ВЛИЯНИЕ ЦЕЛЕНАПРАВЛЕННОЙ ТЕРАПИИ РАЗЛИЧНЫМИ ВИДАМИ РАСТВОРОВ НА ФУНКЦИЮ ПОЧЕК У КАРДИОХИРУРГИЧЕСКИХ ПАЦИЕНТОВ

The article describes the impact of the targeted therapy with colloid and crystalloid infusion solutions on renal function and fluid balance during the surgery and early post-surgery period in the patients who underwent aortocoronary bypass under cardio-pulmonary bypass. No differences have been found in the frequency of acute renal lesion as per AKI and the need in the substitution renal therapy. During one stage of the study the lower rates of urine neutrophil gelatinase-associated lipocalin have been observed in the group of crystalloids. The lack of confident differences in the clinical course of the post-surgery period makes the use of the balanced crystalloid solution more preferable compared to colloid solutions. В статье рассмотрено влияние целенаправленной терапии коллоидными и кристаллоиднымии инфузионными растворами на функцию почек и на баланс жидкости во время операции и в раннем послеоперационном периоде у пациентов, которым выполнено аортокоронарное шунтирование в условиях искусственного кровообращения. Не выявлено различий в частоте острого почечного повреждения по AKI и потребности в заместительной почечной терапии. На одном из этапов исследования зафиксированы более низкие показатели нейтрофильного желатиназа-ассоциированного липокалина мочи в группе кристаллоидов. Отсутствие достоверных различий в клиническом течении послеоперационного периода делает применение сбалансированного кристаллоидного раствора предпочтительнее, чем коллоидных растворов

IMPACT ОF TARGETED THERAPY WITH VARIOUS TYPES ОF SOLUTIONS ON RENAL FUNCTIONS IN THE PATIENTS UNDERGOING CARDIAC SURGERY

The article describes the impact of the targeted therapy with colloid and crystalloid infusion solutions on renal function and fluid balance during the surgery and early post-surgery period in the patients who underwent aortocoronary bypass under cardio-pulmonary bypass. No differences have been found in the frequency of acute renal lesion as per AKI and the need in the substitution renal therapy. During one stage of the study the lower rates of urine neutrophil gelatinase-associated lipocalin have been observed in the group of crystalloids. The lack of confident differences in the clinical course of the post-surgery period makes the use of the balanced crystalloid solution more preferable compared to colloid solutions

In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. Methods: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic—from March 1 to Sept 13, 2020—at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. Findings: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46–60]) were included in the study. Median ECMO duration was 15 days (IQR 8–27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. Interpretation: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. Funding: None