scholarly journals Modern approaches to the correction of hemodynamic disorders in patients with severe combined trauma

2020 ◽  
Vol 3 (1) ◽  
pp. 21-26
Author(s):  
Oleh Loskutov ◽  
Serhii Nedashkivskyi ◽  
Serhii Babak ◽  
Serhii Diachenko ◽  
Borys Kedo ◽  
...  
Keyword(s):  
Blood Circulation ◽  
Extracellular Fluid ◽  
Traumatic Shock ◽  
Severe Trauma ◽  
Infusion Therapy ◽  
Hemodynamic Profile ◽  
Crystalloid Solutions ◽  
Group 2 ◽  
Multicomponent Solutions ◽  
Rational Program

Background. The choice of a rational program of infusion therapy for severe trauma remains an urgent problem. Crystalloid solutions are used as the main infusion media, but data on the effect of balanced multicomponent solutions on the hemodynamic profile in patients with severe trauma in the literature are almost absent. The aim: to investigate the possibility of correction of hemodynamic disorders in patients with severe combined trauma with the use of a modern multicomponent drug based on a 6% solution of sorbitol (reosorbilact). Material and methods: a total of 60 patients with severe combined trauma and the clinic of degree I–II traumatic shock aged 18 to 46 years were examined. Patients were divided into two groups: 1st group (n = 30) – patients who included in the standard complex of intensive care (IС) reosorbilact at a dose of 8–10 ml/kg body weight; 2nd group (n = 30) – patients who underwent a standard IС complex. Results: administration of reosorbilact resulted in a decrease in extracellular fluid volume, an increase in BCC and a transition from hypokinetic to eukinetic circulation within 3 hours of infusion and persisted for up to 6 hours after infusion (p < 0.01). The introduction of adrenomimetics were required: before the study in groups 1 and 2 – 7 (23.3 %) and 6 (20.0 %) patients, after 6 hours – respectively 1 (3.3 %) and 4 (13.3 %), and one day after the introduction of reosorbilact no patient required the introduction of adrenomimetics, whereas in group 2 such patients were 3 (10.0 %, p < 0.05). Conclusions. The use of balanced multicomponent solutions based on sorbitol is accompanied by a change in the hypokinetic type of blood circulation to eukinetic, lack of interhydration hyperhydration, rapid stabilization of hemodynamic parameters and reduced need for adrenomimetic support. Conflict of interest: absent

Use of Continuous Blood Volume Monitoring to Detect Inadequately High Dry Weight

1996 ◽  
Vol 19 (7) ◽  
pp. 411-414 ◽  
Author(s):  
F. Lopot ◽  
P. Kotyk ◽  
J. Bláha ◽  
J. Forejt
Keyword(s):  
Blood Volume ◽  
Vena Cava ◽  
Extracellular Fluid ◽  
Dry Weight ◽  
Whole Body ◽  
The Status ◽  
Varying Length ◽  
Group 3 ◽  
Group 2 ◽  
Total Body

A continuous blood volume monitoring (CBVM) device (Inline Diagnostics, Riverdale, USA) was used to study response to prescribed ultrafiltration during haemodialysis (HD) in 66 stabilised HD patients. Fifty percent of patients showed the expected linear decrease in BV right from the beginning of HD (group 1), 32% exhibited no decrease at all (group 2), while eighteen percent formed the transient group 3 which showed a plateau of varying length after which a decrease occurred. The correct setting of dry weight was verified through evaluation of the ratio of extracellular fluid volume to total body water (VEC/TBW) in 26 patients by means of whole body multifrequency impedometry MFI (Xitron Tech., San Diego, USA) and through measurement of the Vena Cava Inferior diameter (VCID) pre and post HD (in 6 and 5 patients from groups 1 and 3 and from group 2, respectively). The mean VEC/TBW in groups 1 and 3 was 0.56 pre and 0.51 post HD as compared to 0.583 and 0.551 in group 2. VCID decreased on average by 14.1% in groups 1 and 3 but remained stable in group 2. Both findings thus confirmed inadequately high estimation of dry weight. Since CBVM is extremely easy to perform it can be used as a method of choice in detecting inadequately high prescribed dry weight. The status of the cardiovascular system must always be considered before final judgement is made.

scholarly journals Characteristic features of maxillofacial phlegmon morbidity with assessment of efficiency of detoxication therapy

2019 ◽  
Vol 36 (2) ◽  
pp. 29-35
Author(s):  
I. A. Boev ◽  
A. P. Godovalov ◽  
G. I. Shtraube ◽  
G. I. Antakov
Keyword(s):  
Standard Therapy ◽  
Infusion Therapy ◽  
Tissue Destruction ◽  
Endogenous Intoxication ◽  
Sickness Rate ◽  
Perm Krai ◽  
Characteristic Features ◽  
Group 2 ◽  
Opportunistic Pathogenic

Aim. To study the characteristic features of long-term facial phlegmon morbidity in Perm Krai with assessment of the efficiency of infusion therapy using indices of endogenous intoxication expression. Materials and methods. Manifestations of epidemic process of facial phlegmons were studied on the basis of a detailed retrospective analysis of sickness rate among the inhabitants of Perm Krai for the period of 2011–2016. In group 1, all patients besides standard therapy, underwent infusion therapy, and in group 2 – standard therapy alone. Prior to and after the therapy, peripheral blood cellular composition was assessed, and leukocytic indices of intoxication were calculated. Results. A long-term dynamics of facial phlegmon morbidity was established to show the irregularity of process expression according to years. Growth of the quantity of patients is provided by increase in the number of cases with complicated forms. Besides, males play a significant role in formation of sickness rate: the chances for the development of phlegmon among them are 1.49 times higher than in females. In the age structure of morbidity, prevail persons aged 21–30 and 31–50. A half of patients have endogenous intoxication. The course of infusion therapy essentially reduces the expression of endogenous intoxication. Conclusions. There is observed a tendency to growth of facial phlegmon morbidity that is probably connected with changes in etiological structure of pathogenic agents as well as with formation of pathosymbiosis of some opportunistic pathogenic microorganisms. As a rule, phlegmon is being developed against the background of endogenous intoxication, conditioned by both microbial metabolites and tissue destruction products. The efficiency of correction of endogenous intoxication using infusion therapy is shown.

scholarly journals The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement

2018 ◽  
Vol 20 (4) ◽  
pp. 106-112
Author(s):  
I M Samokhvalov ◽  
K P Golovko ◽  
A V Denisov ◽  
S Yu Telitsky ◽  
N A Zhirnova ◽  
...  
Keyword(s):  
Blood Volume ◽  
Medical Devices ◽  
Limited Liability ◽  
Traumatic Shock ◽  
Infusion Therapy ◽  
Volume Resuscitation ◽  
Limited Liability Company ◽  
Circulating Blood Volume ◽  
Medical Evacuation ◽  
Intraosseous Infusion

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

scholarly journals Peculiarities of tissue water fractional composition in case of experimental whole-body hyperthermia

2015 ◽  
Vol 6 (2) ◽  
pp. 97-102
Author(s):  
O. V. Kuznetsova
Keyword(s):  
Relaxation Rate ◽  
Renal Cortex ◽  
Fractional Composition ◽  
Relaxation Times ◽  
Extracellular Fluid ◽  
Whole Body ◽  
T2 Relaxation ◽  
Tissue Water ◽  
Whole Body Hyperthermia ◽  
Group 2

The present study, using proton nuclear magnetic resonance relaxation (NMR) method, was undertaken to compare the water fractional composition in nature tissues (group 1) with those damaged by experimental whole-body hyperthermia (group 2). We measured longitudinal or “spin-lattice” (T1) and transverse or “spin-spin” (T2) relaxation times of protons of tissues (brain, the atria of the heart, the kidneys and the renal cortex) from adult Wistar rats. The differences in T1, T2 and percentage of the intra- and extracellular water between group 1 and 2 were studied to help understand how the water moves in tissues at hyperthermia. The results of this study and the literature data allow to make conclusions about tissue water fractional composition in case of experimental whole-body hyperthermia: (1) fractional composition of water and the distribution of intra- and extracellular fluid in the tissue of the atria of the heart did not change (T1 and T2 relaxation times remained unchanged); (2) the crystalline water fraction increased in brain (longer T1 relaxation rate and shorter T2 relaxation rate). This is obstructing the exchange of protons between free and bound water in brain. Thus, loss of water by brain cells is prevented. The distribution between intra- and extracellular fluid in brain remained unchanged; (3) fraction of free water increased in renal tissue (simultaneous longer T1 and T2 relaxation rates) by reducing the volume of extracellular fluid; (4) thick hydration layer of water (longer T1 relaxation rate, T2 remained unchanged) was formed in the extracellular fluid of renal cortex. This water layer is formed around the sodium ions which concentration is increased in renal cortex tissue of rats from group 2. Аs a result, the amount of fluid secreted by kidneys is reduced, i.e. there is a retention of water in the body. The relevance of our research for the understanding of high temperatures’ adaptation mechanisms is discussed in this paper. 

scholarly journals PECULIARITIES OF ELECTROLYTIC BALANCE IN THE BLOOD OF NEWBORNS WITH KIDNEY DAMAGE DUE TO ASPHYXIA

2019 ◽  
Vol 7 (4) ◽  
pp. 341-350
Author(s):  
A. M. Loboda ◽  
O. I. Smiyan ◽  
S. V. Popov ◽  
V. O. Petrashenko ◽  
D. A. Loboda
Keyword(s):  
Renal Function ◽  
Kidney Function ◽  
Impaired Renal Function ◽  
Neonatal Period ◽  
Diuretic Therapy ◽  
Extracellular Fluid ◽  
Infusion Therapy ◽  
Term Infants ◽  
Sodium Potassium ◽  
Calcium Magnesium

Introduction. The study of the concentration of main electrolytes in serum of blood and erythrocytes in neonates with impaired renal function due to asphyxia is important, because it allows determining violations of their content and balance, tactics of infusion and diuretic therapy. The purpose of the work is explore the features of the content and balance of electrolytes (sodium, potassium, calcium, magnesium) in serum and red blood cells of newborns with disturbance kidney function due to asphyxia. Materials and methods. The study involved 200 term infants with signs of disturbance kidney function: 100 children who have suffered severe asphyxia, 100 children – with moderate asphyxia. Comparison group consisted of 20 infants without asphyxia at birth. The content of electrolytes determined by emission photometry, also expected ratios in pairs Na/K and Ca/Mg and transmembrane ratio of trace elements. Results and discussion. The critical period of formation electrolyte imbalances in neonates with impaired renal function due to moderate asphyxia is the early neonatal period, in case of severe asphyxia – all neonatal period. The feature of ischemic renal impairment in newborns is the development of serum hypernatremia and hyperkalemia, hypocalcemia and hypomagnesemia, decrease the ratio of Na/K and increase Ca/Mg. Red blood cell pool of macroelements in case of neonatorum ischemic nephropathy is characterized by the growth of sodium level and deficiency of potassium, calcium and magnesium, as well as growth transmineralisation Na/K ratio and decrease Ca/Mg. Growth transmembrane ratios relative to sodium and magnesium reflects their transport into the cell, and reducing ratios relative potassium and calcium indicates the predominance of these electrolyte transport in the extracellular fluid. Changes in serum and intracellular electrolyte content and balance must be considered during infusion therapy in infants with impaired renal function due to asphyxia.

scholarly journals Dvovremensko krvarenje kod bolesnika sa povredom slezine

2002 ◽  
Vol 49 (3) ◽  
pp. 55-61 ◽  
Author(s):  
B. Stefanovic ◽  
Aleksandar Karamarkovic ◽  
Z. Loncar ◽  
Sladjana Mijatovic ◽  
B. Stefanovic ◽  
...  
Keyword(s):  
Clinical Problem ◽  
Traumatic Shock ◽  
Severe Trauma ◽  
Lethal Outcome ◽  
Number Of Patients ◽  
Delayed Hemorrhage ◽  
Total Proportion ◽  
Immediate Surgery ◽  
Type Of Injury ◽  
Parameter Values

Although the diagnosis of spleen injuries is not a considerable clinical problem today, subsequent ruptures of this organ may occur in a smaller number of patients (2-5% of total proportion of spleen injuries) following the so-called "free interval". Such injuries are most commonly explained by present hematoma localized in the central spleen, which becomes larger in time, and eventually causes its rupture. This form of lesion may be found both in isolated blunt abdominal injuries and in associated injuries. When it is the question of delayed hemorrhage, our results as well as data obtained from foreign literature, suggest three basic rise factors of the etiology of this type of injury. These are as follows: a) spleen injuries in severe trauma or polytrauma, b) older patients (over 65 years of age), and c) in cases when more than a single blood unit had to be administered for the initial hemodynamic stabilization of a patient. Delayed hemorrhage, which is occult in polytraumatized patients since it is frequently "disguised" by severity of clinical picture and traumatic shock, may subsequently cause sudden fall of hemogram and hemodynamic parameter values, and if immediate surgery is not performed, it may lead to heavy bleeding and lethal outcome of the patient.

scholarly journals Features of the infusion therapy at the prehospital stage with the ongoing bleeding

2021 ◽  
Vol 22 (3) ◽  
pp. 71-78
Author(s):  
A. V. Shchegolev ◽  
A. N. Gricaj ◽  
A. G. Klimov ◽  
V. N. Lapshin ◽  
V. S. Afonchikov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Capillary Pressure ◽  
Scientific Work ◽  
Venous Access ◽  
Infusion Therapy ◽  
Crystalloid Solutions ◽  
Optimal Approach ◽  
Uncontrolled Bleeding

The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.

scholarly journals Infusion and transfusion therapy: main aspects

2021 ◽  
Vol 17 (3) ◽  
pp. 25-29
Author(s):  
V.V. Nikonov ◽  
K.I. Lyzohub ◽  
M.V. Lyzohub
Keyword(s):  
Perioperative Period ◽  
Surgical Patients ◽  
Infusion Therapy ◽  
Evidence Based ◽  
Consensus Guidelines ◽  
Successful Management ◽  
Transfusion Therapy ◽  
Vital Functions ◽  
Crystalloid Solutions ◽  
Based Medicine

The adequate choice of strategy for infusion therapy is an essential component of successful management of critically ill patients. Infusion therapy is one of the main methods of maintai-ning vital functions of patients in the perioperative period. In the practice of a doctor, there are reasonable doubts about the feasibility and safety of various solutions for infusion therapy. Both are fundamental principles of infusion therapy, and the changes that have taken place, of course, need to be understood from the standpoint of evidence-based medicine. Balanced crystalloid solutions were safe and clinically effective, their use is provided by the Bri-tish Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients.

Infusion therapy in newborns

2020 ◽  
pp. 40-48
Author(s):  
Ekaterina Marchenko
Keyword(s):  
Breast Milk ◽  
Enteral Nutrition ◽  
Neonatal Period ◽  
Extracellular Fluid ◽  
Infusion Therapy ◽  
Milk Formula ◽  
Long Time ◽  
Proper Volume

Infusion therapy during the neonatal period is prescribed if it is not possible to start enteral nutrition for infant (breast milk/formula) or if it is necessary to maintain (correct) concentration of glucose and/or electrolytes. The main objective of infusion therapy is to maintain the proper volume of extracellular fluid. For adequate infusion therapy, it is necessary to determine physiological needs for fluids, calculate pathological losses, choose a solution for infusion therapy, calculate the amount of electrolytes administered, and determine the rate of infusion. Despite the fact that infusion therapy has been used widely and for a long time, there are still many unresolved issues, and the main ones are still «When?», «What?» and «How much?»

Differences of Medical Care for Acute Severe Viral Bronchiolitis in Two Urban Areas in Europe

2018 ◽  
Vol 230 (05) ◽  
pp. 245-250
Author(s):  
Christian Dohna-Schwake ◽  
Katrin Mücher ◽  
Florian Stehling ◽  
Tobias Rothoeft ◽  
Claudia Roll ◽  
...  
Keyword(s):  
Medical Care ◽  
Urban Areas ◽  
Winter Season ◽  
Respiratory Support ◽  
Inhalation Therapy ◽  
Urban Region ◽  
Infusion Therapy ◽  
Group 2 ◽  
Acute Viral Bronchiolitis ◽  
Group 1

Abstract Background Acute viral bronchiolitis is a frequent disease in infancy. There is little knowledge on medical care of severely affected infants in different European countries. Patients: Infants (n=146) with bronchiolitis requiring respiratory support in winter season 2015/2016 treated in either one of two regions in Central Europe: South of greater Paris region in France (group 1) and Ruhr area in Germany (group 2). Methods Retrospective chart review. Primary outcome parameter was duration of respiratory support. Results Infants in group 1 (n=96) were younger, suffered less frequently from neurologic disorders and had lower respiratory rates than in group 2 (n=50). CO2 levels and dyspnea score were similar. Ninety percent of infants in group 1 were treated by nasal Continuous Airway Pressure CPAP, while 80% of infants in group 2 were treated by High Flow Nasal Cannula HFNC. Duration of respiratory support was significantly shorter in group 1. Infants in group 2 received more frequently infusion therapy, more antibiotics and more inhalation therapy. Discussion Our results show better outcome for infants with viral bronchiolitis treated in France. Striking differences were the practice of respiratory support (nasal CPAP vs. HFNC) and the prescription of supportive treatments. Conclusion Treatment approaches in severe acute viral bronchiolitis differ widely between a French and a German urban region.

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