Chronic Critical Illness: Current Aspects of the Problem (Review).

Chronic resuscitation patients who have survived the acute phase of a disease represent a fast-growing cohort of patients requiring specialized medical assistant in intensive care and resuscitation units (ICRU) for several months or years. The term "chronic critical illness" (CCI) was proposed for such patients in the mid-80s of the last century. Patients with CCI make up from 5 to 20% of ICRU. Over time, they develop homeostasis disorders resulting in multiple organ failure and death. Mortality in CCI exceeds that of the majority of malignant neoplasms and functional dependence remains in most of survivors. In the present review, the attempt is made to show the main links of CCI pathogenesis which, if acted upon, can prevent unfavorable outcome. The publications describing epidemiology of CCI, its outcomes, and clinical phenotype have been analyzed. Several researchers consider CCI as a result of persistent inflammation, immunosuppression, and catabolism syndrome. Some works show the importance of nutrition for ICRU patients. The role of gastrointestinal tract in CCI formation has been noted. The effect of intensive therapy on microbiota of the ICRU patients has been demonstrated. Microbiome disturbances in dysbiosis and sepsis have been considered, as well as the effect of intestinal microbiome on the distant organs. Post-intensive care syndrome is a significant constituent of CCI. The main sequelae of the syndrome, as well as the general questions of its prevention and treatment, have been denoted.

[Specific features of cerebral blood flow changes after surgical removal of chiasmatic-sellar region tumors using data of transcranial duplex sonography].

Aim of the study was to discover specific features of linear blood velocity in early postoperative period in patients with tumors of chiasmatic-sellar region. Measurement of linear blood velocity using transcranial duplex sonography was performed in 294 patients with tumors of hypothalamo-hypophyseal area (149 suprasellar pituitary adenomas, 145 endosuprasellar, hypophyseal and ventricular craniopharyngiomas). It was found that vasospasm of different severity was present in 62% cases after surgical removal of chiasmatic-sellar region tumors. This "primary vasospasm" was associated with intraoperative damage to a vessel. Delayed angiospasm was caused by subarachnoid hemorrhage into basal cisterns due to hyperactivation of neuroendocrine systems of adenohypophysis and aldosterone. Persistent vasospasm with linear blood velocity over 200 cm/s results in irreversible ischemic damage of subcortical and hypothalamic structures.

[Water-electrolyte and endocrine disorders after craniopharyngomectomy in a child]. / Vodno-élektrolitnye i éndokrinnye narusheniia posle udaleniia kraniofaringiomy u rebenka.

The paper considers a type of three-phase course of diabetes insipidus with the development of the syndrome of inadequate secretion of antidiuretic hormone (SIADH) in a child after radical removal of endosupracellar craniopharyngoma. The parameters of cerebral blood flow, homeostatic fluctuations, the blood levels of thyroid hormones were compared with the time course of changes in the patient's clinical status. SIADH was accompanied by impaired consciousness, convulsion, developed common edematous syndrome, including interstitial edema of the lung, progressive suprarenal and thyroid insufficiency. The concurrence of SIADH with polyhormonal deficiency and the edematous syndrome determined the lines of intensive care.

[Endogenous intoxication and its treatment with sodium hypochlorite in neurosurgical patients]. / Endogennaia intoksikatsiia i ee lechenie s primeneniem gipokhlorita natriia u neiroreanimatsionnykh bol'nykh.

Blood plasma levels of medium-mass molecules (MMM), antioxidant activity (AOA), and malonic dialdehyde (MDA) were measured in 51 neurosurgical patients before and directly and 24 h after intravenous drip infusion of sodium hypochlorite (SHC) solution. Preliminary in vitro studies showed the most expressed drop of initially high MDA and MMM levels to be associated with an increase of AOA. It was observed at SHC concentration of 0.05 mg/ml, corresponding to infusion of SHC in a concentration of 600 mg/liter in 0.1 of the total circulating blood volume. Even a single dose of SHC alleviated endogenous intoxication and decreased the concentration of MMM and lipid peroxidation products. The proper AOA of the blood did not drop in this case, and in patients with initially low AOA it appreciably increased. Infusion of SHC normalized the values of Kp, which reflected its high detoxifying activity in endogenous poisoning caused mainly by inflammatory changes.