Purpose. Evaluation of the influence of intra-operative targeted infusion therapy managed by the monitoring of stroke volume variability on post-operative results of major surgeries of gastrointestinal organs.Materials and Methods. The prospective study included 80 patients subjected to selective operative interventions of abdominal organs involving entero-enteroanastomosis. In the experimental group (n=39), the infusion therapy was conducted according to the developed targeted therapy protocol, of which the key parameter was stroke volume variability. In the control group (n=41), infusion therapy was conducted based on routine hemodynamic monitoring (average arterial pressure, heart rate, blood loss level with regard to intra-operative situation). In both groups, operative intervention was carried out in identical conditions (combined anesthesia, identical drugs to induce and maintain anesthesia); the only differences included infusion therapy.Results. In the experimental group versus the control group the intra-operative infusion volume was smaller, the number of patients with complications and the total number of complications were reliably lower, and the gastrointestinal tract functional recovery occurred earlier. Conclusion. A targeted infusion therapy based on a stroke volume variability monitoring as the key parameter allows optimizing the infusion load and facilitates reduction of the number of patients with complications and earlier recovery of gastrointestinal tract functions after major operative abdominal interventions.
Background: Thoracoscopic ablation is an effective treatment of patients with atrial fibrillation. Nowadays, 2 types of ablative devices are available in clinical practice allowing one to perform the thoracoscopic procedure Medtronic and AtriCure. However, the contemporary clinical literature does not have enough data that would compare these two approaches. Aims: to perform a comparative analysis of the short-term results of two minimally invasive strategies in thoracoscopic ablation for atrial fibrillation. Methods: 232 patients underwent thoracoscopic ablation for atrial fibrillation in two clinical centers for the period from 2016 to August 2021. The patients were divided into 2 groups. The first group was represented by those patients to whom a Medtronic device was applied (n=140), the second group was treated with an AtriCure device (n=92). The patients were comparable in their age, gender, initial severity of the condition. The follow-up consisted of laboratory tests, chest Х-ray, electrocardiography, 24-hour Holter monitor, echocardiography. The structure and prevalence of postoperative and intraoperative complications, specifics of the postoperative period were compared between the two groups. Results: According to the structure and prevalence of intraoperative complications the 2 groups are comparable to each other: 4.3% and 1.1% for the 1st group and 2nd group, respectively (p 0.05). The postoperative complications had developed in 6 (4.3%) and 5 (5.4%) patients in groups 1 and 2, respectively (p 0.05). At the time of discharge from hospital, a sinus rhythm was registered in 93.6% of patients (1st group), and 85.9% (2nd group) (p 0.05). Conclusions: Both strategies have demonstrated comparable short-term results in patients with lone atrial fibrillation. A further research is needed to evaluate the effectiveness of this strategy in a long-term period.
Цель исследования. Оценка эффективности проведения рекрутирующего приема и подбора уровня ПДКВ у больных с начальными стадиями ОРДС. Материал и методы. В исследование вошли 16 больных (14 мужчин, 2 женщин) в воз расте от 46 до 78 лет (62±5,6) с ОРДС различного генеза. Рекрутирующий прием (РП) выполнялся методом пошаго вого увеличения ПДКВ и давления вдоха под контролем динамической податливости легких и показателей гемодина мики. В ходе исследования определялись показатели газового состава крови и гемодинамики. Результаты. Проведение рекрутирующего приема привело к повышению индекса оксигенации с 153,5±48,3 мм рт. см. до 348,5±53,2 мм рт. ст. При установленном ПДКВ на уровне «точка закрытия» +2 см вод. ст., через 30-40 мин показа тели оксигенации возвращались к исходным. В случае, когда установленный ПДКВ превышал ТЗ на 8-10 см вод. ст. эффект от РП сохранялся до 24 часов. При проведении рекрутирующего приема с максимальным давлением 50-60 см вод. ст. снижение СИ отмечалось у всех больных, во всех наблюдениях и достигало 30-50% от исходных значе ний, что требовало оптимизации кардиотонической терапии. Продолжительность такого выраженного снижения СВ во время проведения РП не превышала 5 мин. После выполнения РП, во время ИВЛ с ПДКВ 18-26 см вод. ст., зна чения СИ практически не отличались от исходных (соответственно, 3,31±0,41 и 3,37±0,36 л/мин/м 2 ), хотя доза допа мина, необходимая для поддержания нормальной гемодинамики была несколько выше (7,5±2,3 и 6,3±2,6 мкг/ кг/мин). Заключение. Анализ приведенных клинических наблюдений свидетельствует о высокой эффективности про ведения рекрутирующего приема у пациентов на ранних стадиях ОПЛ. Длительность эффекта РП в отдельных на блюдениях может зависеть от установленного уровня ПДКВ. Установка ПДКВ на уровне ТЗ +2-4 см вод. ст. у ряда больных не препятствует повторному «дерекрутменту» альвеол. В таких наблюдениях целесообразно подбирать уро вень ПДКВ индивидуально, ориентируясь на динамику ИО и Cdyn в течение длительного времени. В этой ситуации возможна установка ПДКВ на уровне ТЗ +8-10 см вод. ст. или на максимальном уровне, не вызывающем гемодина мических нарушений. Ключевые слова: ОРДС, рекрутирующий прием, «дерекрутмент» альвеол, ПДКВ. Objective: to evaluate the efficiency of a recruiting maneuver (RM) and adjustment of positive end expiratory pressure (PEEP) in patients with early acute respiratory distress syndrome (ARDS). Subjects and methods. The study enrolled 16 patients (14 men and 2 women) aged 46 to 78 years (range 62±5.6 years) with ARDS of various genesis. RM was made, by stepwisely increasing PEEP and inspiratory pressure under the control of dynamic lung compliance and hemodynamic para meters. The values of blood gas composition and hemodynamics were determined during the study. Results. RM caused an increase in oxygenation index (OI) from 153.5±48.3 to 348.5±53.2 mm Hg. Oxygenation values returned to the baseline levels 30-40 min after the PEEP was set at the closure point of +2 cm H 2 O. If the set PEEP was 8-10 cm H 2 O higher than the objective, t...
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