Респираторная тактика во время искусственного кровообращения при кардиохирургических операциях

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.Большое место в структуре причин послеоперационной дыхательной недостаточности в кардиохирургии занимает ателектазирование легочной ткани, формирующееся во время искусственного кровообращения (ИК). Частота этого осложнения составляет 54‒92%.Цель: оценка эффективности различных методик респираторной поддержки во время ИК.Материалы и методы. В исследование рандомизировано 60 кардиохирургических пациентов. Группа CPAP (положительное давление в дыхательных путях +5 см H2O) и группа VC (вентиляция легких во время ИК с параметрами: дыхательный объем 3 мл/кг, частота дыхания 6/мин, положительное давление конца выдоха +5 см Н2О).Результаты. Индекс оксигенации в группе VC был выше, чем в группе СРАР, на этапах после окончания ИК (289,6 ± 100,0 в группе VC и 223,1 ± 152,0 в группе СРАР), на конец операции (в группе VC 318,7 ± 73,8 и в группе СРАР 275,2 ± 90,0). Частота интраоперационных (VC 16% и СРАР 43%) и послеоперационных рекрутирующих маневров легких (VC 7% и СРАР 26%) в группе VC по сравнению с группой СРАР была ниже. Частота развития ателектазов в группе VC (10%) снизилась по сравнению со СРАР (36,6%).Вывод. Проведение малообъемной вентиляции легких в период ИК оказывает более благоприятное влияние на оксигенирующую функцию легких по сравнению с респираторной поддержкой в режиме СРАР

Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

Objective: Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. Design: Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). Setting: Tertiary and University hospitals. Interventions: 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). Measurements: The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. Conclusions: The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections

Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

74sireservedObjective: Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. Design: Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). Setting: Tertiary and University hospitals. Interventions: 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). Measurements: The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. Conclusions: The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections.mixedMonti G.; Galbiati C.; Toffoletto F.; Calabro M.G.; Colombo S.; Ferrara B.; Giardina G.; Lembo R.; Marzaroli M.; Moizo E.; Mucci M.; Pasculli N.; Plumari V.P.; Scandroglio A.M.; Tozzi M.; Momesso E.; Boffa N.; Lobreglio R.; Montrucchio G.; Guarracino F.; Benedetto U.; Biondi-Zoccai G.; D'Ascenzo F.; D'Andrea N.; Paternoster G.; Ananiadou S.; Ballestra M.; De Sio A.; Pota V.; Cotoia A.; Della Selva A.; Bruni A.; Iapichino G.; Bradic N.; Corradi F.; Gemma M.; Nogtev P.; Petrova M.; Agro F.E.; Cabrini L.; Forfori F.; Likhvantsev V.; Bove T.; Finco G.; Landoni G.; Zangrillo A.; Ajello S.; Cappelletti A.M.; Fominskiy E.; Nisi F.G.; Pazzanese V.; Pieri M.; Canavosio F.; Palmesino F.; Bernasconi M.; Gallioli G.; Marino G.; Vetrugno L.; Millin C.; Missio D.; Gallicchio F.; Azzali B.; Bozzetti M.; Cristadoro D.; Perone R.; Cantatore L.P.; Curci G.; Pabon I.M.; Garofalo E.; Mainetti M.; Calamai I.; Maraggia D.; Mattei A.; Yavorovskiy A.Monti, G.; Galbiati, C.; Toffoletto, F.; Calabro, M. G.; Colombo, S.; Ferrara, B.; Giardina, G.; Lembo, R.; Marzaroli, M.; Moizo, E.; Mucci, M.; Pasculli, N.; Plumari, V. P.; Scandroglio, A. M.; Tozzi, M.; Momesso, E.; Boffa, N.; Lobreglio, R.; Montrucchio, G.; Guarracino, F.; Benedetto, U.; Biondi-Zoccai, G.; D'Ascenzo, F.; D'Andrea, N.; Paternoster, G.; Ananiadou, S.; Ballestra, M.; De Sio, A.; Pota, V.; Cotoia, A.; Della Selva, A.; Bruni, A.; Iapichino, G.; Bradic, N.; Corradi, F.; Gemma, M.; Nogtev, P.; Petrova, M.; Agro, F. E.; Cabrini, L.; Forfori, F.; Likhvantsev, V.; Bove, T.; Finco, G.; Landoni, G.; Zangrillo, A.; Ajello, S.; Cappelletti, A. M.; Fominskiy, E.; Nisi, F. G.; Pazzanese, V.; Pieri, M.; Canavosio, F.; Palmesino, F.; Bernasconi, M.; Gallioli, G.; Marino, G.; Vetrugno, L.; Millin, C.; Missio, D.; Gallicchio, F.; Azzali, B.; Bozzetti, M.; Cristadoro, D.; Perone, R.; Cantatore, L. P.; Curci, G.; Pabon, I. M.; Garofalo, E.; Mainetti, M.; Calamai, I.; Maraggia, D.; Mattei, A.; Yavorovskiy, A