ПОСЛЕОПЕРАЦИОННЫЙ ДЕЛИРИЙ: ЧТО НОВОГО ПРЕДЛАГАЕТ НАМ НОВОЕ РУКОВОДСТВО ESA-2017?

Postoperative delirium is being actively discussed by anesthesiologists for a long period of time. This article has been written due to new guidelines on prevention and management of this disorder compiled by the group of experts under umbrella of European Society of Anaesthesiology. Comparing this edition with the previous recommendations of American Society of Anesthesiologists the authors attempt to follow the evolution of doctors' views (anesthesiologists and intensive care physicians) on the discussed issue. Послеоперационный делирий – проблема, достаточно давно и активно обсуждаемая анестезиологическим сообществом. Непосредственным поводом к написанию настоящей статьи стала разработка группой экспертов под эгидой Европейской ассоциации анестезиологов (ESA) новых рекомендаций по предупреждению и лечению обсуждаемого состояния. Сравнивая данное издание с предыдущими рекомендациями Американской ассоциации анестезиологов, авторы пытаются проследить эволюцию взглядов врачей – анестезиологов и интенсивистов – на обсуждаемую проблему.

Endocrine aspect of overtraining in athletes

Striving to achieve the goals of the training process with the irrational use of physical activity can lead to a decrease in the adaptive and reserve capabilities of the athlete. The development of changes in the endocrine, cardiovascular and central nervous systems may result in the development of overtraining syndrome. There is no unified approach to the definition, diagnosis, treatment and prevention of overtraining syndrome in the literature up to the present day. The endocrine aspects of the development of the overtraining syndrome are not sufficiently studied. In particular, there is no clear understanding of the degree of involvement of various hormonal mechanisms in its pathogenesis and ideas about the possibilities of using hormone levels to diagnose this condition. The purpose of this publication is to summarize and systematize the available concepts regarding the endocrine aspects of the overtraining syndrome

ИНГАЛЯЦИОННАЯ СЕДАЦИЯ У ПАЦИЕНТОВ С СЕПСИС-АССОЦИИРОВАННЫМ ДЕЛИРИЕМ

Delirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days. Делирий в палате интенсивной терапии – проблема, достаточно давно и активно обсуждаемая анестезиологическим сообществом. Однако на сегодняшний день имеется весьма скудный набор доказательств относительно эффективности тех или иных методов профилактики и лечения обсуждаемого состояния. Цель работы: изучить влияние ингаляционной седации на интенсивность и продолжительность течения сепсис-ассоциированного делирия в палате интенсивной терапии хирургического стационара. Методы. Выполнено одноцентровое, проспективное, рандомизированное сравнительное исследование эффективности применения ингаляционной седации у пациентов с сепсис-ассоциированным делирием. В группе сравнения проводили внутривенную седацию пропофолом. Обследованы 187 взрослых пациентов, госпитализированных в отделение реанимации Городской клинической больницы № 67 им. Л. А. Ворохобова. Результаты. Использование ингаляционной седации, в сравнении с внутривенной пропофолом, сокращало продолжительность делирия: в группе «Севоран» данное осложнение было купировано на 5-й день [4; 7], тогда как в группе «Пропофол» продолжительность делирия составила 7 [6; 8] дней (p = 0,03). В исследовании не обнаружено влияния ингаляционной седации на выраженность окислительного стресса (уровень карбонилированных пептидов в плазме пациентов) и степень нейронального повреждения (различия между группами незначимы при p = 0,37). Также ни на одном из фиксированных этапов исследования не зафиксировано различий в величине прокальцитонина и оценке по шкале органной дисфункции (SOFA). Заключение. Частота развития делирия в смешанной популяции пациентов с сепсисом составляет 27,9%. Использование ингаляционной седации севофлураном, по сравнению с внутривенной методикой на основе пропофола, сокращает необходимый срок терапии делирия с 7 до 5 сут.

Predictors of the Severity and Duration of Treatment of Sepsis-Associated Delirium

Mental illnesses in patients with sepsis occur in 23—32% of cases and are an unfavorable prognostic sign. At present, the causes of these disorders are adequately explained by the theory of neuroinflammation that takes into account the pathogenic influence of the systemic inflammatory reaction and related endothelial dysfunction on the central nervous system function.The purpose of the study was to evaluate the relevance of the severity of the systemic inflammatory response, the intensity of oxidative stress and the severity of patient's general state to prediction of the duration of delirium and therapy outcomes in patients with sepsis-associated delirium.Materials and methods. A pilot, single-center, prospective, cohort study was performed in 187 adult patients diagnosed with sepsis who were treated in the intensive care unit of L. A.Vorokhobov Municipal Clinical Hospital No. 67. The following tests and examinations were performed: Vasoactive-Inotropic Score (VIS), Sepsis-related Organ Failure Assessment score (SOFA), Intensive Care Delirium Screening Checklist (ICDSC); plasma levels of carbonylated peptides, procalcitonin (PCT), and neuromarkers were monitored; and a correlation analysis with the severity of the sepsis, its duration and therapy outcomes was performed.Results. A moderate correlation (R=0.68; P<0.05) between the plasma concentration of carbonylated peptides and the duration of delirium was found. The S100b protein level, a marker of neuronal damage, also closely correlated (R=0.75; P<0.05) with the duration of delirium. In the group of ICDSC, SOFA, and VIS, the latter turned out to be the most significant predictor of the delirium duration (P=0.02). In the group in which SOFA, carbonylated peptides and PCT levels monitored, the organ failure scale was the leading one (P=0.02).Conclusion. The vasoactive-inotropic score (VIS) is a more relevant predictor of the delirium duration than ICDSC and SOFA; the organ failure scale assessment has a greater correlation with the delirium duration than carbonylated peptides and PCT level monitoring; the VIS is the best predictor of the mortality in patients with sepsis

INHALATION SEDATION IN THOSE WITH SEPSIS-ASSOCIATED DELIRIUM

Delirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days

Formation and optical properties of hybrid organic-inorganic MAPbI3 perovskite films

A rapid progress in the development of solar cells based on hybrid organic-inorganic perovskites CH3NH3PbI3 (MAPbI3) is observed in recent years, and power conversion efficiency as high as 22.1 % has been reported. However, a low stability is the main drawback of these materials, which impedes their practical use for solar energy conversion. This work is devoted to the synthesis of CH3NH3PbI3 films from CH3NH3I and PbI2 precursors and spectroscopic investigation of their stability under high-intensity laser illumination