[Intestine morphology and microbiocenosis changes in critically ill patients in neurosurgery]. / Izmenenie morfologii i mikrobiotsenoza kishechnika u neirokhirurgicheskikh patsientov v kriticheskom sostoyanii.

In recent years, the effect of critical conditions on intestine and the role of such changes in maintenance and progression of systemic disorders are of particular attention. This issue is relevant in critically ill neurosurgical patients too. Intestine morphology and microbiome changes in these patients represent a wide field for researches in intensive care and prevention of secondary damage to other organs and systems. This review ensures a current approach to the problem of intestine morphology and microbiome changes in critically ill neurosurgical patients. We reviewed the data from clinical studies and experiments reproducing a critical condition in animals. Most publications are indexed in the PubMed, e-library, Google Scholar databases. We also analyzed the data from NEJM, JAMA, Lancet, Critical Care and other issues. The manuscript contains an overview of 44 foreign and 13 domestic references; over 50% of researches were published within the past 5 years. Searching depth was over 50 years.

[Factors limiting nutritional support for patients in chronic critical illness].

Patients in chronic critical illness after brain injury may experience various conditions that limit nutritional support. The aim of this work is to analyze the factors limiting or hindering the provision of nutritional support (in particular, enteral clinical nutrition) in patients in chronic critical illness after brain damage. Material and methods. This study is a prospective observational cohort study. In the course of the study, 47 patients (27 men and 20 women, mean age 52±18.4 years) in a chronic critical illness who were undergoing rehabilitation after brain damage and who had certain limitations in the provision of nutritional support were evaluated. The duration of the patients' stay in the intensive care unit was from 21 to 30 days. During hospitalization, adverse events and conditions were recorded in these patients, limiting the conduct of enteral clinical nutrition. Results. Among the undesirable phenomena and conditions limiting enteral nutrition, diarrheal syndrome most often developed - in 41.7% of patients (associated with the use of antibiotics in 25.0% of the examined). The second group in terms of frequency - the development of surgical pathology (of various etiology) - in 31.7% of patients, which attracted special attention, taking into account the neurological and/or neurosurgical nature of the underlying disease. At the same time, the appearance of a high residual volume of the stomach against the background of an increase in hydrocephalus developed only in 5.0% of cases. More attention should be paid to patients who are in the most severe physical condition, since they have a high probability of the occurrence of several factors at once that limit the use of clinical nutrition - this category of the studied sample included 19.1% of patients. Conclusion. Strict adherence to the technology of enteral nutrition can increase the efficiency of enteral nutrition in patients in chronic critical condition.

[Use of the IntelliVent-ASV mode for maintaining the target EtCO2 range in patients with severe TBI]. / Ispol'zovanie rezhima IntelliVent-ASV dlia podderzhaniia tselevogo diapazona EtCO2 u patsientov s tiazheloi ChMT.

PURPOSE: the study purpose was to evaluate the efficacy of the IntelliVent-ASV mode in maintaining the target range of PaCO2 in patients with severe TBI. MATERIAL AND METHODS: The study included 12 severe TBI patients with the wakefulness level scored 4-9 (GCS). This was a crossover design study. Two ventilation modes were consecutively used: IntelliVent-ASV and P-CMV, for 12 h each. When using the P-CMV mode, the ventilation parameters were set to maintain PaCO2 in a range of 35-38 mm Hg. The IntelliVent-ASV mode involved the Brain Injury ventilation algorithm. The target range of EtCO2 was set in accordance with the delta PaCO2-EtCO2 to maintain PaCO2 in a range of 35-38. At the beginning of each ventilation period and every 3 hours, the arterial blood gas composition was analyzed. When PaCO2 occurred out of the 35-38 range, appropriate adjustments were made to the ventilation parameters. In the P-CMV mode, the Pinsp and RR parameters were adjusted to achieve the target PaCO2 range. In IntelliVent mode, a shift of the target EtCO2 range was adjusted in accordance with a changed PaCO2-EtCO2 difference. In all patients, ICP, blood pressure, and EtCO2 were monitored; the arterial blood gas composition was analyzed every 3 h; the frequency of manual settings of ventilation parameters was recorded. RESULTS: The EtCO2 and PaCO2 parameters were found not to be significantly different in the P-CMV and IntelliVent modes, but the spread in these parameters was significantly lower in the IntelliVent ventilation mode. The PaCO2 parameter occurred out of the target range significantly less often in the IntelliVent mode than in the P-CMV mode. The mean frequency of manual respirator settings needed to maintain the target EtCO2 range was significantly lower in the IntelliVent-ASV mode than in the P-CMV mode. CONCLUSION: The IntelliVent-ASV mode provides more efficient maintenance of PaCO2 in the target range compared to traditional artificial ventilation using fewer manual settings of the ventilation parameters.

[Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position].

Paradoxical air embolism (PAE) is a rare life-threatening complication when air emboli enter arteries of the systemic circulation and cause their occlusion. Here, we describe a clinical case of PAE developed during neurosurgery in a patient in the sitting position. PAE led to injuries to the cerebral blood vessels, coronary arteries, and lungs, which caused death of the patient. An effective measure for preventing PAE is abandoning surgery in the sitting position in favor of surgery in the prone position.

[Optic nerve decompression in treatment of neoplasms involving optic canal].

Neoplasms extending to the optic canal is a diverse group of more than 15 histological types. Elimination of the optic nerve compression is crucial for favorable visual outcome. Material and method. We perform a prospective analysis of 97 patients with different neoplasms with involvement of the optic canal in whom surgery was performed in neurooncological department of Burdenko Neurosurgical Institute during the period from 2010 to 2012. Extent of resection and recurrence rates were determined by pre- and postoperative CT and MRI studies. Results. 97 patients (78 women and 19 men) were involved in the study. Mean age was 49,4 years. Patients were followed for mean of 15.9 months (1-36 month). Total resection was achieved in 54 (55.6%) patients, gross-total resection in 40 (41,2%), partial resection in 3 (3.2%). Underwent postoperative stereotactic radiation therapy 30 patients. There was no recurrence in a series of observations. 4 patients showed extension into both optic canals. Visual disturbances were the main presenting symptoms in 50 (51.5%) patients. 10 (10.3%) patients had normal visual status initially. Visual improvement after surgery was seen in (37%) of 87 patients with visual disturbances. Visual deterioration occurred in 17 (19%) patients. Transient visual deterioration occurred in 1 patient with recovery to the base level over time. The visual outcome was affected by the duration of the symptoms before surgery and the stage of visual disturbances according to the eyeground changes. Conclusions. Involvement of the optic canal is a common phenomenon in craniofacial tumors. Neoplasms extending to the optic canal is a diverse group of both the localization and histology. Decompression of the optic nerves is a crucial step in the surgical management of this neoplasms to optimize visual recovery and prevent tumor recurrence.