Synthetic Analogue of Leu-Enkephalin Prevents Endothelial Dysfunction in vitro

The purpose of the study was to determine the efficacy of a synthetic leu-enkephalin stabilized analogue to prevent damage of endothelial cells monolayer in vitro caused by serum samples from septic shock patients.Materials and methods. The experiments were performed using the EaHy.926 endothelial cells monolayer. We studied the in vitro effect of synthetic leu-enkephalin analogue on the cell damage caused by serum samples from five septic shock patients. The status of endothelial intercellular junctions was estimated by immunofluorescence microscopy and western blot with antibodies against adherens junction protein, VE-cadherin, and against the tight junctions protein, claudin. Cell viability was determined by staining with propidium iodide.Results. Preconditioning with a synthetic leu-enkephalin analogue (10, 50 and 100 μg/ml) of endothelial cells in vitro prevented the destruction of both tight and adherens junction and partially prevented endothelial cell death.Conclusion. Preconditioning with a synthetic leu-enkephalin analogue partially prevents endothelial cell damage caused by exposure to septic patients’ sera in vitro. These data ensure the need for clinical trials on the effectiveness of a synthetic leu-enkephalin analogue for prevention of sepsis-associated endothelial dysfunction in clinics

ФАКТОРЫ, ОПРЕДЕЛЯЮЩИЕ КЛИНИЧЕСКИЕ ИСХОДЫ У ПАЦИЕНТОВ С ТЯЖЕЛОЙ СОЧЕТАННОЙ ТРАВМОЙ, ОСЛОЖНЕННОЙ ДЕЛИРИЕМ

Search for most effective way of management of non-specific delirium is an important aspect of treatment of severe concomitant trauma. The objective of the study: to investigate the correlation and impact of sedation method on those injured with delirium during the intensive care of severe concomitant trauma. Subjects and Methods. The retrospective prospective analysis of two groups of patients with delirium was performed, 30 patients in each group, who received sedation with dexmedetomidine or propofol. Results. After stopping delirium, the intensity of multiple organ dysfunctions was lower in the group of patients who had sedation with dexmedetomidine. The complex of unfavorable events – death within 1 year and continuous cognitive deficiency was 4 times more frequent in the group of patients after sedation with propofol. Evaluation of the trauma severity was a significant predictor of unfavorable outcomes. Conclusions. The use of dexmedetomidine for management of delirium resulted in the reduction of multiple organ dysfunctions versus propofol. The severity of trauma was associated with chances to develop a continuous cognitive dysfunction and lethal outcome. Use of dexmedetomidine promoted early rehabilitation in case of cognitive dysfunction. Поиск наиболее эффективного воздействия на неспецифический делирий является важным аспектом лечебного процесса тяжелой сочетанной травмы. Цель работы: изучить связь и влияние метода седации у пострадавших с делирием в интенсивной терапии тяжелой сочетанной травмы. Материалы и методы. Проведен ретроспективно-проспективный анализ двух групп пострадавших с делирием по 30 пациентов в каждой, получавших различную седацию дексмедетомидином или пропофолом. Результаты. После купирования делирия выраженность полиорганной дисфункции была ниже в группе с седацией дексмедетомидином. Совокупность неблагоприятных событий – смерть в сроки до одного года и длительный когнитивный дефицит – встречалась в 4 раза чаще в группе пациентов после седации пропофолом. Оценка тяжести травмы явилась значимым предиктором развития неблагоприятных исходов. Выводы. Использование дексмедетомидина для купирования делирия приводит к снижению выраженности полиорганной дисфункции в сравнении с пропофолом. Тяжесть травмы связана с вероятностью возникновения длительной когнитивной дисфункции и наступления летального исхода. Использование дексмедетомидина способствует ранней реабилитации при когнитивной дисфункции.

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.

ИНГАЛЯЦИОННАЯ СЕДАЦИЯ У КАРДИОХИРУРГИЧЕСКИХ БОЛЬНЫХ В ОТДЕЛЕНИИ ИНТЕНСИВНОЙ ТЕРАПИИ

From the time when special tools for delivery of volatile anesthetics in the intensive care units (ICU) became available, inhalation sedation is getting more and more popular among emergency physicians. Despite some persisting questions, it should be acknowledged that currently there are no technical problems when providing inhalation sedation. Currently, it is recognized that inhalation sedation is simple, reliable, convenient to use and it causes no significant unfavorable consequences. The above is fairly enough to recommend this method for the intensive care when it is necessary. The contemplated therapeutic properties of halogen-containing anesthetics could be an additional reason to use inhalation sedation. However, the clinical value of anesthetic pre-conditioning and anti-inflammatory effect is still doubtful. New clinical trials are needed in order to define the place of inhalation sedation in ICU.С момента появления специальных устройств для доставки летучих анестетиков в условиях палаты интенсивной терапии (ПИТ) популярность ингаляционной седации среди реаниматологов стремительно растет. Несмотря на некоторые сохраняющиеся вопросы, следует признать, что в настоящее время нет технических проблем при проведении ингаляционной седации. Сегодня признаны простота, надежность, удобство использования и отсутствие значимых неблагоприятных последствий ингаляционной седации. Этого набора вполне достаточно, чтобы рекомендовать при необходимости реализацию этого метода в отделении интенсивной терапии. Дополнительным основанием для применения ингаляционной седации могут быть предполагаемые лечебные свойства галогенсодержащих анестетиков. Однако клиническая значимость как анестетического прекондиционирования, так и противовоспалительной активности до сих пор под вопросом. Для определения реального места ингаляционной седации в ПИТ необходимы новые клинические исследования

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

FACTORS DEFINING CLINICAL OUTCOMES IN THE PATIENTS WITH SEVERE CONCOMITANT TRAUMA COMPLICATED BY DELIRIUM

Search for most effective way of management of non-specific delirium is an important aspect of treatment of severe concomitant trauma. The objective of the study: to investigate the correlation and impact of sedation method on those injured with delirium during the intensive care of severe concomitant trauma. Subjects and Methods. The retrospective prospective analysis of two groups of patients with delirium was performed, 30 patients in each group, who received sedation with dexmedetomidine or propofol. Results. After stopping delirium, the intensity of multiple organ dysfunctions was lower in the group of patients who had sedation with dexmedetomidine. The complex of unfavorable events – death within 1 year and continuous cognitive deficiency was 4 times more frequent in the group of patients after sedation with propofol. Evaluation of the trauma severity was a significant predictor of unfavorable outcomes. Conclusions. The use of dexmedetomidine for management of delirium resulted in the reduction of multiple organ dysfunctions versus propofol. The severity of trauma was associated with chances to develop a continuous cognitive dysfunction and lethal outcome. Use of dexmedetomidine promoted early rehabilitation in case of cognitive dysfunction

INHALATION SEDATION IN THE PATIENTS AFTER CARDIAC SURGERY IN INTENSIVE CARE UNITS

From the time when special tools for delivery of volatile anesthetics in the intensive care units (ICU) became available, inhalation sedation is getting more and more popular among emergency physicians. Despite some persisting questions, it should be acknowledged that currently there are no technical problems when providing inhalation sedation. Currently, it is recognized that inhalation sedation is simple, reliable, convenient to use and it causes no significant unfavorable consequences. The above is fairly enough to recommend this method for the intensive care when it is necessary. The contemplated therapeutic properties of halogen-containing anesthetics could be an additional reason to use inhalation sedation. However, the clinical value of anesthetic pre-conditioning and anti-inflammatory effect is still doubtful. New clinical trials are needed in order to define the place of inhalation sedation in ICU

SUCCESSFUL TREATMENT FOR ATYPICAL HEMOLYTIC UREMIC SYNDROME IN A PUERPERA

Objective: to show the problems of differential diagnosis and treatment of atypical hemolytic-uremic syndrome in a 23-year-old patient.Results. Eculizumab (Soliris), (Alexon Pharmaceuticals Inc., USA) that is a glycosylated humanized monoclonal antibody to immunoglobulins (IgG2/4k) is shown to be effective in treating this disease.Conclusion. Atypical hemolytical-uremic syndrome in pregnancy is a disease, whose treatment difficulties are largely associated with the problem of differential diagnosis with thrombotic thrombocytopenic purpura and man-ifestations of multiple organ dysfunction. The treatment for this disease gives a key role to Eculizumab