%)-застой в малом круге кровообращения, у 10 (7,2%)-травма легкого и гемоторакс. Общая летальность при ОРДС составила 21,6%. При ОДН легкой и средней степени умерли 15,1%, тяжелой-75% больных. Среди больных с ОДН внутрибольничная пневмония отмечена в 40,6%, летальных исходов от этого осложнения не было. Выводы. ОДН наблюдали у 3,5% кардиохирургических больных (летальность 9,4%), наиболее часто при операциях на грудном и торакоабдоминальном отделе аорты. Ведущей причиной смерти являлся ОРДС, летальность при легкой и средней степени cоставила 15,1%, при тяжелой-75%. Внутрибольничная пневмония диагностирована у 1,4% кардиохирургических больных, к летальным исходам она не приводила. Ключевые слова: острая дыхательная недостаточность, кардиохирургия, острый респираторный дистресс-синдром.
Postoperative complications in cardiovascular surgery remain an important unresolved problem, in particular in patients with aortic aneurysm. The role of the altered microbiota in such patients is of great interest. The aim of this pilot study was to determine whether the development of postoperative complications in patients with aortic aneurysm is related with initial or acquired disorders of microbiota metabolism by monitoring the level of some aromatic microbial metabolites (AMMs) circulating in the blood before the surgery and in the early postoperative period. The study comprised patients with aortic aneurysm (n = 79), including patients without complications (n = 36) and patients with all types of complications (n = 43). The serum samples from the patients were collected before and 6 h after the end of the surgery. The most significant results were obtained for the sum of three sepsis-associated AMMs. This level was higher before the surgery in comparison with that of healthy volunteers (n = 48), p < 0.001, and it was also higher in the early postoperative period in patients with all types of complications compared to those without complications, p = 0.001; the area under the ROC curve, the cut-off value, and the odds ratio were 0.7; 2.9 µmol/L, and 5.5, respectively. Impaired microbiota metabolism is important in the development of complications after complex reconstructive aortic surgery, which is the basis for the search for a new prevention strategy.
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