[Protein malnutrition in patient in the early postoperative period after uncomplicated removal of the brain tumors].

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.

[First experience of using adaptive support ventilation (ASV) mode in patients with severe traumatic brain injury].

Capabilities and limitations of ASV mode in TBI patients are studied. 12 patients with severe TBI were enrolled in the study. ICP, MAP, CPP were monitored in all the patients. Cerebral regional blood flow was monitored by thermal diffusion in four patients. Hamilton G5 ventilator was used for mechanical ventilation and respiratory monitoring in all cases. Starting mode of mechanical ventilation was ASV with 100% mechanical substitution. The patient was regarded as ASV-nonresponder and switched to another mode when normoventilation was not possible with any percent of respiratory substitution. ASV mode provided normoventilation during all period of mechanical ventilation in 88 ou of 12 patients. In 4 out of 12 patients ASV mode led to hyperventilation with EtC02 decrease, cerebral regional blood flow slowing and P0,1 index increase. In three patients hyperventilation was induced by high rate of spontaneous breaths caused by brainstem irritation. Switching these patients to SIMV-VC led to normoventilation, normalization of etC02 and cerebral regional blood flow, and P0,1 index decrease. In one patient hyperventilation was caused by lung mechanics disorder when ventilator tried to achieve target minute volume by low tidal volume and high respiratory rate. ASV mode provides adequate lung ventilation during respiratory support period in most patients with severe TBI. It can prove ineffective for some patients with brainstem irritation or lung mechanics disorders.

[Using ASV mode for respiratory support withdrawal in patients after posterior fossa surgery].

The study gives data on how to improve the way from mechanical to spontaneous breathing in patients with weakened respiratory drive after posterior fossa tumor removal. We compared the effectiveness of two methods of weaning from mechanical ventilation in these patients. The main group consisted of 6 patients weaned from ventilator with ASV mode. The control group was made up of 10 patients weaned from ventilator with SIMV or PS modes. The duration of weaning from ventilator using ASV mode was significantly shorter than with SIMV or PS modes. During ASV ventilation spontaneous breath rate gradually increased. In all patients the level of P0,1 index representing respiratory center activity was initially lower than normal. While spontaneous breath activity increased the level of P0,1 index also gradually normalized. Plmax index (respiratory effort index) measured once a day increased as well. Weakened respiratory drive is accompanied by P0,1 and Plmax indexes' decrease in patients after posterior fossa tumor removal. ASV mode in these patients allows quicker weaning from mechanical ventilation.