[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)¼: a comparative analysis of the outcomes of stroke]. / Rossiiskoe mnogotsentrovoe observatsionnoe klinicheskoe issledovanie «Registr respiratornoi terapii u patsientov s ONMK (RETAS)¼: sravnitel'naya kharakteristika iskhodov insul'ta.

OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (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 higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

[Influence of chemosensional disorders on taste preferences in cancer patients who are receiving oral nutrition supplements].

Chemosensory disorders (CSD) such as disorders of taste and smell are one of the causes of malnutrition in cancer patients. The aim of the research was to evaluate the influence of CSD on taste preferences in cancer patients receiving oral nutritional supplements (ONS). Material and methods. The procedure involves 100 oncological patients (26 men, 74 women; 57.0±1.2 years old). The taste preferences in these patients were assessed using a digital rating scale during ONS. All patients had cancer outside the head and neck area and underwent specific treatment. The functional status on the ECOG scale was 0-II. All patients had indications for DPP (ESMO scale >2 points). Patients were offered a mixture of sweet (banana, coffee, vanilla) and unsweetened (vegetable, chicken soup) tastes in a disposable 30 ml container. The patient was asked to take a sip and evaluate the smell, taste, strength of taste and density (consistency) of the sample on a digital rating scale from 0 to 5 points, where 0 - I do not feel, 5 - I feel excellent. The maximum possible number of points for each sample was 20. Results. Signs of CSD (score <10) were detected in 69% of patients [95% confidence interval (CI) 59.5-77.7]. In this group, the frequency of choosing unsweetened tastes for ONS was 59.4% (95% CI 47.5-70.8), sweet - 40.6% (95% CI 29.2-52.5). In the group of patients without signs of CSD, the frequency of choosing savory tastes was 29.0% (95% CI 14.1-46.7), sweet - 71.0% (95% CI 53.3-85.9) (р=0.0049). Conclusion. The presence of CSD significantly affects the taste preferences of cancer patients and significantly increases the likelihood of choosing products for ONS with unsweetened taste (unsweetened foods).

[Cytoflavin as a modulator of rehabilitation treatment of patients with ischemic stroke complicated by post-intensive care syndrome]. / Tsitoflavin kak komponent reabilitatsionnogo lecheniya patsientov s ishemicheskim insul'tom, oslozhnennym PIT-sindromom.

OBJECTIVE: To assess an effect of cytoflavin on the results of rehabilitation treatment and the increase in exercise tolerance in patients with stroke complicated by post-intensive care syndrome (PICS). MATERIAL AND METHODS: The data of 53 patients who underwent neurorehabilitation in the ICU after ischemic stroke were analyzed. Depending on the treatment regimen, the patients were divided into two groups. Group 1 (main, n=36) received cytoflavin (iv drip in a volume of 10 ml of a solution for injections per 200 ml of a 0.9% solution of sodium chloride) for 10 days in addition to the complex of neurorehabilitation measures. Group 2 (control, n=17) included patients, who had only a standard set of neurorehabilitation measures for 10 days. The efficacy of the therapy was evaluated using indirect calorimetry, and the oxygen and energy load price index was calculated. To assess the tolerability of rehabilitation methods, a verticalization test was used. Treatment tolerance was assessed by the incidence of adverse reactions in each group. RESULTS AND CONCLUSION: The components of the energytropic effect of cytoflavin can have a positive modulating effect, increasing the tolerance of rehabilitation measures for the treatment of PICS in patients with ischemic stroke. Further research is required.

[Changes in lipid and carbohydrate metabolism in patients with severe sepsis of different etiology].

UNLABELLED: Different origin (heterogeneity) of sepsis is a key stone in many discussions regarding options for the course and outcome, despite the general rules of development of the pathogenic mechanisms. PURPOSE OF THE STUDY: To compare data of systemic inflammation (CRP, PCT, IL-8, IL-6, IL-4, TNF-alpha) and markers of endothelial dysfunction (NO, lactate, D-dimers), also lipid (cholesterol, triglycerides, HDL, LDL, VLDL) and carbohydrate metabolism between the two groups of patients with severe intra-abdominal infection (n = 109) and severe sepsis of other etiologies (n = 53). RESULTS: We found out a significant difference between the groups in serum levels of the CRP, IL-4 and cholesterol at all stages of the study. During severe abdominal sepsis was accompanied by a significantly higher level of cholesterol, LDL and VLDL, as well as higher values of glycaemia. Patients with sepsis other etiology showed a lighter and more dynamic course of the disease was significantly lower 28-day mortality.

[Effect of an original enteral feeding protocol on clinical outcome indicators in patients with acute cerebral damage of vascular and traumatic genesis].

The prospective randomized controlled study enrolled 58 patients diagnosed as having brain injury and hemorrhagic stroke. Enteral feeding was started within the first 24 hours after admission to an intensive care unit (ICU); a control group (n = 28) was given an isocalorie formula while a study group (n = 28) received a combination of a hypercalorie formula and a fiber-containing formula. In the study group, the intestine was stimulated with erythromycin within the first 3 days. Glasgow coma scale (GCS) and APACHE II scores, the degree of a systemic inflammatory response (SIR) and multiple organ failure (MOF), serum albumin and glucose levels, energy expenditure and balance, and nitrogen excretion and balance were estimated on day 10. Treatment results on day 30, length of ICU stay, AV duration, mortality, and use of blood preparations were compared. On study day 10, nitrogen and energy balances and the pattern of signs of SIR and MOF were significantly better and fresh frozen plasma and albumin solutions were used less in the study group than in the control one. There were differences in APACHE II and GCS scores, energy expenditure and nitrogen loss, plasma albumin and glucose concentrations, mortality, and volume of used packed red blood cells. The original enteric feeding protocol based on the use of dietary fiber-fortified hypercalorie diets in combination with the new method of gastric motility stimulation makes it possible to reduce the accumulation of deficiency of energy and plastic substrates, to alleviate the manifestations of SIR and MOF and to decrease the consumption of blood components and preparations.

[Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study].

Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. The results of individual studies serve as the basis for refusing the use of synthetic colloid agents in the therapy of severe sepsis. The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.

[Changes in lipid metabolic parameters in patients with severe sepsis].

The vital importance of systemic inflammatory reactions in developing a critical condition of any etiology is generally accepted at the present developmental stage of reanimatology and intensive care. The metabolic component remains a less studied part of a complex of the universal pathophysiological changes that characterize a critical condition. Lipid metabolic changes in sepsis are less investigated. Some publications indicate a role of fatty acids in regulating a systemic inflammatory reaction and in maintaining the balance of pro- and anti-inflammatory reactions in the development of a systemic inflammatory reaction. Others show their role in endothelial damage. The latter are of great interest due to the fact that lipolysis occurs just on the endothelium with the involvement of lipases. The purpose of this study was to reveal lipid metabolic changes and to define an association between the lipid metabolic parameters and the severity of a systemic inflammatory reaction in patients with severe sepsis, as well as their possible impact on the outcome of the critical condition.

[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.

[Dynamic metabolic monitoring as a basis of nutritional support in acute cerebral insufficiency of vascular genesis].

Within the framework of a prospective controlled study, the metabolic status was evaluated in 148 patients with stroke, by using the dynamic metabolic monitoring technique comprising the calculation of real daily calorie consumption, the assessment of the degree of hypermetabolism, protein hypercatabolism, nutritional disorders, and needs for nutrients, and the daily evaluation of nutritional support. As a result, the authors provide evidence that dynamic metabolic monitoring rapidly and adequately reflect changes in the degree of hypercatabolism and hypermetabolism in patients with lesions of the central nervous system and the structures responsible for regulation of metabolism and nutritional support in accordance with monitoring data makes it possible to enhance the efficiency of intensive care and to reduce the frequency of neurotrophic complications.

[Effect of various colloidal solutions on pulmonary oxygenizing function in patients with acute lung lesion].

The effects of 6% hydroxyethyl starch and 10% albumin solution on the parameters of central hemodynamics and pulmonary extravascular water were studied in acute lung lesion. The patients were divided into 2 groups that did not significantly differ by the baseline severity of a condition (APACHE II and Murray scales). Groups 1 and 2 patients were transfused 6% hydroxyethyl starch and 10% albumin solution, respectively. The "PICCO PLUS" system was used to determine the parameters of central hemodynamics, pulmonary extravascular water, and oxygenation before and after infusion of the test colloidal solutions. Unlike 10% albumin solution, 6% hydroxyethyl starch was found to significantly increase preload parameters, without deteriorating pulmonary oxygenizing function due to the accumulation of extravascular liquid.

[Nutritional support in critical conditions as intensive care technology].

The patients of intensive care units represent a group in which nutritional support methods, such as enteral and parenteral feeding, are most frequently used to correct protein and energy metabolisms. The purpose of this paper is to analyze the most significant clinical problems ensuing in nutritional support in an intensive care unit, such as the high incidence of hospital exhaustion, difficulties in metabolic monitoring and in the determination of patients' needs for nutrients, in the choice for media for intravenous and enteral feeding, in the prevention of possible complications of nutritional support; organizational aspects.

[Approaches to nutrition of patients with severe thermal trauma]. / Podkhody k pitaniiu bol'nykh s tiazheloi termicheskoi travmoi.

Basic principles of feeding of the patients (adult and children) with a serious thermal trauma, which cause considerable disturbances of a homeostasis of organism: hypermetabolic inverse of a metabolism, decrease of immune resistance, losses of water and electrolytes masses. Early use of quality and valuable nutrition for such patients (under observation was 56 patient--adult and children of different age) is a method of treatment reliably improving outcome of an intensive therapy reducing number of complications of a burn disease and contributing to the prompt convalescence of the patients.

[Characteristics of amino acid metabolism in patients with severe sepsis and septic shock]. / Nekotorye osobennosti metabolizma aminokislot u bol'nykh tiazhelym sepsisom i septicheskim shokom.

The development of the multiorgan dysfunction syndrome, directly determining the severity of the septic process, is characterized by not only inverse ratio of the energy and plastic material, but by metabolic changes which are still unclear and cannot yet be explained. Our purpose was to detect some features of amino acid metabolism in patients with grave sepsis and septic shock. The concentrations of plasma free amino acids were measured on days 1, 3, and 5 in 37 patients with grave sepsis and septic shock. The diagnosis of grave sepsis, septic shock, and organ dysfunction was made proceeding from the criteria defined by R. Bone. The study revealed reliably increased (p < 0.05) levels of arginine, proline, alanine, and the arginine-ornithine index reflecting the direction of arginine transformation in patients with septic shock and grave organ dysfunction (for at least 3 systems). This may be explained by active degradation of endogenous proteins of skeletal muscles, which is characteristic of septic hypermetabolism. Strong correlations were revealed between arginine level and the APACHE-II score (r = 0.57), proline and the same score (r = 0.51), mean arterial pressure and the arginine-ornithine index (r = -0.72), APACHE-II score and the arginine-ornithine index (r = 0.79), arterial lactate and the arginine-ornithine index (r = 0.64). Hence, amino acid metabolism apparently mediates the effects of septic cascade mediators on the following cell.