About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery

A.E. Bautin, A.V. Ksendikova, S.S. Belolipetskiy, N.R. Abutalimova, A.O. Marichev, A.V. Naimushin, V.L. Etin, A.M. Radovskiy, L.I. Karpova, V.K. Grebennik, M.L. Gordeev

Almazov National Medical Research Centre, St. Petersburg

For correspondence: Andrei E. Bautin, MD. PhD, Head of research division in anesthesiology and intensive care, Almazov National Medical Research Centre, St. Petersburg; e-mail: abautin@mail.ru, tel. +79217539110

For citation: Bautin AE, Ksendikova AV, Belolipetskiy SS, Abutalimova NR, Marichev AO, Naimushin AV, Etin VL, Radovskiy AM, Karpova LI, Grebennik VK, Gordeev ML. About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery. Alexander Saltanov Intensive Care Herald. 2019;2:66–74.

DOI: 10.21320/1818-474X-2019-2-66-74

Pharmacological scores, such as inotropic score (IS) and vasoactive-inotropic score (VIS) were created to quantify doses of vasoactive and inotropic drugs. The number of studies where IS and VIS were used for evaluation of postoperative period of adult patients after cardiac surgery is small.

Objective: to estimate IS and VIS as an approach for monitoring of the hemodynamic profile and clinical outcomes in the early postoperative period of cardiac surgery.

Methods. The study involved 144 patients older than 18 years who underwent cardiac surgery under cardiopulmonary bypass (CPB). In perioperative period we measured cardiac output using a Swan-Ganz catheter with the calculation of central hemodynamic parameters, and also VIS and IS wcre calculated. We evaluated the prognostic value of these pharmacological scores in the development of complications of the early postoperative period, as well as their correlation with the duration of respiratory support, the length of stay in the ICU, and total hospital time.

Results. IS ≥ 10 significantly associated with prolonged respiratory support, a long stay in the ICU and with a mortality rate of 28.6 %. Patients with IS ≥ 10 are characterized by a violation of tissue perfusion, main cause of which may be a low cardiac output syndrome. IS ≥ 10 can be used as criteria for the low cardiac output syndrome with impaired organ perfusion. The use of this pharmacological score as a predictor of adverse clinical outcomes and increased mortality is justified. The hemodynamic profile of patients with VIS ≥ 10 is characterized by the absence of signs of cardiac output decrease and normal organ perfusion. It has low prognostic significance for the adverse postoperative clinical outcomes and should not be used as perioperative criteria for low cardiac output. In addition, VIS ≥ 10 requires careful use as a predictor of adverse postoperative outcomes and mortality.

Keywords: Vasoactive-inotropic score, inotropic score, cardiac surgery, cardiopulmonary bypass, low cardiac output syndrome, vasoplegia syndrome, perioperative period, cardiac anesthesiology

Received: 11.03.2019


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Perioperative Management of Patients with Chronic Renal Failure

S.V. Sinkov, S.V. Grigor’ev

Kuban State Medical University of the Ministry of Public Health of the Russian Federation, Krasnodar

For correspondence: Sergey Vasilievich Sinkov — Doctor of Med. Sci., associate professor of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University, head of the Intensive Care Unit № 3 of Regional Clinical Hospital № 2; e-mail: ssinkov@yandex.ru

For citation: Sinkov SV, Grigor’ev SV. Perioperative Management of Patients with Chronic Renal Failure. Intensive Care Herald. 2017;4:58–65.

The review presents modern approaches to managing patients with chronic kidney disease at various stages of the perioperative period.

Among patients requiring surgical intervention, the proportion of patients with initially impaired renal function is increasing, many of them are on programmed dialysis. Reduction of kidney function is observed in 36 % of persons over the age of 60 and in 16 % of patients of working age.

The main goal of perioperative management of the patient with concomitant renal pathology is the prevention of the development of acute renal damage on a background of chronic. Such patients require more careful monitoring at all stages of treatment, a special infusion therapy approach, continuity during renal replacement therapy, correction of analgesics, anesthetics, antimicrobials and anticoagulants doses. Non-compliance with these principles is inevitably associated with an increase in the frequency of perioperative complications and mortality.

Keywords: chronic kidney disease, perioperative period

Received: 22.09.2017


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Perioperative Management Of Patients With Alcohol Dependence

A.Ye. Muronov

Kuban State Medical University, Krasnodar

For correspondence: Alexey Ye. Muronov — M.D., assistant professor, Department of anesthesiology, intensive care and transfusiology of Kuban State Medical University, Krasnodar; e-mail: aemuronov@mail.ru

For citation: Muronov AYe. Perioperative Management of Patients with Alcohol Dependence. Intensive Care Herald. 2017;2:61–68.

The review article covers the issues of perioperative management of patients with alcohol dependence. Particular attention is paid to the most common methods of diagnosing alcohol dependence: the collection of anamnesis and the detection of the amount of alcohol consumed, the use of special questionnaires, direct and indirect laboratory criteria, prevention of development and therapy of alcohol withdrawal syndrome and alcoholic delirium, and infectious complications.

Keywords: alcohol dependence, perioperative period, alcohol withdrawal syndrome

Received: 12.04.2017


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Perioperative management of geriatric patients. Project of clinical recommendations

I.B. Zabolotskikh1, E.S. Gorobets2 E.V. Grigoriev3, I.A. Kozlov4, K.M. Lebedinsky5, T.S. Musaeva1, A.M. Ovechkin6, N.V. Trembach1, V.E. Khoronenko6

1 Federal State Budgetary Educational Institution for Higher Education «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar

2 Blokhin Russian Cancer Research Centre, Moscow

3 Federal State Budgetary Educational Institution for Higher Education “Kemerovo State Medical University” of the Ministry of Healthcare of the Russian Federation, Kemerovo

4 Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy (“MONIKI”), Moscow

5 State budget institution of higher education “North-Western State Medical University named after I.I. Mechnikov” under the Ministry of Public Health of the Russian Federation, Saint-Petersburg

6 Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow

For correspondence: Igor B. Zabolotskikh — Doctor of Med. Sci., professor, head of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University; e-mail: pobeda_zib@mail.ru

For citation: Zabolotskikh IB, Gorobets ES, Grigoriev EV, et al. Perioperative Management of Geriatric Patients. Project of Clinical Recommendations. Alexander Saltanov Intensive Care Herald. 2018;1:60–74.

DOI: 10.21320/1818-474X-2018-1-60-74

The need for surgical treatment in elderly patients arises four times more often than the population average. Due to the tendency to increase life expectancy, the number of elderly patients who underwent surgery increases, which requires an increase in the geriatric care, including surgical and anesthetic care. It is well known that in comparison with young patients, older subjects have a higher risk of developing adverse postoperative outcomes as a result of age-related decline in physiological functions, the presence of several comorbidities, polypharmacy, cognitive dysfunction and specific geriatric syndromes such as frailty. The presented recommendations generalize modern principles of perioperative management in patients of older age groups. Particular attention is paid to the peculiarities of preoperative examination, including the evaluation of geriatric syndromes, the choice of anesthesia method and the correct calculation of doses of drugs for anesthesia. Great importance at the present time made the role of cognitive status of older patients and post-operative cognitive dysfunction, which substantially affects the outcome of the disease. These recommendations include measures to assess cognitive status and prevent complications associated with cognitive impairment. Individualization of approach to management of geriatric patients is the basis of effective prevention of perioperative complications.

Keywords: geriatrics, anesthesia, perioperative period

Received: 12.03.2018


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