Inhaled Antibiotics in Reanimatology: Problem State and Development Prospects (Review)

Кузовлев, А. Н.; Grechko, Andrey V.

doi:10.15360/1813-9779-2017-5-69-84

Cited by 9 publications

(4 citation statements)

References 41 publications

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“…Использовали дыхательный контур без увлажнителя; удаляли фильтр-тепловлагообменник на время ингаляции, размещали его на клапане выдоха; небулайзер помещали на аппарат искусственной вентиляции легких (ИВЛ) в месте присоединения линии вдоха или на линию вдоха контура в 30 см от тройника; использовали дыхательный объем около 500 мл, поток газа около 40 л/мин, соотношение вдоха к выдоху более 1, выключали потоковый триггер; ингаляцию проводили в течение 30 мин. После завершения ингаляции проверяли остаточный объем препарата в небулайзере и проводили его дезинфекцию [1][2].…”

Section: Methodsunclassified

“…Moistener-free breathing circuit was used; for the period of inhalation, filter/heat and moisture exchanger was removed and placed on the expiratory valve; the nebuliser was placed on the lung ventilator (LV) at the point of inspiratory line connection or on the circuit inspiratory line at a distance of 30 cm from the T-piece; breathing volume of about 500 ml was used, gas flow was about 40 l/min, inspiration to expiration ratio was more than Ѕ, flow trigger was switched off; inhalation was carried out for 30 min. At the end of inhalation, the residual volume of the drug in the nebuliser was checked and decontamination of the latter was performed [1][2].…”

Section: Methodsmentioning

confidence: 99%

“…Необходимо принимать во внимание то, что в соответствии с Российским законодательством решение о назначении ингаляционной антибиотикотерапии должен принимать консилиум федеральной специализированной медицинской организации при условии наличия добровольного информированного согласия пациента или его законных представителей (Приказ Минздравсоцразвития России от 09.08.2005 г. №494 «О применении лекарственных средств у больных по жизненным показаниям») [1][2][3]. В соответствии с рекомендациями Американского общества инфекционных заболеваний (Infectious Diseases Society of America, IDSA) 2016 г. ИА можно применять в комбинации с внутривенными при наличии чувствительности только к аминогликозидам или колистину [4].…”

Section: Introductionunclassified

“…IU (160-240 mg) twice a day. It should be taken into account that pursuant to the Russian legislation, the decision to prescribe inhaled antibiotic therapy must be taken by a case conference of a federal specialist of medical organization subject to voluntary informed consent of a patient or his lawful representatives (Order of the Russian Ministry of Healthcare and Social Development «On Use of Medicines in Patients for Life Saving» dated 09.08.2005, No.494) [1][2][3]. According to Guidelines of Infectious Diseases Society of America (IDSA), 2016, IA can be applied in combination with intravenous thereapy when there is sensitivity only to aminoglycosides or colistin [4].…”

Section: Introductionmentioning

confidence: 99%

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Dynamics of Inhaled Tobramycin Concentration in Blood and Bronchoalveolar Lavage Fluid during Nosocomial Pneumonia (Preliminary Report)

Кузовлев

Шабанов

Тюрин

2018

Obŝaâ reanimatologiâ

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This study was aimed to evaluate the dynamics of inhaled tobramycin concentration in bronchoalveolar lavage fluid and blood in victims with nosocomial pneumonia.Materials and Methods. The study is presented as a series of clinical observations: 5 patients with severe concomitant craniocerebral injury were included, who were treated in the general resuscitation unit (men 4 (87.5%), women 1 (12.5%); age 36Ѓ}12 years; Injury Severity Score (ISS) 40.9Ѓ}8.3; acute blood loss volume 2356Ѓ}997 ml; mean bed-days 12.50 days; mortality 16.7%). Statistical analysis of data obtained was carried out using Statistica 10.0 software. Difference was considered significant at p<0.05.Results. The dynamics of tobramycin concentrations was as follows: 1 hr. blood/BAL 0.96Ѓ}0.44 μg/ml / 49.6 μg/ml; 3 hrs. blood/BAL 0.98Ѓ}0.82 μg/ml / 15.5 μg/ml; 5 hrs. blood/BAL 0.79Ѓ}0.83 μg/ml / 3.5 μg/ml. Conclusion.The results obtained confirm significant local concentrations of tobramycin in sputum and low in blood, which corresponds to the results of pharmacokinetic studies and clinical studies of inhaled tobramycin efficacy. At present, gathering of material for the study continues.

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Section: Methodsunclassified

Section: Methodsmentioning

confidence: 99%

Section: Introductionunclassified

Section: Introductionmentioning

confidence: 99%

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Dynamics of Inhaled Tobramycin Concentration in Blood and Bronchoalveolar Lavage Fluid during Nosocomial Pneumonia (Preliminary Report)

Кузовлев

Шабанов

Тюрин

2018

Obŝaâ reanimatologiâ

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Risk Factors for the Development and Severe Course of Ventilator-Associated Tracheobronchitis in Patients with Prolonged Mechanical Ventilation

Ibadov,

Sabirov,

Eshonkhodjaev

et al. 2023

Obŝaâ reanimatologiâ

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Objective. Identification of risk factors for the development and severe course of ventilator-associated tracheobronchitis (VAT) in patients on prolonged mechanical ventilation (PMV).Methods. VAT incidence rate in the intensive care unit of Academician V. Vakhidov Republican Scientific and Practical Medical Center for Surgery for the period 2018-2022 was evaluated retrospectively in 724 patients who were on PMV (more than 48 hours). Patients’ clinical and demographic characteristics were subjected to factor analysis. Mean age was 52.4±3.3 (18-81) years. VAT was diagnosed based on clinical signs (fever >38°C, leukocytosis > 12 000 ctlls/ml, or leukopenia <4 000 cells/ml, purulent endotracheal secretions, or conversion to purulent), radiological (no progression of existing or emergence of new pulmonary infiltrates) and microbiological (polymorphonuclear lymphocytes with or without bacteria, moderate-to active growth of colonies of potentially pathogenic microorganisms) criteria. VAT prophylaxis was based on the use of bacterial filters and humidification of the respiratory gas; selective decontamination of the digestive tract; regulation of pressure in the tracheal cuff; sanitation of the oral cavity. Treatment of VAT included antimicrobial drugs administered i/v and/or inhalational, bronchodilators, expectorants and mucolytics.Results. VAT incidence rate decreased over time from 24.7% to 10.1% (χ2=9.52; p=0.003) with invariable practice of ventilator support. The incidence of the most severe VAT (hemorrhagic catarrhal purulent) also gradually decreased from 44.7% to 14.3% (χ2=4.53; p=0.034).The duration of PMV and ICU stay in patients with VAT gradually decreased from 202.1±6.15 hours to 125.3±7.81 hours (t=7.73; p<0.0001), and from 9.7±0.25 days to 6.6±0.3 days (t=7.94; p<0.0001), respectively. In patients with VAT (n=122), in contrast to patients without VAT (n=602), the incidence of concomitant COPD was higher – 22.9% vs 10.6%, respectively (p<0.001). Gram-negative flora was the leading cause for development of severe tracheobronchitis, including Acinetobacter spp. - in 24% of cases, Klebsiella pneumoniae – in 11.6%, Pseudomonas aeruginosa – in 13.0%, Esherichia coli – 10.6%. Less frequently were isolated Staphylococcus aureus – in 5.3%, Enterococcus spp. – in 2.2% and Candida fungi– in 17.0%. The following predictors of severe VAT were identified: age over 60 years (OR=2.28; 95% CI 1.0-4.9), SAPS II > 40 scores (OR=5.9; 95% CI 2.6-13.8), duration of mechanical ventilation > 144 hours (OR=5.4; 95% CI 1.8-16.7) and the presence of malignant neoplasms (OR=2.83; 95% CI 1.2-6.9).Conclusion. Decrease in VAT incidence rates, reduced duration of mechanical ventilation and ICU stay are indicative of adequate VAT prevention and treatment strategies within the analyzed period. Factors associated with VAT development and predictors of severe VAT can be used for identification of high risk patients.

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On the diagnosis and treatment of nosocomial tracheobronchitis in intensive care medicine

Кузовлев¹,

Rehabilitology²,

Шабанов³

et al. 2018

Annals of Critical Care

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Обзор литературы освещает современное состояние проблемы нозокомиальной пневмонии и нозокомиального трахеобронхита. Обсуждается важная для реаниматологии концепция нозокомиального трахеобронхита, потенциальная роль ингаляционных антибиотиков в лечении данного состояния и возможности таким образом предупредить развитие нозокомиальной пневмонии.

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Inhaled Antibiotics in Reanimatology: Problem State and Development Prospects (Review)

Cited by 9 publications

References 41 publications

Dynamics of Inhaled Tobramycin Concentration in Blood and Bronchoalveolar Lavage Fluid during Nosocomial Pneumonia (Preliminary Report)

Dynamics of Inhaled Tobramycin Concentration in Blood and Bronchoalveolar Lavage Fluid during Nosocomial Pneumonia (Preliminary Report)

Risk Factors for the Development and Severe Course of Ventilator-Associated Tracheobronchitis in Patients with Prolonged Mechanical Ventilation

On the diagnosis and treatment of nosocomial tracheobronchitis in intensive care medicine

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