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Biomedical subjects

V S Timokhov

Publications and source records attributed to V S Timokhov.

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

[Complement system during hemofiltration in patients with multiple organ failure].

Nine patients (8 men and 1 woman) were treated. Sepsis was diagnosed in 7 of them. All patients were subjected to forced ventilation of the lungs, 6 were in need of inotropic support. The severity of clinical status was 31 +/- 0.8 according to APACHE II score. One patient survived. The main method of substitute renal therapy (SRT) was permanent hemofiltration with spontaneous arteriovenous perfusion. The results indicate manifest depletion of the complement system augmenting with the progress of multiple organ failure (MOF). Extracorporeal perfusion in SRT had no additional negative effects on the complement system damaged by disease. Nonselective penetration of individual complement fractions into the filtrate in the course of perfusion was noted. Therefore, the complement system is severely damaged in patients with MOF; it can modulate the SRT because of penetration of its individual fractions.

APACHE↗
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[Lactate kinetics during constant hemodiafiltration in critically severe patients with the systemic inflammatory response syndrome and multiple organ failure].

High-volume hemodiafiltration is a new approach to the treatment of critical patients with generalized inflammatory reaction and multiple organ failure. Increase of the liquid exchange during the procedure is fraught with the development of secondary metabolic disorders in cases when lactate-based buffer is used (with high amounts of lactate). This study was undertaken to evaluate the consequences for the acid-base balance in patients with hypoxia and circulatory failure. Twelve patients (6 men and 6 women) with APACHE II score 25 were examined. The major treatment modality was continuous hemodiafiltration. The results indicate that lactate-buffered solutions can be used in critical patients, because they do not cause a notable increase in the blood lactate levels due to its good utilization. Moreover, it is associated with correction of disorders in acid-base balance. No negative clinical consequences were observed after using lactate anion in high concentrations as the major buffer compound.

Acid-Base Equilibrium↗
PubMedDate not supplied

[High-volume hemodiafiltration in the treatment of sepsis and multiple organ failure: 2 methods of the elimination of TNF-alpha].

Permanent hemodiafiltration (PHDF) as a method for treating patients with sepsis and multiple organ failure (MOF) corrects the severity of generalized inflammatory reaction, which is caused by hyperproduction of bioactive substances. Cytokines can be eliminated from circulation by 2 methods of kidney-replacing therapy: convection and adsorption on hemofilter membrane. Despite the slight adsorption clearance, our results indicate that experimental data not always correspond to the clinical situation. Pronounced cytokinemia persists in patients with sepsis and MOF during PHDF. In addition to correction of the main hemostasis parameters, kidney-replacing therapy eliminates an appreciable amount of TNF-alpha and other proinflammatory cytokines. Estimation of TNF-alpha balance indicates its good adsorption on the surface of hemodiafilter membrane.

Adult↗
PubMedDate not supplied

[Acute lung injury syndrome and hemodiafiltration].

Acute lung injury syndrome is one of the most frequent components of polyorgan failure, particularly resultant from sepsis. Replacing renal therapy can correct uremic disorders in the hemostasis and gaseous exchange disorders in the lungs by eliminating excessive fluid in case of hyperhydration and by eliminating inflammation mediators. The present study demonstrated a favorable impact of hemodiafiltration on ventilation oxygen status of patients with acute lung injuries, which was confirmed by positive changes in blood oxygen pressure, intrapulmonary shunt, alveolar-arterial oxygen difference, etc. Changes in oxygen transport corresponded to those in patients with sepsis and shock without hemodiafiltration.

Acute Disease↗
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[Renal replacement therapy in acute infectious renal insufficiency].

A modern view on renal failure in patients with infectious diseases is presented and possibilities of various methods of renal replacement therapy are evaluated. The authors emphasize the obligatory combination of etiotropic and pathogenetic therapy. A clinical case is presented: a patient with tropical and 3-day malaria was effectively treated by high-flow intermittent hemofiltration.

Acute Kidney Injury↗
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[Systemic hemodynamics in constant hemofiltration in patients with septic shock].

Hemodiafiltration (HDF) is a method of pathogenetic therapy for the systemic inflammatory response syndrome in patients with sepsis and shock irrespective of renal failure. Systemic hemodynamics was examined in 18 patients with septic shock treated by HDF (2 groups). HDF was associated with stabilization of systemic hemodynamics in 50% patients (cardiac index, total peripheral resistance, index of the left heart work increased and the number of heart beats, central venous pressure, mean pressure in the pulmonary artery, pulmonary capillary wedging pressure decreased, oxygen consumption index increased, etc.), which allowed a reduction of the initial dopamine and norepinephrine doses 3-fold and lower by the end of days 3-4 of HDF treatment. An opposite tendency was observed in group 2 (refractory shock). Despite high (72.2%) mortality which was mainly caused by the progress of multiple organ dysfunction or untimely surgical intervention, it is obvious that HDF created conditions for surviving the critical period of disease in patients with progressive sepsis.

APACHE↗
PubMedDate not supplied

[Kinetic modeling during continuous hemodiafiltration in patients with sepsis and multiorgan failure].

Kinetic simulation in terms of urea and creatinine is the best way of prescribing a dialysis dose and assessing its quality as it considers differences in a patient's body weight, the level of catabolism, the rate of equilibration, including the recirculation phenomenon noticeably observed under shock. A 2-pool model of distribution of urea and creatinine was employed in the study. The latter was carried out in 31 patients (17 males and 14 females) with sepsis and multi-organ failure receiving 50 sessions of continuous hemodiafiltration (CHDF). The mean duration of CHDF was 73.8 +/- 7.0 (4.0-207.0) hours, the daily volumes of a substitute, a dialysate, and an effluent (filtrate + dialysate) were 33 +/- 1.0 (5.0-60.0), 43.9 +/- 0.8 (2.6-62.0), and 80.4 +/- 1.6 (12.0-122.3) liters a day, respectively. An analysis confirmed the high efficiency of CHDF close to that of the daily volume-body weight ratio and showed that such conditions of the procedure are optimal in maintaining azotemia at the subnormal level irrespective of the degree of cababolism.

Creatinine↗
PubMedDate not supplied

[Pharmacokinetic simulation of different modes of renal replacement therapy].

Based on the results of examination of patients with severe acute renal failure and multiorgan insufficiency, the authors give a comparative analysis of different modes of renal replacement therapy, such as intermittent hemofiltration, continuous arteriovenous hemofiltration, and continuous venovenous hemodiafiltration. Kinetic simulation in terms of urea and creatinine, by employing a one- and two-pool model for the disposition of these substances in the patient's body was taken as a basic method. The analysis led to the conclusion that continuous hemodiafiltration (CHDF) with an actually large volume of filtration and dialysis was the optimum technique for correcting uremic impairments of homeostasis in critically ill patients. CHDF failed to induce a significant metabolic stress and to noticeably affect the rate of urea and creatinine generation. Overall, all the filtration treatments are an effective means of eliminating low-molecular-weight nitrogenous metabolites that are characterized by the high rate of generation and the large volume of disposition in the organism. It is necessary only to correctly select a dose of renal therapy.

Acute Kidney Injury↗
PubMedDate not supplied

[The level of neopterin in the plasma of patients with acute kidney failure during treatment with continuous arteriovenous hemofiltration].

Neopterin is a biochemical marker of cellular mediated immune reactions and may be used in elucidating the cause of acute renal failure. 9 patients (6 males, 3 females) aged 23 to 56 years suffering from a severe form of the disease were examined. A continuous arteriovenous hemofiltration was used as a treatment with exchanging 29.2 +/- 2.0 (14-65) kg of fluid during 24 hours. The patients' diet included protein and amino acids of 1.2-1.5 g/kg of body weight, 35-45 Kcal/kg of body weight per 24 hours with meal and parenteral infusions. 4 patients died. Contents of neopterin in the plasma of the healthy equaled to 6.8 +/- 03 (3.4-11.3) nmol/l (radioimmunoassay; Henning; Berlin, GmbH). In patients with acute renal failure plasma neopterin contents were increased, i.e. 130.0 +/- +/- 9.6 (48.2-200.2) nmol/l and in two thirds of the cases and correlated with creatinine levels (r = + 0.60 +/- 0.17; p less than 0.05; n = 23), thus showing a simultaneous influence of anuria and continuous arteriovenous hemofiltration on a neopterin pool amount at the same time, in patients with tropical malaria and hemotransfusion shocks (2 cases), the neopterin contents were extremely high and did not correlate with the creatinine level. During continuous hemofiltration at a rate of 21.6 +/- 1.3 (15.9-36.9) ml/min neopterine clearance was 17.2 +/- 2.1 (6.7-36.2) ml/min. Neopterin hyperproduction after blood transfusion suggests an immune conflict as a possible cause of acute renal failure.

Acute Kidney Injury↗
PubMedDate not supplied

[Middle-molecule oligopeptide kinetics during intermittent hemofiltration in patients with acute kidney failure].

Acute renal failure was treated by intermittent hemofiltration in 19 patients (8 males and 11 females), 13 of which survived and 6 died. All of them underwent examinations for kinetics and clearance of middle-mass oligopeptides (MMOP) performed by gel filtration (sephadex G-15) and densitometry in UV light (280 nm) using C phi-24 device. Plasma levels of oligopeptides in acute renal failure were found increased 20-fold. They consisted mainly of MMOP (1000-3000 D) entering the 13th eluate fraction. There appeared a correlation between oligopeptides and creatinine plasma levels. Under hemofiltration lasting for 6.45 hours and replacing approximately total body fluid, nearly all the baseline extracellular oligopeptide pool was removed. The average rate of the filtration reached 127 ml/min, clearance of oligopeptides being 57.9 ml/min or more than 22 1 of fluid per one procedure. Intermittent hemofiltration went in enhanced (8-fold) MMOP generation responsible for residual high levels of them in plasma after the procedure.

Acute Kidney Injury↗
PubMedDate not supplied

[The removal of beta 2-microglobulin during continuous and intermittent hemofiltration].

The kinetics of beta 2-microglobulin was studied during chronic arteriovenous filtration of the blood (altogether 8 sessions with a mean duration of 54 hrs, the rate of filtration, 0.5 kg/hr, substitution volume 12.5 kg/day) or intermittent ultrafiltration (altogether 20 sessions with a mean duration of 5.64 hrs, the rate of filtration 10 kg/hr; substitution volume, 10 kg/hr) in 8 patients with acute renal failure (ARF) and 5 ones with chronic renal failure (CRF). The authors employed filters HF-55,77,88 manufactured by "Gambro" (a polyamide membrane) and filters D-30 production by "Amicon" (a polysulfone membrane). The substitution was performed in some of ARF patients after the dilution and in some of them pre- and postdilution substitution was combined. CRF patients were parenterally substituted with balanced solution. Heparine was injected in a dose of 10-15 units per hour. The initial blood levels of beta 2microglobulin in the patients under chronic procedure were 16.6 +/- 70.7 (39.2 +/- 9.35) mg/litre, final levels 9.3 +/- 73.3 (32.5 +/- 6.36) mg/litre. The elimination volume of beta 2-microglobulin and the filtration solution was 80.5 +/- 291.2 (162.7 +/- 20.2) mg/day, comprised 1/5 of the pool and was in proportion to the amount of the substituted fluid. In the patients with intermittent filtration the initial blood levels of beta 2-microglobulin were 15-30 (25.5 +/- 1.5) mg/litre while its final levels were 5.7 +/- 26.9 (15.1 +/- 1.2) mg/litre. The elimination volume of beta 2-microglobulin and the filtration solution was 66.6 +/- 372.1 (176.1 +/- 15.8) mg per session. (ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗