Intensive Care Outcomes and Differences Between Survivors and Deceased Patients in a Terminal Coma: A Retrospective Observational Study

Background. Early prognosis for the outcome of a coma-induced critical condition is central to selecting an optimal tactic for patient management. This question remains insufficiently studied, thus justifying the task of identifying significant criteria for differences in terminal coma patients (stage III, irreversible) who died and those recovered to different levels of consciousness.Objectives. To analyze the intensive care outcomes for patients in a terminal coma and to establish differences between the initial state of patients who have died and those who have recovered to different levels of consciousness.Methods. A retrospective observational study was conducted on 210 patients aged 21 to 65 hospitalized in the Anesthesiology and Resuscitation Unit of Ochapovsky Regional Clinical Hospital No. 1 (Krasnodarsky Krai) with a diagnosis of terminal coma in the period from 2010 to 2015. The study did not include patients with pregnancy, histologically-confirmed malignancies, cardiovascular diseases (NYHA classes III-IV, according to the New York Heart Association Functional Classification), terminal liver cirrhosis and chronic kidney disease at the stage of hemodialysis. Depending on the critical condition outcome, the admitted patients were divided into groups: group 1 (n = 101) — patients with adverse outcomes; group 2 (n = 109) — patients with relatively favorable outcomes (recovery to a level of consciousness at score 4 and higher, according to The Glasgow Coma Scale). The condition was assessed with referring to available clinical data. Statistical processing of the obtained study results was carried out via nonparametric techniques using Microsoft Excel 10 (Microsoft, USA) and Statistica 6.0 (StatSoft, USA).Results. The mortality structure against the background of a terminal coma in the following diagnosis: polytrauma — 54%, hemorrhagic stroke — 56%, isolated traumatic brain injury — 37%, acute cerebrovascular accidents (ischemic type) — 33% and acute posthypoxic dyscirculatory encephalopathy — 11%. Intergroup differences between the deceased and survivors were obtained in the following parameters: age (older with unfavorable outcome); base deficit — by 52%; glucose — by 47.6%; troponin — by 47.1%; potassium — by 13.7% and daily diuresis — by 27.5%.Conclusion. The obtained results are likely to be used in a combination of clinical, instrumental and laboratory examinations in order to provide early detection of the risk group with an adverse outcome

Prediction of intraoperative arterial hypotension associated with the spinal anesthesia. Prospective observational study

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1

Postoperative delirium in elderly patients after thoracic surgery

Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery;    (–4.8151) multiplied by the blood glucose level the morning after surgery

The correlation functions of the XX Heisenberg magnet and random walks of vicious walkers

A relationship of the random walks on one-dimensional periodic lattice and the correlation functions of the XX Heisenberg spin chain is investigated. The operator averages taken over the ferromagnetic state play a role of generating functions of the number of paths made by the so-called "vicious" random walkers (the vicious walkers annihilate each other provided they arrive at the same lattice site). It is shown that the two-point correlation function of spins, calculated over eigen-states of the XX magnet, can be interpreted as the generating function of paths made by a single walker in a medium characterized by a non-constant number of vicious neighbors. The answers are obtained for a number of paths made by the described walker from some fixed lattice site to another sufficiently remote one. Asymptotical estimates for the number of paths are provided in the limit, when the number of steps is increased.Comment: 16 pages, 1 figure, LaTeX. Extended talk at the Conference "Classical and Quantum Integrable Systems CQIS-08" (Protvino, Russia, January 21-24, 2008). To appear in Theoretical and Mathematical Physics in 2009 (In Russian

Oxygen-dependent metabolism of polymorphonuclear leukocytes in the peripheral blood of patients with intolerance to non-steroidal anti-inflammatory drugs

We investigated the oxygen-dependent metabolism of polymorphonuclear leukocytes (PML) in peripheral blood of patients with intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) with different clinical manifestations with methods stimulated barium sulfate luminol- and lucigenin-dependent chemiluminescence. Revealed the violations of oxidative metabolism PML the blood in patients with asthmatic triad, resulting in a decrease in the total production of reactive oxygen species (ROS) and production of superoxide anion radical PML compared with healthy donors. In patients with chronic urticaria, worsening after administration of NSAIDs, significant changes in ROS production relative to such a healthy donors were not identified

Operator interpretation of resonances generated by some operator matrices

We consider the analytic continuation of the transfer function for a 2x2 matrix Hamiltonian into the unphysical sheets of the energy Riemann surface. We construct a family of non-selfadjoint operators which reproduce certain parts of the transfer-function spectrum including resonances situated on the unphysical sheets neighboring the physical sheet. On this basis, completeness and basis properties for the root vectors of the transfer function (including those for the resonances) are proved.Comment: LaTeX, 15 pages, no figures; Contribution to Proceedings of the Mark Krein International Conference on Operator Theory and Applications, Odessa, August 18-22, 199

Experimental investigation of high-energy photon splitting in atomic fields

The new data analysis of the experiment, where the photon splitting in the atomic fields has been observed for the first time, is presented. This experiment was performed at the tagged photon beam of the ROKK-1M facility at the VEPP-4M collider. In the energy region of 120-450 MeV, the statistics of $1.6\cdot 10^9$ photons incident on the BGO target was collected. About 400 candidates to the photon splitting events were reconstructed. Within the attained experimental accuracy, the experimental results are consistent with the cross section calculated exactly in an atomic field. The predictions obtained in the Born approximation significantly differ from the experimental results.Comment: 11 pages, 6 figures, LaTe

ЭФФЕКТЫ ПРЕДОПЕРАЦИОННОГО ВВЕДЕНИЯ КОНЦЕНТРИРОВАННОЙ ГЛЮКОЗЫ ПРИ АНЕСТЕЗИОЛОГИЧЕСКОМ ОБЕСПЕЧЕНИИ ОПЕРАЦИЙ НА ЛЕГКИХ

The article presents the experience of use and efficiency of pre-operative carbohydrate administration of 20% glucose intravenously during anasthesiological support of thorax cancer surgery. The article shows the parameters of hemodynamics, results of intra and post-operative laboratory monitoring of glycemia, albumin levels, time of the enteral feeding start, duration of patients’ stay in the intensive care department and duration of the general hospital stay, basing on the above parameters the conclusion has been made about reduction in significance of metabolic stress response to surgical aggression in this category of the patients. Освещены опыт использования и эффективность предоперационной углеводной нагрузки 20% глюкозой внутривенно при анестезиологическом обеспечении онкоторакальных операций. Показаны параметры гемодинамики, результаты интра- и послеоперационного лабораторного контроля уровня гликемии, альбумина, время начала энтерального питания, сроки нахождения пациентов в отделении интенсивной терапии и в стационаре в целом, на основании которых сделано заключение о снижении выраженности метаболического стресс-ответа на хирургическую агрессию у пациентов данной категории.