Седация и неинвазивная масочная вентиляция у пациентов с послеоперационным делирием и острой дыхательной недостаточностью

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality.Цель работы: сравнить безопасность и эффективность дексмедетомидина и галоперидола у пациентов с делирием и острой дыхательной недостаточностью при применении неинвазивной масочной вентиляции легких.Материалы и методы. Провели ретроспективный анализ данных 61 пациента (57 мужчин, 4 женщины) с соматогенным делирием и острой дыхательной недостаточностью при проведении неинвазивной масочной вентиляции легких (НИМВЛ) в отделении реанимации и интенсивной терапии ГКБ им. С. П. Боткина в 2017–2018 гг. В зависимости от вида препарата седации пациентов разделили на две группы: дексмедетомидина (n=31) и галоперидола (n=30). Дексмедетомидин назначали в виде продленной инфузии со скоростью 0,2–1,4 мкг/кг/ч под контролем уровня сознания; галоперидол больные получали в виде внутривенных фракционных введений до достижения достаточного уровня седации в дозе 2,5 мг 2–3 раза в день.Результаты. Эффективность седации для достижения необходимого уровня кооперации и проведения НИМВЛ составила в группах дексмедетомидина 87,1% (27 пациентов) и галоперидола 66,6% (20 пациентов). При оценке седации у больных обеих групп по шкале RASS показатели достоверно не различались и соответствовали в среднем 1,7±0,3 (открывает глаза на оклик). В группе галоперидола у 10 из 30 (33,3%) пациентов не удалось достичь достаточного уровня седации, что потребовало немедленной интубации трахеи и проведения инвазивной ИВЛ. Летальность в этой группе составила 20% (6 пациентов), тогда как в группе дексмедетомидина — 6,4% (2 пациента).Заключение. Применение дексмедетомидина, несмотря на более выраженную лабильность гемодинамических параметров, позволяет проводить НИМВЛ при достаточной кооперации с пациентом, уменьшает частоту интубации трахеи, риск развития осложнений и летальность

Cooperation between Russian research organizations and industrial companies: factors and problems

The study is focused on the cooperation of Russian companies with research organizations in implementing R&D projects during technological innovation. Taking into account behavioral changes, authors carry out a micro-level analysis based on empirical data of executive survey of over 600 Russian industrial firms (2011—2012) and about 350 research organizations and universities (2012). The authors emphasize the key factors of firms’ demand for outsourcing R&D reveal the main barriers to the development of university-industry cooperation and their particularities for different cooperation actors. The analysis shows that there is a positive relation between the size of a company and R&D outsourcing. As for the factor of age, the highest cooperation activity of Russian firms is observed among enterprises founded over 20 years ago. As far as concernes cooperation activity of research organizations, large ones are significantly more likely to cooperate with business. A common prerequisite for research organizations' R&D cooperation with business is sufficient academic ranking. Business and science evaluate differently various obstacles to effective cooperation. For firms, the main problems are the inflated costs of national R&Ds, insufficient research organizations’ orientation at company needs, and low quality of developments. As for representatives of research organizations, they mention as barriers primarily the lack of companies' receptivity to innovation and inadequate information about promising developments. Businesses are more optimistic about cooperation with science if they already have a relevant experience of interaction. In the case of research organizations we observe a different pattern: most problems seem more significant to organizations conducting R&D in business interests

Sedation and Non-Invasive Mask Ventilation in Patients with Delirium and Acute Respiratory Failure

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality