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Biomedical subjects

A A Eremenko

Publications and source records attributed to A A Eremenko.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Use of "NovoSeven" (rFVIIa) hemostatic in patients operated with extracorporeal blood circulation].

The "NovoSeven" drug was used in 25 patients (male - 18, female - 7) operated on the heart and main vessels including with artificial extracorporeal circulation (AEC). Patients did not have any clinically significant impairment in blood circulation before surgery. Perioperatively, all of them and, immediately after surgery, 4 them had uncontrollable hemorrhages at 10-25 ml/min in spite of extensive hemostatic therapy, including freshly frozen plasma, cryoprecipitate, thromboconcentrate, trasilol and ?-amine acid. Yet in 30 min after "NovoSeven" administration, hemorrhages seized virtually in all patients irrespective of a surgical intervention. It normalized the hemostasis by it differential action on an impairment depending on an activated or suppressed coagulation. Thus, the conclusion is that the "NovoSeven" (rFVIIa) is an effective hemostatic ensuring the correction of massive intra- and postoperative blood losses in cardiosurgery patients. The drug cuts the need in using the donor-blood components, thus, diminishing the risk of multi organ failure that can develop immediately after surgery.

Blood Coagulation↗
PubMedDate not supplied

[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome].

Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. The indications for extubation of patients were as follows: PaO2/FiO2 of 200 and more mm Hg, respiratory rate (RR) of less than 30 per min, respiratory volume of more than 6 ml/kg with pressure support at inspiration of less than 5 cm H2O and with the total pressure at the exhalation end of no more than 3 cm H2O. Mask ventilation sessions were started in a growing dyspnea of more than 26 per min, a decreased content of oxyhemoglobin in arterial blood (below 95% at oxygen inhalation of 10-15 l/min), involvement of auxiliary muscles in breathing and at subjective complaints of patients related with complicated breathing and with being short of air. The mask SIMV ventilation with a preset apparatus-aided rate of inhales of 2-6/min, with Bi-PAP and PSV inhale pressure of 15 cm/ H2O and with PEEP of 3-5 cm/ H2O was made by 40-120 min sessions; the number of IFMLV sessions ranged from 6 to 22/patient, mean - 11 +/- 1.1 h. The total IFMLV duration was 10.7 +/- 1.1 h. The need for respiratory support persisted for 4-6 days after extubation. In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.

Adult↗
PubMedDate not supplied

[Intraaortic balloon counterpulsation in the treatment of perioperative cardiogenic shock-complicated myocardial infarction during aortocoronary bypass surgery].

The paper presents the results of use of intraaortic balloon counterpulsation (IABC) in complex therapy for cardiogemic shock in 31 patients with perioperative myocardial infarction (PMI) developed during aortocoronary bypass surgery under extracorporeal circulation (EC) and cold cardioplegia. The diagnosis of PMI was confirmed by the ECG data (the emergence of new Q waves) and by the high level of CPC-MB (more than 6%). IABC was performed, by using a Kontron M-7000 apparatus. The time elapsed from the onset of myocardial infarction to the start of IABC averaged 15.7 + 4.3 hours and the duration of the latter did 105 +/- 13 hours. IABC was initiated in 4 (12.9%) patients in the operating room before EC, in 20 (64.5%) during disconnection from EC, in 7 (22.6%) patients, who were unresponsive to pharmacological therapy, 6-26 hours after surgery. All the patients were divided into 2 groups: (1) 22 patients who had benefited from complex therapy using IABC; they were all successfully disconnected from the balloon pump; (2) 9 patients with refractory heart failure who had died during IABC. The latter has been shown to be one of the effective treatments of PMI and cardiogenic shock during aortocoronary bypass surgery, which achieves hemodynamic stabilization in 70.9% of cases. The results of complex therapy for cardiogenic shock depend on the site and extent of myocardial infarction. Lesions to the anterolateroposterior or anteroseptal area of the left ventricle belong to poor predictors. The outcomes of treatment are poor if there are significant hemodynamic disorders that require, besides cardiotonic agents, the administration of large doses of agents having a potent vasopressor effect (adrenaline and noradrenaline). Improvements in left ventricular pump function, cardiac output, and a significant reduction in the doses of sympathomimetics within the first 12 hours of IABC should be considered to be a good predictor. With the complex treatment of cardiogenic shock, by using counterpulsation after aortocoronary bypass surgery is 51.6%. The early initiation of IABC within 6 hours following the development of myocardial infarction allows mortality to be reduced.

Aged↗
PubMedDate not supplied

[Use of a Transtec transdermal therapeutic system of buprenorphine for analgesia in the early periods after cardiosurgical operations].

The analgesic effect of a transdermal therapeutic system (TTS) (Transtec) of buprenorphine was evaluated for analgesia in cardiosurgical patients in the early postoperative period. Before sternotomy, Transtec was applied to the skin of the shoulder in 30 patients operated on the heart under extracorporeal circulation. A control group comprised 20 patients receiving the nonsteroidal anti-inflammatory agent Xifocam in an intravenous dose of 8 mg twice daily. The first injection of Xefocam was made 1.5-2 hours prior to tracheal extubation. With the use of Transtec, the degree of pain was 1.58 scores by the five-score scale at the moment of tracheal extubation; it reduced to 1 score 16 hours after extrubation; it was 0.76 scores by the end of the first day, less than 0.5 score by the middle of day 2, reduced to zero by the end of day 3. By the moment of tracheal extubation, the degree of pain in patients receiving Xefocam was 3 scores; by the end of 24 hours, it reduced to 2 scores and remained the same by the end of day 3. During more effective analgesia with Transtec, inspiratory lung capacity was much higher than during that with Xefocam. The difference in the mean values of this parameter was 510 to 830 ml (p < 0.05) at the stages of the investigation. The findings confirmed a rather long (72-hour) continuous and steady analgesic effect of Transtec TTS. Due to the analgesic effect of Transtec, there was a significant improvement of respiratory function in patients after cardiothoracic operations.

Administration, Cutaneous↗
PubMedDate not supplied

[Results of the use of intraaortic balloon counterpulsation in patients with perioperative myocardial infarct].

The results of complex intensive therapy of cardiogenic shock have been studied in 17 patients with acute myocardial infarction developed as a complication of reconstructive surgery for ischemic heart disease. Complex therapy of cardiogenic shock included the use of intraaortic balloon contrapulsation, adrenomimetic agents, controlled lung ventilation and other intensive care procedures. 11 patients (64.7%) recovered from cardiogenic shock, 4 of them survived and were discharged from hospital. In 6 patients (35.3%) the combined use of adrenomimetics and intraaortic balloon contrapulsation had no effect. The results of intensive care procedures were shown to depend on the size of perioperative myocardial infarction, which affected the severity of hemodynamic disturbances and duration and efficacy of complex intensive therapy of cardiogenic shock. The use of intraaortic balloon contrapulsation in cardiogenic shock resistant to adrenomimetic agents led to temporary hemodynamic stabilization without improving the prognosis.

Adult↗
PubMedDate not supplied

[Reaction of the blood circulation and its oxygen transport function to the discontinuation of prolonged mechanical lung ventilation in heart surgery patients with an uncomplicated postoperative period].

The studies of changes in central hemodynamics and oxygen balance during discontinuation of controlled lung ventilation in 24 cardiosurgical patients with uncomplicated postoperative period have demonstrated 2 types of circulatory response to transition to adequate spontaneous respiration. It has been shown that an increase in O2 consumption due to the involvement of respiratory muscles is the main factor affecting the resetting of central hemodynamics and oxygen balance during transition to spontaneous respiration. While in patients with normodynamic type of circulation O2 increment is as a rule caused by an increase in cardiac performance, in cardiosurgical patients with hyperdynamic type of circulation O2 increment is mainly ensured by enhanced tissue O2 extraction.

Cardiac Surgical Procedures↗
PubMedDate not supplied

[Methodologic approach to the discontinuation of long-term artificial ventilation in cardiosurgical patients with postoperative cardiac insufficiency].

Correction of postoperative heart failure by continuous dopamine infusion makes it possible to avoid a decrease in cardiac performance and development of inadequate oxygen tissue supply in the course of discontinuation of controlled lung ventilation. It has been demonstrated that in a number of cases it is necessary to increase the drug dose to prevent inadequate oxygen supply of organs and tissues in patients with exhausted tissue reserves.

Aortic Valve↗
PubMedDate not supplied

[Disorders of O2 transport and their correction in heart surgery patients].

Basic factors of O2 transport disturbances and mechanisms of their compensation have been studied in 1200 patients after cardiac surgery. It has been shown that O2 transport decrease is induced by damages in oxygenating blood function, decreased cardiac performance and hemoglobin blood level, oxyhemoglobin dissociation curve deviation and changes in Hb affinity to O2 with regard to 2,3-DPG content. The causes of arterial O2 transport damage affect the treatment procedures, including oxygen therapy, controlled lung ventilation, erythrocyte mass transfusion, inotropic drug administration, hypothermia.

Cardiac Surgical Procedures↗
PubMedDate not supplied

[Diagnostic value of laboratory indicators in various states of oxygen transport function of the blood in patients, operated on under conditions of cardiopulmonary bypass].

Changes in oxygen and acid-base balance have been studied in 86 patients with different oxygen transport function after cardiopulmonary bypass surgery. It has been shown that diagnostic value of such indexes as SO2 and pO2 in mixed venous blood, O2 consumption and transport, blood and erythrocyte acid-base balance, lactate concentration depends on the cardiac pump function, microcirculatory patterns, pulmonary oxygenation and cell metabolism. In case of acute circulatory disturbances in the early postoperative period the prognostic value of each laboratory finding is in close correlation with the degree of circulatory failure. The observation of changes in oxygen and acid-base balance in the first hours after the operation enables a more accurate diagnosis of disturbances in the inner body medium and a choice of pathogenetically verified methods of their correction in patients after cardiopulmonary bypass surgery to be made.

Blood Chemical Analysis↗
PubMedDate not supplied

[The use of computers for diagnosis and control of the treatment of acid-base imbalance during controlled lung ventilation in patients following thoracic surgery].

An algorithm for diagnosis and control over therapy of acid-base imbalance during controlled lung ventilation in patients after thoracic surgery has been elaborated and described. Acid-base balance was studied 162 times in 32 patients after thoracic surgery. Automatic diagnosis and control over acid-base imbalance therapy rule out subjective interpretation of the findings obtained and make it possible, if necessary, to titrate accurately the dosage of correcting drugs and establish the priority of treatment procedures.

Acid-Base Imbalance↗