Changes in Systemic Hemodynamics in Orthostasis in Patients With Long-Term Impairment of Consciousness

Дороговцев, В. Н.; Skvortsov, Artem Eduardovich; Юдина, Е. А.

doi:10.15360/1813-9779-2018-6-12-22

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…Для этих целей на поворотном столе-вертикализаторе с электрическим приводом выполняли пассивный ортостатический тест 0-30-60-0° с экспозицией 10 мин в каждом положении, что значительно меньше, чем в настоящем исследовании (60 мин), но достаточно для оценки состояния и ортостатической стабильности кровообращения у таких пациентов. Были отмечены удовлетворительная ортостатическая стабильность у 84% пациентов и преобладание гипокинетического типа кровообращения, выраженность которого коррелировала со степенью тяжести повреждения головного мозга [17].…”

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Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damages

Дороговцев

Yankevich

Янкевич³

et al. 2020

Physical and rehabilitation medicine, medical rehabilitation

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Objectives: Patients in the post-comatose period after critical brain damages and long-term treatment in intensive care units require special approaches to verticalization due to the risk of orthostatic circulatory disorders and deepening of ischemic processes in the brain. Aim: to study orthostatic disorders occurring during verticalization in patients with and without chronic consciousness disorders, after severe brain damages. Material and methods: 72 patients were examined during the post-comatose period, including 49 (68%) after severe stroke, 17 after severe brain injury, 3 patients with posthypoxic encephalopathy and 3 after brain tumor removal. Non-invasive registration of blood pressure (BP) in the brachial artery and monitoring beat to beat of BP was performed using Drager's bedside monitor complete with a finger sensor. Heart rate monitoring was performed automatically by computer-controlled R to R intervals in real time. The results: Orthostatic circulatory disorders were detected in the majority (19 out of 24) of patients with chronic consciousness impairments and in 12 out of 48 patients who were conscious. The most frequent disorder in group 1 was postural tachycardia syndrome, which was not revealed in patients of group 2. Orthostatic hypotension was observed in 25% of group 1 patients and in 20,8% of group 2 patients. Orthostatic hypertension in both groups did not exceed 10%. Conclusion: orthostatic circulatory disorders were revealed in 19 out of 24 patients in group 1 (79,2%) and in 25% in group 2. Application of the new protocol with real-time monitoring of BP and HR allowed to perform verticalization in all patients without complications. The structure of orthostatic circulatory disorders was established, which should be considered at the beginning of the process of verticalization of patients in the post-comatose period after severe brain damages.

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Section: Discussionunclassified

Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damages

Дороговцев

Yankevich

Янкевич³

et al. 2020

Physical and rehabilitation medicine, medical rehabilitation

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Sensitivity of the Baroreceptors and the State of the Autonomic Nervous System in Patients with Chronic Impairment of Consciousness Due to Severe Brain Damage

Дороговцев¹,

Янкевич²,

Parfenov³

et al. 2019

Obŝaâ reanimatologiâ

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Purpose of the study: to examine sensibility of baroreceptors and the autonomic nervous in the passive orthostatic test in patients with chronic impairment of consciousness due to severe brain damage and determine their role in the rehabilitation process.Materials and methods. The study included 30 patients with long-term impairment of consciousness due to severe brain damage (group 1), 10 of them being in the vegetative state (VS) and 20 being in the minimally conscious state (MCS). Craniocerebral trauma was the main cause of severe damage in that group (53% of patients). The comparison group included 24 patients with focal neurological symptoms caused predominantly — 79.2% of cases — by cerebrovascular disorders (group 2). The control group (group 3) consisted of 22 healthy volunteers of a comparable age. All measurements were done with the help of a Task Force Monitor 1030i (CNSystem, Austria) in the course of passive orthostatic test at 0°–30°–60°–0°. Changes in the power of low-frequency (LFS) and highfrequency spectrum (HFS) of heart rate variability and baroreceptors sensibility (BRS) were analyzed. Statistical analysis was carried out using Statistica-10 software. Significance of inter-group differences on unrelated samples was determined by the Mann–Whitney U-test. Differences between groups were considered significant at P 0.05.Results. Maximal background values of BRS were found in the control group. In group 1 and 2 patients, considerable decrease of that index was noted, which was proportional to the brain damage severity. Similar dynamics was observed for the indices of autonomic nervous system sensibility (LFS and HFS). The main trend of orthostatic changes of BRS, LFS, and HFS was characterized by progressive decrease of the indices with increase of the patients’ angle of tilting and their return to the baseline level after the patients were put back into the horizontal position. 4 patients of group 1 (14%) displayed signs of orthostatic disorders upon tilting to 30°: in 3 cases, orthostatic hypotension was observed, and in one case the postural orthostatic tachycardia syndrome (POTS) was diagnosed. Those patients differed by lower BRS and higher sympathetic system activity (LFS) vs. the same indices of other patients in that group.Conclusion. Patients with chronic impairment of consciousness during the post-comatose period after a severe brain damage display a significant decrease of baroreceptors sensibility and autonomic nervous system disorders manifesting in significantly lower activity of the sympathetic and parasympathetic systems. The prominence of such disorders is associated with brain damage severity. Their risk of developing orthostatic hypotension during tilting towards a vertical position is higher in patients who have lower baroreceptors sensibility, and this should be taken into account beginning the process of their verticalization.

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Changes in Systemic Hemodynamics in Orthostasis in Patients With Long-Term Impairment of Consciousness

Cited by 2 publications

References 20 publications

Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damages

Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damages

Sensitivity of the Baroreceptors and the State of the Autonomic Nervous System in Patients with Chronic Impairment of Consciousness Due to Severe Brain Damage

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