Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Obj'ectives. To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. Materials and methods. A multicenter observational clinical study “REspiratory Therapy for Acute Stroke” (RETAS) was conducted under the aegis of the “Federation of Anaesthesiologists and Reanimatologists” (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 high mortality (in patients with 20 or more NIH scores) (p = 0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension (in patients with 20 or more NIH scores) (p = 0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIH scores) (p < 0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (p < 0.001). We found that the use of standard respiratory status monitoring scales (CPIS, LIS, etc.) was associated with a decrease in mortality (p < 0.001). Conclusions. We identified risk factors that increase mortality in patients with acute stroke with respiratory support: initial hypoxemia, lack of instrumental monitoring of ICP and monitoring of respiratory status according to standard scales, the use of hyperventilation, as well as volume-controlled ventilation.
Objective: to evaluate the efficiency of a training method using special infant formulas as part of combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia.Patients and methods. The investigation enrolled 55 patients (30 men and 25 women) aged 45–80 years with dysphagia during the acute period of ischemic stroke. Thirty patients used special astringent formulas as part of combined therapy and 25 patients did not. The investigators studied the time of course of changes in the restoration of swallowing function, by using the Penetration-Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from probe feeding to independent one.Results and discussion. The best restoration of swallowing function was shown to be achieved through training using formulas with different astringency. Stronger astringent formulas, like solid foods, stimulate better the pharyngeal receptor apparatus; the most active restoration of a dynamic swallowing stereotype occurs. The gradual transition to a milder astringent formula allows restoration of the skill to swallow thinner liquid foods. It takes 10 days to achieve a significant clinical effect in most patients, mainly in those with pseudobulbar disorders. Training may be prolonged to 2 weeks or more in severe cases, in bulbar dysfunctions.Conclusion. The training rehabilitation method using special infant formulas in combination with electrical stimulation in patients with ischemic stroke and neurogenic dysphagia allows achieving the significantly better indicators of restoration of swallowing function in accordance with the PAS scale. The application of the method contributes to the significantly better transition from probe feeding to independent one.
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