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1.
Artigo em Russo | MEDLINE | ID: mdl-31577269

RESUMO

OBJECTIVE: The aim of this study was to estimate the prognostic value of magnetic resonance imaging (MRI) classification of traumatic brain lesion localization and levels in patients with a brain injury of various severity in a few days to three weeks after the injury. MATERIAL AND METHODS: The cohort of 278 patients with traumatic brain injury (TBI) of various severity aged 8-74 y.o. (average -31.4±13.8, median - 29 (21.3; 37.0) was included in the analysis. The severity of TBI at admission varied from 3 to 15 Glasgow coma scores (GCS) (average - 8±4, median - 7 (5; 12). The main indications and conditions for MRI were: inconsistency between computed tomography (CT) data and neurological status, the necessity to clarify the location and type of brain damage, the absence of metal implants, the stabilization of the patient's vital functions, etc. MRI was performed during the first three weeks after the injury using T1, T2, T2-FLAIR, DWI, T2*GRE, SWAN sequences. The damage to the brain was classified according to 8 grades depending on the lesion levels (cortical-subcortical level, corpus callosum, basal ganglia and/or thalamus, and/or internal, and/or external capsules, uni- or bilateral brain stem injury at a different level). Outcomes were assessed by the Glasgow outcome scale (GOS) 6 months after injury. RESULTS: The significant correlations were found for the entire cohort between MRI grading and TBI severity (by GCS) and outcome (by GOS) of the injury (R=-0.66; p<0.0001; R=-0.69; p<0.0001, respectively). A high accuracy (77%), sensitivity (77%) and specificity (76%) of the proposed MRI classification in predicting injury outcomes (AUC=0.85) were confirmed using the logistic regression and ROC analysis. The assessment of MRI-classification prognostic value in subgroups of patients examined during the first, second, and third weeks after injury showed significant correlations between the GCS and the GOS as well as between MRI-grading and GCS, and GOS in all three subgroups. In the subgroup of patients examined during the first 14 days after the injury, the correlation coefficients were higher compared with those obtained in a subgroup examined 15-21 days after the injury. The highest correlations between MRI grading, TBI severity, and the outcome were found in the subgroup of patients who underwent MRI in the first three days after the injury (n=58). CONCLUSION: The proposed MRI classification of traumatic brain lesion levels and localization based on the use of different MR sequences reliably correlated with the clinical estimate of TBI severity by GCS and the outcomes by GOS in patients examined during the first three weeks after injury. The strongest correlation was observed for patients examined during the first three days after the injury.


Assuntos
Lesões Encefálicas , Imagem por Ressonância Magnética , Neuroimagem , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/diagnóstico por imagem , Criança , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
2.
Artigo em Russo | MEDLINE | ID: mdl-29927420

RESUMO

Autoregulation of cerebral blood flow (ACBF) is a system of mechanisms for maintaining stable adequate perfusion of the brain despite changes in systemic arterial pressure. In recent years, new data on the numerous metabolic and systemic mechanisms of cerebral blood flow regulation have been obtained, but the role of neurogenic regulation has not yet been fully understood and, therefore, not considered in clinical practice. AIM: The study aim was to assess the effect of anatomical injuries to deep brain structures on the extent and duration of ACBF abnormalities in a model of severe diffuse axonal injury (DAI). RESULTS: The study demonstrated that brain injury in the projection of a dopaminergic structure (substantia nigra) and a cholinergic structure (nucleus basalis of Meynert region) was more common in patients with impaired ACBF and was associated with a longer duration of the impairment. CONCLUSION: The obtained data may indicate the presence of central (neurogenic) pathways of cerebral vessel tone regulation; traumatic injury of the pathways leads to a more severe and prolonged period of impaired ACBF. Probably, injury to these regulatory structures in some patients has an indirect effect on the course of intracranial hypertension. Further experimental and clinical studies in this direction are needed to elucidate all elements of neurogenic regulation of cerebral vessel tone and ACBF mechanisms.


Assuntos
Lesões Encefálicas , Lesão Axonal Difusa , Pressão Sanguínea , Encéfalo , Circulação Cerebrovascular , Homeostase , Humanos , Pressão Intracraniana
3.
Artigo em Russo | MEDLINE | ID: mdl-29076469

RESUMO

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.


Assuntos
Algoritmos , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/terapia , Dióxido de Carbono/sangue , Respiração Artificial/métodos , Adulto , Gasometria/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/instrumentação
4.
Artigo em Russo | MEDLINE | ID: mdl-29393290

RESUMO

BACKGROUND: Noninvasive techniques to evaluate intracranial pressure (ICP) are important for everyday practice in intensive care and neurosurgery departments. CT data can be used to evaluate the optic nerve sheath diameter (ONSD) and, indirectly, the ICP value. The ONSD value is an additional criterion in deciding on invasive monitoring of ICP. AIM: To analyze a correlation between CT-based ONSD and the results of invasive measurements of ICP in patients with severe traumatic brain injury. MATERIAL AND METHODS: The study evaluated 41 patients with severe traumatic brain injury within the first 48 h after injury. Invasive monitoring of ICP (Codman & Shurtlett, MA, USA) was performed during 7±1.7 days. ONSD was measured using axial CT scans (CereTom, Neurologica Danvers, MA, USA) with a slice thickness of 2.5 mm. The ONSD value was measured at a distance of 3 mm from the posterior eyeball contour. The patients were allocated in a group with normal ICP (10 patients) and a group with high ICP (31 patients). ONSD served as an ICP classifier. The data were processed using ROC analysis. RESULTS: According to the CT data, the optimal threshold ONSD value was 6.35 mm in patients in the acute TBI period. The sensitivity was 0.93 (95% СI 0.84-1.00), the specificity was 0.80 (95% СI 0.50-1.00), and AUC was 0.87 (95% СI 0.69-1.00). CONCLUSION: We found a correlation between the CT-based ONSD and the median ICP (R=0.32, p<0.05). An ONSD value of 6.35 mm and more is one of the signs of previous or existing ICP.


Assuntos
Lesões Encefálicas Traumáticas , Pressão Intracraniana , Bainha de Mielina , Nervo Óptico , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/fisiopatologia , Índices de Gravidade do Trauma
5.
Anesteziol Reanimatol ; 61(2): 108-12, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27468499

RESUMO

The aim of the study was to assess the significance of NT-proBNP levels as a predictor of the severity of patients' condition after severe TBI and critical stress of the heart. In this prospective observational study 118 patients admitted on 1-4 day after severe TBI (GCS <8 points on admission) was supervised. The average age of patients was 32 +/- 16 years, 28 women and 90 men were in this group. 12 of the observed patients died within the first 10 days. NT-proBNP level was determined by immunochemiluminescent analyzer "Immulite 2000" (Siemens). Blood sampling was performed daily at 8:00 am during the acute period--an average for 7 days (5 to 10) from the date of admission. At the same time hemodynamic status was assessed by PiCCO. It has been shown that NT-proBNP level may be not only a marker of severity of condition and poor outcome in patients with severe TBI, but also can be used as a good predictor of exhaustion of compensatory myocardial capacity in these patients.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Peptídeo Natriurético Encefálico/sangue , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
6.
Anesteziol Reanimatol ; 61(1): 37-9, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27192853

RESUMO

INTRODUCTION: "Standard" assessment of ICP by measuring liquor ventricular pressure recently questioned. THE OBJECTIVE OF THE STUDY: Compare the values of ventricular and parenchymal ICP against the closure of open liquor drainage and during active CSF drainage. MATERIALS AND METHODS: Examined 7 patients with TBI and intracranial hypertension syndrome, GCS 5.6 ± 1.2 points, 4.2 ± age 33 years. Compared parenchymal and ventricular ICP in three time periods: 1--during closure of ventricular drainage, 2--during of the open drains and drainage at the level of 14-15 mmHg, 3--during the period of active drainage. When comparing two methods of measurement used Bland-Altman method. RESULTS: 1. During time period of the closed drainage correlation coefficient was r = 0.83, p < 0.001. Bland-Altman method: the difference of the two measurements is equal to the minimum and 0.7 mm Hg, the standard deviation of 2.02 mm Hg 2. During time period of the open drainage was reduction of the correlation coefficient to r = 0.46, p < 0.01. Bland-Altman method: an increase in the difference of the two measurements to -0.84 mmHg, standard deviation 2.8 mm Hg 3. During time period of the active drainage of cerebrospinal fluid was marked difference between methods of measurement. Bland-Altman method: the difference was 8.64 mm Hg, and a standard deviation of 2.6 mm Hg. CONCLUSIONS: 1. During the closure of the ventricular drainage were good correlation between ventricular and parenchymal ICR 2. During open the liquor drainage correlation between the two methods of measuring the intracranial pressure is reduced. 3. During the active CSF drainage correlation between the two methods of measuring intracranial pressure can be completely lost. Under these conditions, CSF pressure is not correctly reflect the ICP 4. For an accurate and continuous measurement of intracranial pressure on the background of the active CSF drainage should be carried out simultaneous parenchymal ICP measurement.


Assuntos
Ventrículos Cerebrais/fisiopatologia , Traumatismos Craniocerebrais/diagnóstico , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Monitorização Fisiológica/métodos , Adulto , Derivações do Líquido Cefalorraquidiano , Traumatismos Craniocerebrais/líquido cefalorraquidiano , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Hipertensão Intracraniana/líquido cefalorraquidiano , Hipertensão Intracraniana/etiologia , Masculino , Monitorização Fisiológica/instrumentação , Sensibilidade e Especificidade , Índices de Gravidade do Trauma
7.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-27029336

RESUMO

Traumatic brain injury (TBI) is one of the major causes of death and disability in young and middle-aged people. The most problematic group is comprised of patients with severe TBI who are in a coma. The adequate diagnosis of primary brain injuries and timely prevention and treatment of the secondary injury mechanisms largely define the possibility of reducing mortality and severe disabling consequences. When developing these guidelines, we used our experience in the development of international and national recommendations for the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot wounds to the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury, which had been published in recent years. The proposed guidelines concern intensive care of severe TBI in adults and are particularly intended for neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in the treatment of these patients.


Assuntos
Lesões Encefálicas , Cuidados Críticos/métodos , Monitorização Fisiológica/métodos , Neuroimagem/métodos , Índices de Gravidade do Trauma , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/patologia , Lesões Encefálicas/terapia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto
8.
Anesteziol Reanimatol ; 60(4): 65-9, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26596036

RESUMO

The clinical observation illustrates the role of screening of inflammatory markers and advanced hemodynamic monitoring in optimization of the treatment of the patient with severe traumatic brain injury (sTBI). The level of consciousness by the Glasgow Coma Scale at admission was 5 points. From the first day of stay the patient suffered hyperthermia to 39,0° C° The diagnosis of the aspiration pneumonia was determined by radiological signs, bronchoscopy and inflammatory blood markers, C-reactive protein, leukocytosis. From the second day the constant infusion of norepinephrine was necessary to maintain mean ABP above 80 mmHg. On the 10th day the patient's condition deteriorated sharply. Developed hyperthermia to 40, 2° and cardiovascular collapse (in spite of the high level of norepinephrine support a sharp decline in ABP up to 49/20 mmHg). Invasive advanced hemodynamic PiCCO monitoring (transpulmonary thermodilution) was started Septic shock was suspected. Standard laboratory tests did not meet the criteria for septic shock. Witnessed a slight increase in CRP and procalcitonin (PCT) was within normal limits. Diagnostic search was supplemented by a study of interleukins (IL-6 and IL-2R) in the blood plasma. The significant increase in their values, was regarded as the initial manifestations of the systemic inflammatory response. Sepsis was confirmed. The extended antibiotic therapy started Continuous Veno-Venous hemofiltration was used as part of treatment of the inflammatory-toxic condition. In two days of the therapy the patient's condition has stabilized, the patient recovered consciousness in the form of opening the eyes, simple instructions. At discharge, the patient's condition according to the Glasgow outcome scale was estimated at 4 points.


Assuntos
Hemorragia Cerebral Traumática/terapia , Traumatismos Craniocerebrais/terapia , Traumatismo Múltiplo/terapia , Choque Séptico/tratamento farmacológico , Adulto , Hemorragia Cerebral Traumática/complicações , Hemorragia Cerebral Traumática/diagnóstico , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Choque Séptico/etiologia , Choque Séptico/microbiologia , Índices de Gravidade do Trauma , Resultado do Tratamento
9.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-26977799

RESUMO

The presented case illustrates a new approach to making a decision about decompressive craniectomy in the patient with sever traumatic brain injury and intracranial hypertension. The approach is based on continuous assessment of cerebral autoregulation using Prx-monitoring in addition to monitoring of intracranial pressure and cerebral perfusion pressure. Prx-monitoring enables timely detection of autoregulation failure and provides the opportunity to make a decision about decompressive craniectomy before starting such aggressive methods of intensive care as hypothermia or barbiturate coma.


Assuntos
Lesões Encefálicas , Tomada de Decisões , Craniectomia Descompressiva , Hipertensão Intracraniana , Adulto , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/cirurgia , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/fisiopatologia , Hipertensão Intracraniana/cirurgia , Masculino , Radiografia
10.
Zh Vopr Neirokhir Im N N Burdenko ; 79(6): 100-106, 2015.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-26977800

RESUMO

Traumatic brain injury is one of the main causes of mortality and disability in young and middle-aged individuals. The patients with severe traumatic brain injury who are in coma are the most difficult to deal with. Appropriate diagnosis of the primary brain injuries and early prevention and treatment of secondary damage mechanisms largely determine the possibility of reducing mortality and severe disabling consequences. The authors compiled these guidelines based on their experience in development of international and Russian recommendations on the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot injury of the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used the materials of international and Russian recommendations on the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury published in recent years. The proposed recommendations are related to organization of medical care and diagnosis of severe traumatic brain injury in adults and are primarily addressed to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and emergency room doctors, who are routinely involved in management of these patients.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Neuroimagem , Índices de Gravidade do Trauma , Adulto , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto
11.
Zh Vopr Neirokhir Im N N Burdenko ; 78(5): 41-7; discussion 47-8, 2014.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-25406907

RESUMO

OBJECTIVE: Assess to impact hypothermia on ABP, CPP, ICP and cerebral autoregulation. Material and methods. 14 patients with TBI (GOS<9) underwent hypothermia by Thermogard system within 32-35 °C (Zoll, USA). ICP was measured intraparenchymal by Codman sensor. Cerebral autoregulation was estimated by correlation coefficient Prx (Soft ICM Plus, Cambridge, UK). Temperature was measured in urinary bladder. There were selected five time periods: 1 - phase of initial state, 2 - phase of induction hypothermia, 3 - phase of hypothermia, 4 - phase of rewarming, 5 - phase after finishing hypothermia. All data preset as Mediana (min; max). Stat analysis was perfomed using Soft Statistica 10.0. Results. Phase 1 lasted nearly 7 (2; 12) h, ABP 94 (81; 102), CPP - 73 (52; 87), ICP 27 (16; 45) mm Hg, Prx 0,25 (-0,15; 0,7), temperature 38,2 °C (37; 39,8). Phase 2: 5 (2; 12) h, ABP 95 (85; 114), CPP 80 (65; 96), ICP 18 (10; 22) mm Hg, Prx -0,055 (-0,15; 0,7), temperature 35,2 °C (34,5; 35,5). Phase 3: 55 (20; 100) h, there were not significant changed ABP, CPP, Prx, ICP 15 (10; 18) mm Hg, temperature was 33,5 °C (32; 34,7). Phase 4: 17 (8; 24) h, ABP 90 (70; 100), CPP 77 (55; 85), ICP 15 (9; 27) mm Hg and Prx 0,2 (-0,2; 0,32). Temperature 36,9 °C (35,9; 38,5). Phase 5: 20 (6; 240) h, ABP 87(53; 110), CPP 72 (47; 107), ICP 17 (10; 32) mm Hg and Prx 0,2 (-0,2; 0,6). Temperature 37,7 °C (36,7; 39,0). Conclusion. Hypothermia is an effective method for correction of intracranial hypertension. Hypothermia can use as a additional option of intensive care during refractory intracranial hypertension. Rewarming phase is the most dangerous time on the re-development of intracranial hypertension and disruption of autoregulation.


Assuntos
Lesões Encefálicas/terapia , Procedimentos Endovasculares/métodos , Hipotermia Induzida/métodos , Hipertensão Intracraniana/terapia , Adolescente , Adulto , Temperatura Corporal , Lesões Encefálicas/complicações , Feminino , Homeostase , Humanos , Hipertensão Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade
12.
Anesteziol Reanimatol ; (2): 10-4, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25055486

RESUMO

UNLABELLED: Postoperative intracranial infectious complications are one of the most topical problems of neurosurgical intensive care due to theirs significant capability to impair outcomes of the main disease. PURPOSE OF THE STUDY: To define the risk factors of postoperative meningitis in patients with chiasm-sellar tumors. RESEARCH OBJECTIVES: 1. to define the effect of somatic and intracranial risk factors on occurrence of postoperative meningitis in patients after transsphenoidal and transcranial approaches to the tumor. 2. To define the effect of postoperative meningitis on outcomes of treatment in patients after transsphenoidal and transcranial approaches to the tumor. MATERIALS AND METHODS: Somatic and intracranial risk factors of occurrence of postoperative meningitis (pneumonia, urinary tract infection, sepsis, intra-abdominal hypertension, the presence of external ventricular and lumbar drainage, monitoring of intracranial pressure, cerebrospinal fluid, and reoperation) were fixed every day. The study was conducted in the ICU of the Burdenko from October, 2010 to July, 2012. The 34 patients (19 males, 15 females) were included in the study (average age 47.5 years). The patients were divided into two groups; 17 patients each group. The group-1 included patients after transcranial approach to the tumor and the group-2 included patients after transsphenoidal approach. RESULTS: In the group-1 a meningitis occurred in 3 patients (17.6% +/- 9.2%, DI [-0.4 - 35.6]). In the group-2 a meningitis occurred in 7 patients (41.2% +/- 11.9) DI 95% [17.8 - 64.4]. Accumulation of cerebrospinal fluid under the skin flap authentically increased a risk of a meningitis occurrence in patients after transcranial approach to the tumor (p = 0.031). There was no defined statistical significance of other risk factors. But there was defined a trend of the increasing of meningitis occurrence in patients after transsphenoidal approach in case of lumbar drainage or reoperation. Duration of mechanical ventilation and ICU stay in patients with meningitis was authentically longer than in patients without meningitis in both groups. In the group-2 the duration of mechanical ventilation and ICU stay was significantly shorter than in the group-1. CONCLUSIONS: Meningitis is not a typical complication of postoperative period in patients with transcranial approach to the tumor. After transsphenoidal approach a meningitis occurrence is likely in case of postoperative liquorrhea, lumbar drainage or reoperation. Subcutaneous accumulation of cerebrospinal fluid is a single defined statistically significant risk factor of meningitis. Postoperative meningitis impairs a condition of patients with chiasm-sellar tumors, increases the duration of mechanical ventilation and impairs treatment outcomes.


Assuntos
Meningite/etiologia , Neoplasias do Nervo Óptico/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Líquido Cefalorraquidiano/metabolismo , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Meningite/epidemiologia , Pessoa de Meia-Idade , Moscou/epidemiologia , Quiasma Óptico/patologia , Neoplasias do Nervo Óptico/patologia , Neoplasias Hipofisárias/patologia , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Sela Túrcica/patologia , Resultado do Tratamento
13.
Zh Vopr Neirokhir Im N N Burdenko ; 78(1): 4-13; discussion 13, 2014.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-24761591

RESUMO

In this paper, the relationship between brain lesion localization (verified by magnetic resonance imaging (MRI)) and the severity of traumatic brain injury (TBI) and its outcomes is presented. Magnetic resonance studies in different modes (T1, T2, FLAIR, DWI, DTI, T2 * GRE, SWAN) were performed in 162 patients with acute TBI. Statistical analysis was done using Statistica 6, 8 software and R programming language. A new advanced MRI-based classification of TBI was introduced implying the assessment of hemispheric and brainstem traumatic lesions level and localization. Statistically significant correlations were found between the Glasgow coma and outcome scales scores (p < 0.001), and the proposed MRI grading scale scores, which means a high prognostic value of the new classification. The knowledge of injured brain microanatomy coming from sensitive neuroimaging, in conjunction with the assessment of mechanisms, aggravating factors and clinical manifestation of brain trauma is the basis for the actual predictive model of TBI. The proposed advanced MRI classification contributes to this concept development.


Assuntos
Lesões Encefálicas/diagnóstico , Coma Pós-Traumatismo da Cabeça/diagnóstico , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Lesões Encefálicas/classificação , Criança , Interpretação Estatística de Dados , Feminino , Escala de Coma de Glasgow , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Prognóstico
14.
Anesteziol Reanimatol ; (1): 47-52, 2014.
Artigo em Russo | MEDLINE | ID: mdl-24749310

RESUMO

UNLABELLED: Main tasks of early postoperative period in patients after posterior fossa surgery are the timely and safe weaning from mechanical ventilation and extubation. For clinical assessment of the hypopharynx function we use an algorithm developed in the intensive care unit (ICU) of the Burdenko Scientific Research Institute of Neurosurgery. Disadvantages of the clinical test for assessment of patient's readiness for extubation are subjectivity and impossibility to use it in conditions of even superficial sedation. Shot-latency somato-sensory evoked potentials (SSEP) can be applied in conditions of sedation and objectify the brain stem deficit. The goal of the study was to define the changes of cortical SSEP in patients with disorders of swallowing after posterior fossa surgery. To assess the swallowing disorders we used a scale of swallowing disorders in intubated patients with brain stem damage. We compared results of cortical SSEP, test of swallowing disorders in intubated patients and clinical results of extubation. 17 patients with tumors of posterior fossa were included in the study. All patients were divided into two groups depending on duration of mechanical ventilation. Patients of the group-1 were successfully extubated in 4.5 hours. Patients of the group-2 were mechanically ventilated more than 15 hours because of impossibility to pass the test of readiness for extubation. RESULTS: Central conduction time symmetry index after the surgery was lower in the group-1 than in group-2. There was inverse correlation between amplitude of cortical response N20 and time from the patient's admission to the ICU until the moment of extubation. CONCLUSIONS: Asymmetry of central conduction time and decreasing of N20 amplitude can be used as additional predictor of swallowing disorder.


Assuntos
Transtornos de Deglutição/diagnóstico , Potenciais Somatossensoriais Evocados/fisiologia , Neoplasias Infratentoriais/cirurgia , Monitorização Neurofisiológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Extubação , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Respiração Artificial , Fatores de Tempo , Adulto Jovem
15.
Anesteziol Reanimatol ; (4): 44-50, 2013.
Artigo em Russo | MEDLINE | ID: mdl-24341042

RESUMO

The goal of the study was to assess frequency of plato waves, their influence on outcomes and define factors leading to plato waves. Ninety eight patients with severe traumatic brain injury (TBI) were included. Blood pressure (BP), intracranial pressure (ICP), cerebral perfusion pressure (CPP) and pressure reactivity index (Prx) were registered. Age was 34 +/- 13.6. There were 73 male and 25 female. Glasgow Coma Scale (GCS) was 6 +/- 1.4. Plato waves developed in 24 patients (group 1), 74 patients (group 2) did not have plato waves. Median of plato waves in the 1st group was 7[3.5; 7]. They developed on 3rd [2;4.5] day. Maximum level of ICP during plato waves was 47.5 [40;53] mmHg, its duration was 8.5 [7;27] minutes. In the group 1 Prx was significantly lower during first day, than in the group 2. Duration of ICP monitoring was longer in the group I due to presence of plato waves in these patients. CPP did not differ in groups, because CPP was strictly controlled. Patients of the group I had preserved autoregulation and less severe trauma (predominance of closed trauma and Marshall I, II type of brain damage). Plato waves did not predict bad outcomes.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Neurofisiológica/métodos , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Monitorização Neurofisiológica/instrumentação , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
16.
Anesteziol Reanimatol ; (4): 50-4, 2013.
Artigo em Russo | MEDLINE | ID: mdl-24341043

RESUMO

Delirium is a clinical sign of acute cerebral dysfunction. It is characterized by consciousness alterations with attention impairment and mentally disorganization. Frequency of delirium is 40-80% in general intensive care and more in patients in neurointensive care unit. We tried to assess citicoline (Ceraxon, Nycomed) safety and efficacy in treatment of postoperative delirium in patients with tumors of chiasm-sellar area of brain. 12 patients were included in citicoline group and 8--in control group. In both group combined type of delirium was common: 83.3% and 75%, accordingly. Citicoline didn't influence on delirium duration. Median of duration of mechanical ventilation was 1.5 and 6 days; mean and standard deviation were 10.5 +/- 15.4 and 17.5 +/- 27.9 days. Median of length of stay in ICU was 7 and 9.5 days; mean and standard deviation were 25.4 +/- 33.1 and 14.9 +/- 15.1 days. These results show that citicoline didn't influence on duration of mechanical ventilation and length of stay in ICU. Outcomes were similar in both groups, but frequency of full functional state recovery in citicoline group was significantly higher: 5 (41.7%) to 2 (25%) in control group (p < 0.05). We consider that citicoline therapy is safe for patients with tumors of chiasm-sellar area and lead to increasing of frequency of full functional state recovery.


Assuntos
Citidina Difosfato Colina/uso terapêutico , Delírio/tratamento farmacológico , Procedimentos Neurocirúrgicos , Nootrópicos/uso terapêutico , Adulto , Neoplasias Encefálicas/cirurgia , Cuidados Críticos/métodos , Citidina Difosfato Colina/administração & dosagem , Delírio/etiologia , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Nootrópicos/administração & dosagem , Resultado do Tratamento
17.
Zh Vopr Neirokhir Im N N Burdenko ; 76(4): 26-30; discussion 30-1, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23033589

RESUMO

Aim of the study was to investigate the status of thyroid homeostasis and the relationship between severe traumatic brain injury (TBI) and thyroid disorders. The study included 56 patients. Protocol of the study concluded: noninvasive and invasive hemodynamic monitoring, including PICCO, transcranial Doppler ultrasonography, measurement of intracranial pressure (ICP), indirect calorimetry, levels of thyroid stimulating hormone (TSH), T3, T4 and free fractions. Patients were divided into three groups. Group 1--with normal thyroid hormones (n = 20), Group 2--with the low T3 (n = 23) and Group 3 with the low T3 and T4 (n = 13). Correlation between the Glasgow Coma Scale (GCS) and thyroid hormone levels was obtained: the first group between GCS and T4 (r = 0.50), GCS, and free fraction T4 (r = 0.51); between the GCS and TSH (r = 0.51), T3 (r = 0.48) and T4 (r = 0.57) in the second group, and the third--with TSH (r = 0.67). Poor outcomes in the first group compound 15%, in the second group--39.2%, and in the third group--62.5% of patients. Doses of vasopressors were significantly higher in groups 2 and 3 compared with a first group. ICP was significantly higher in the group with the low T3 and T4. Development of intracranial hypertension correlated with the formation of thyroid insufficiency. Deficiency of thyroid hormones, especially the simultaneous reduction and T3, and T4 is associated with poor outcome in patients with severe TBI. Doses of sympathomimetic drugs used to optimize the parameters of systemic hemodynamics in acute severe head injury were higher in patients with deficiency of thyroid hormones.


Assuntos
Lesões Encefálicas/sangue , Homeostase , Doenças da Glândula Tireoide/sangue , Hormônios Tireóideos/sangue , Lesões Encefálicas/complicações , Lesões Encefálicas/tratamento farmacológico , Feminino , Humanos , Masculino , Doenças da Glândula Tireoide/tratamento farmacológico , Doenças da Glândula Tireoide/etiologia , Índices de Gravidade do Trauma
18.
Zh Vopr Neirokhir Im N N Burdenko ; 76(4): 32-6; discussion 36, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23033590

RESUMO

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.


Assuntos
Albuminas/metabolismo , Neoplasias Encefálicas/cirurgia , Nitrogênio/urina , Complicações Pós-Operatórias , Desnutrição Proteico-Calórica , Transferrina/metabolismo , Adulto , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/urina , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/urina , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/dietoterapia , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/urina
19.
Zh Vopr Neirokhir Im N N Burdenko ; 76(6): 20-7; discussion 27, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23379179

RESUMO

Mechanism of arterial hypotension (AH) in patients with sellar region tumors (SRT) and complicated postoperative period consists in decrease of systemic vascular resistance and relative hypovolemia. Therapeutic directions for blood pressure (BP) stabilization are clear. However criteria of optimal BP in these patients are absent. Object of the study was defining such criteria. Prospective study was conducted from January, 2011 to January, 2012. Inclusion criteria were: adults; SRT; early postoperative period. Thirty patients were included into the study. Patients were divided into three groups. Group I (n=11) consisted of patients with uncomplicated postoperative period; group II (n=12) - patients with complicated postoperative and with stable hemodynamics; group III (n=7) - patients with complicated postoperative period and AH. Median of central venous saturation (ScvO2) was normal in all groups. ScvO2 was significantly higher than jugular vein saturation (SjvO2) in all measurement. In group I SjvO2 was normal, and it was higher, than in group II. In group SjvO2 did not achieve normal level during three days of the study. Mean BP did not change during these days. In group III SjvO2 was decreased if mean BP was between 70 and 90 mmHg. This level of SjvO2 did not differ from SjvO2 in group II. When mean BP increased up to 100-110 mmHg SjvO2 significantly increased too in the group III and achieved level of the group I (normal level). Outcomes were favorable in all patients of the group I (GOS=4, 5). Median of length of stay (LOS) in the ICU was 1 day. In group II outcomes were favorable in 10 (83.3%) patients, 2 (16.7%) patients died. Median LOS in ICU was 7 days. In group III outcomes were favorable in 6 (85.7%) patients, unfavorable outcome (GOS=3) was in 1 (24.3%) patient. Median LOS in ICU was 12 days. There were no significant differences in all groups in the lactate levels both in central vein and in jugular vein. ScvO2 can not be a criterion for BP optimization in patients with SRT. In patients with uncomplicated postoperative period SjvO2 is normal. In patients with complicated postoperative period and normal BP SjvO2 remains decreased. In patients with complicated postoperative period and arterial hypotension normal level of SjvO2 can be achieved if mean BP is increased up to 100-110 mmHg. SjvO2 normalization can improve outcomes in patients with SRT and complicated postoperative period.


Assuntos
Pressão Sanguínea , Neoplasias Encefálicas/cirurgia , Hipotensão , Complicações Pós-Operatórias , Adulto , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/fisiopatologia , Feminino , Humanos , Hipotensão/sangue , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipotensão/terapia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Estudos Prospectivos
20.
Zh Vopr Neirokhir Im N N Burdenko ; 75(3): 3-16; discussion 17-8, 2011.
Artigo em Russo | MEDLINE | ID: mdl-22066252

RESUMO

Forty patients with severe traumatic brain injury (GCS score 8 and less) aged 16-54 years treated in our clinic were analyzed. Correlations between clinical symptoms, CT signs of diffuse and focal traumatic lesions, intracranial hemorrhage, indices of cerebral blood flow (CBF) according to perfusion CT study, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were assessed. Main mechanism of injury in 27 of 40 (67.5%) patients was acceleration-deceleration due to traffic accidents which usually leads to diffuse axonal injury (DAI) of different severity. In the other 13 (32.5%) cases injury was associated with coup-countercoup mechanism which caused focal contusions mostly. Not only GCS score but CT-signs of DAI severity, intracranial hemorrhage and minimal levels of CPP had significant prognostic value. Results of perfusion CT studies demonstrated that in 37 of 40 (92.5%) patients cerebral blood flow decreased (below 28.6 ml/100 g/min) in one or more arterial blood distribution areas. Increase of CBF was registered in 9 cases (over 69 ml/100 g/min), in 6 of them elevation of CBF in one arterial distribution area was associated with reduction in the other. Generally, mean CBF values were higher in the middle cerebral artery circulation than in the other. The lowest CBF levels (16.3 +/- 6 ml/100 g/min) were observed in cortical and subcortical hemorrhagic foci while these values were significantly higher in the same contralateral intact zones (36.0 +/- 10.0 ml/100 g/min; p < 0.01). In 3 patients with DAI the CBF in the midbrain varied from 12.5 to 30.1 ml/100 g/min with the lowest levels in hemorrhagic focus in cerebral peduncle. It corresponded to cystic-atrophic alterations found on subsequent follow-up MRI. Thus, reduction of CBF and episodes of low CPP were the leading pathophysiological phenomena of diffuse and focal brain damages.


Assuntos
Lesões Encefálicas/fisiopatologia , Circulação Cerebrovascular , Pressão Intracraniana , Monitorização Fisiológica , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
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