Nosocomial pneumonia (NP) -is a disease associat ed with a formation of new focal and infiltrative changes on the chest X ray 48 hrs after the hospitalization along with the clinical data confirming their infectious nature (fever, purulent sputum or purulent discharge from the tracheo bronchial tree, leukocytosis, etc.), excluding infections which were incubated on the admission [1].Nosocomial pneumonia -is the most prevalent intensive care unit infection. The high prevalence of NP is due to the widespread and irrational use of antibiotics and artificial pulmonary ventilation. The Russian National data confirm that NP incidence in surgical patients is 6% after elective surgery and 15% after emergency surgery. The inci dence of ventilator associated pneumonia is 22% after elec tive surgery in ventilation longer than 2 days and 34,5% after emergency abdominal surgery; up to 55% in acute res piratory distress syndrome. Every day in intensive care unit stay increases the risk of NP by 3%. Nosocomial pneu monia significantly deteriorates the course of any disease, increase the duration of intensive care unit stay by 4,3-6,1 days and mortality. The attributable mortality of NP is between 5,8 to 27% [2][3][4][5].The pathogenesis of NP in critically ill patients is based on an imbalance between the lung protective mecha nisms and microbial aggression. The lung can be infected either exogenously or endogenously. Aspiration of pharyn
Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.
Нозокомиальная пневмония -вторая по встречаемости нозокомиальная инфекция в отделениях реа-ниматологии и наиболее распространенная у пациентов на искусственной вентиляции легких (9-27%). Целью данного обзора литературы является обсуждение наиболее современной отечественной и зарубеж-ной доказательной базы по использованию ингаляционных антибиотиков в реаниматологии. Поиск отече-ственных публикаций (обзоры литературы, обсервационные исследования, двойные слепые рандомизиро-ванные исследования) проводился в базе данных elibrary.ru, зарубежных -в базе данных PubMed. за пе-риод 2005-2017 гг. Использовались следующие поисковые запросы: «ингаляционные антибиотики», «но-зокомиальная пневмония», «ингаляционный тобрамицин», «ингаляционный колистин», «inhaled antibiotics», «inhaled colistin», «inhaled tobramycin». В анализ включено 67 публикаций 2007-2017 гг., одна пуб-ликация 2000 года. В обзоре литературы представлены описания препаратов, современные возможности ингаляционной антибиотикотерапии нозокомиальной пневмонии, преимущества и недостатки данного метода лечения. Особое внимание уделено использованию ингаляционных аминогликозидов и ингаля-ционного колистина при нозокомиальной пневмонии в отделениях реаниматологии. Ключевые слова: нозокомиальная пневмония; ингаляционные антибиотики; аминогликозиды; тобрамицин; колистиNosocomial pneumonia is the second most common nosocomial infection in critical care units and most common in ALV patients (9-27%). The purpose of this literature review is to discuss the latest domestic and foreign body of evidence concerning the use of inhaled antibiotics в critical care. Search for domestic publications (literature reviews, observation studies, double blind randomized studies) was carried out in elibrary.ru database, for foreign -in PubMed. Database for the period of yrs. [2005][2006][2007][2008][2009][2010][2011][2012][2013][2014][2015][2016][2017]. The following search enquiries were used: «inhaled antibiotics», «nosocomial pneumonia», «inhaled tobramycin», «inhaled colistin». The analysis includes 67 publications of yrs. 2007-2017 and 1 publication of yr. 2000. The literature review includes drug descriptions, contemporary capabilities of inhaled antibiotic therapy for nosocomial pneumonia, the advantages and drawbacks of this method of treatment. Special attention is focused on the use of inhaled aminoglycosides and inhaled colistin during nosocomial pneumonia in critical care units. Keywords Адрес для корреспонденции:Артем Кузовлев E-mail: artem_kuzovlev@mail.ru Correspondence to:Artem Kuzovlev E-mail: artem_kuzovlev@mail.ru ВведениеНозокомиальная пневмония (НП), связанная с проведением искусственной вентиляции легких (ИВЛ), -пневмония, развившаяся не ранее чем через 48 ч от момента интубации трахеи и начала проведения ИВЛ при отсутствии признаков легоч- IntroductionNosocomial pneumonia (NP) related to mechanical lung ventilation (MLV) is a pneumonia that has developed not earlier than 48 hrs. after tracheal intubation and onset of MLV in the absence of lung infection signs at...
Neurotrophins are proteins that play an important role in the nervous system functioning by regulating cell proliferation, differentiation, processes of neuronal survival and death, and by participating in the mechanisms of neuronal plasticity. The brain-derived neurotrophic factor (BDNF) is one of the most well-described representatives of the neurotrophin family, which has received close attention over recent years. It is considered one of the key mediators of neuronal survival and recovery, and a drop of the BDNF level is considered a common mechanism underlying the development of various neurodegenerative diseases. The review discusses changes in BDNF levels in ischemic and traumatic brain damage, the prospects of its use in the clinical practice as a marker of brain dysfunction, as well as the possibility of its use for the treatment of post-ischemic encephalopathies.
Острыйреспираторный дистресс синдром (ОРДС) -частое осложнение критических состояний, обусловленное развитием некардиогенного отека лег ких в результате повреждения (дистрофия, некроз, апоптоз) эндотелия, альвеолярного эпителия, их ба зальных мембран (включая структуры аэрогематичес кого барьера) и повышения проницаемости сосудов ге момикроциркуляции при воздействии экзогенных или эндогенных факторов агрессии. С учетом общности этиологии, факторов риска и патогенеза острое по вреждение легких следует рассматривать как первую и обратимую стадию ОРДС [1-3].Acute respiratory distress syndrome (ARDS) is a prevalent complication of critical illness caused by a dam age (dystrophy, necrosis, apoptosis) of the vascular endothelium, alveolar epithelium and their basal mem branes (including structures of aerohematic barrier). This damage is caused by exogenous or endogenous factors and leads to an increase of vascular permeability and develop ment of noncardogenic pulmonary edema. Taking into account the similarity of etiology, risk factors and patho genesis, the acute lung injury is currently considered as a first and reversible stage of ARDS [1-3]. Редакционная статья посвящена разработке алгоритма диагностики и прогноза течения острого респираторного дистресс синдрома (ОРДС), основанного на использовании данных, полученных в НИИ общей реаниматологии им. В. А. Неговского в 2012-2014 гг. Представлены современные подходы к диагностике и лечению ОРДС. Приведены собственные данные и данные зарубежной литературы последних лет, свидетельствующие о потенциале количест венного определения сурфактатных белков SP A и SP D, продуцируемых клетками дыхательного эпителия, для раннего диагноза и прогноза течения ОРДС. Предложен новый алгоритм ранней диагностики и прогноза развития ОРДС, основанный на использовании поэтапного определения количественного содержания SP A и SP D в плазме больных при критических состояниях. Циркулирующие молекулы SP A и SP D рассматриваются в качестве кан дидатных биомаркеров, имеющих существенную ценность для создания мультипараметрической панели биомарке ров для диагноза и прогноза ОРДС как жизнеугрожающего критического состояния. Editorial dedicated to the development of the algorithm of diagnosis and prognosis of acute respiratory distress syndrome (ARDS), based on the use of recent data (2012-2014) from the V. A. Negovsky Institute of General reanimatology. Modern approaches to the diagnosis and treatment of ARDS are discussed. Available modern data including results of own recent investigation have clearly demonstrated the potential of quantifying surfactant proteins SP A and SP D, which pro duced by cells of the respiratory epithelium, for the early diagnosis and prognosis of ARDS. A new algorithm for diagnosis and prognosis of ARDS based on a sequential quantification of SP A and SP D molecules in the plasma of patients in crit ical conditions is suggested. Circulating SP A and SP D are considered as valuable candidate biomarkers for developing multiparametric panel of biomarkers for diagnosis and p...
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