Optimizing Fluid Management Guided by Volumetric Parameters in Patients with Sepsis and ARDS.

We compared two de-escalation strategies guided by either extravascular lung water or global end-diastolic volume-oriented algorithms in patients with sepsis and ARDS. Sixty patients with sepsis and ARDS were randomized to receive de-escalation fluid therapy, guided either by the extravascular lung water index (EVLWI, = 30) or the global end-diastolic volume index (GEDVI, = 30). In cases of GEDVI > 650 mL/m or EVLWI > 10 mL/kg, diuretics and/or controlled ultrafiltration were administered to achieve the cumulative 48-h fluid balance in the range of 0 to -3000 mL.

The Validation of Cardiac Index and Stroke-Volume Variation Measured by the Pulse-Wave Transit Time-Analysis Versus Conventional Pulse-Contour Analysis After Off-Pump Coronary Artery Bypass Grafting: Observational Study.

Objective: To compare the reliability of cardiac index (CI) and stroke-volume variation (SVV) measured by the pulse-wave transit-time (PWTT) method using estimated continuous cardiac output (esCCO) technique with conventional pulse-contour analysis after off-pump coronary artery bypass grafting (OPCAB).

Design: A single-center, prospective, observational study.

Setting: At a 1,000-bed university hospital.

Invasive and Non-invasive Dynamic Parameters to Predict Fluid Responsiveness After Off-pump Coronary Surgery.

Objective: This study aimed to assess the predictive value of invasive and non-invasive dynamic parameters for evaluation of fluid responsiveness after off-pump coronary artery bypass grafting.

Methods: Thirty-two adult patients after off-pump coronary surgery were enrolled into a single-center pilot prospective observational study. After arrival to the intensive care unit, all patients received standard fluid challenge test to assess fluid responsiveness.

[Comparative evaluation of the microstructure of combined samples made on the basis of acrylic plastic].

The Relevance Of The Study: Is dictated by the insufficient strength of the bases of removable plate prostheses made of acrylic plastic masses. The literature data confirm the high prevalence of strips of removable plate prostheses made of acrylic plastics, regardless of the complexity of the clinical situation, but in great dependence on the time of use of prostheses. The search for new approaches to reduce the risks of structural failures, regardless of the operating time, led to the emergence of a metal mesh and a composite frame.

Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome - A sub-analysis of a prospective cohort.

Purpose: To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days.

Methods: Mechanically ventilated patients who had blood gas analyses performed and intra-abdominal pressure measured, were included from a prospective cohort. Subgroups were defined by the absence (Group 1) or the presence of either IAH (Group 2) or HRF (Group 3) or both (Group 4).

Dynamic Tests to Predict Fluid Responsiveness After Off-Pump Coronary Artery Bypass Grafting.

Objective: To test the hypothesis that a positive end-expiratory pressure test and the mini-fluid challenge predict fluid responsiveness in patients after off-pump coronary artery bypass grafting.

Design: Single-center pilot prospective observational study.

Setting: City Hospital #1 of Arkhangelsk, Russian Federation.

The Predictive Value of Integrated Pulmonary Index after Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study.

Background: The early warning scores may increase the safety of perioperative period. The objective of this study was to assess the diagnostic and predictive role of Integrated Pulmonary Index (IPI) after off-pump coronary artery bypass grafting (OPCAB).

Materials And Methods: Forty adult patients undergoing elective OPCAB were enrolled into a single-center prospective observational study.

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting.

Background: The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB.

[CONTINUOUS HEMOGLOBIN MONITORING USING PULSE CO-OXIMETRY IN CARDIAC SURGERY.].

The Aim: To assess the accuracy ofcontinuous hemoglobin monitoring using pulse co-oximetry and revealfactors affecting the results of the measurements during early postoperative period in cardiac surgery.

Materials And Methods: 27 patients undergoing off-pump CABG and 16patients after elective complex (repair or replacement of two or more valves) or combined (valve and coronary artery) cardiac surgery requiring CPB were enrolled into a prospective observational study. Both groups received continuous hemoglobin monitoring using pulse co-oximetry (SpHb).

Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study.

Objective: To assess the accuracy and applicability of a novel system, not requiring calibration, for continuous lactate monitoring with intravascular microdialysis in high-risk cardiac surgery.

Design: Single-center prospective observational study.

Setting: City Hospital #1 of Arkhangelsk, Russian Federation.

Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair.

Aim: To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period.

Methods: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation.

Validation of cardiac output monitoring based on uncalibrated pulse contour analysis vs transpulmonary thermodilution during off-pump coronary artery bypass grafting.

Background: Cardiac output monitoring, as a part of a goal-directed haemodynamic management, has been shown to improve perioperative outcome in high-risk patients undergoing major surgical interventions. However, thorough validation of cardiac output monitoring devices in different clinical conditions is warranted. The aim of our study was to compare the reliability of a novel system for cardiac index (CI) monitoring based on uncalibrated pulse contour analysis (UPCA) with transpulmonary thermodilution (TPTD) during off-pump coronary artery bypass grafting (OPCAB).

[Choice of optimal perfusion flow rate during surgical correction of combined acquired heart diseases].

Cardiac output during the use of cardiopulmonary bypass (CPB) is defined by perfusion flow rate, which is calculated by multiplying the perfusion index (PI) on the body surface area. To date, there is no clear definition of an optimal PI and flow rate of perfusion. 60 patients operated with CPB were enrolled in the prospective study to determine the relations between different modes of perfusion and oxygen transport during surgical correction of combined valvular heart disease.

Monitoring of anesthetic depth during surgical correction of acquired valvular disorders: single center, randomized trial.

Objective: The authors' primary objective was to test the hypothesis that Cerebral State Index (CSI)-guided control of anesthetic depth might reduce the consumption of anesthetics and shorten the duration of ICU and hospital stays after surgical correction of combined valve disorders.

Design: Single center, randomized trial.

Setting: City Hospital Number 1 of Arkhangelsk, Russian Federation.

Normothermic cardiopulmonary bypass increases cerebral tissue oxygenation during combined valve surgery: a single-centre, randomized trial.

Objectives: In cardiac surgery, the choice of temperature regimen during cardiopulmonary bypass (CPB) remains a subject of debate. Hypothermia reduces tissue metabolic demands, but may impair the autoregulation of cerebral blood flow and contribute to neurological morbidity. The aim of this study was to evaluate the effect of two different temperature regimens during CPB on the systemic oxygen transport and the cerebral oxygenation during surgical correction of acquired heart diseases.

Derecruitment test and surfactant therapy in patients with acute lung injury.

Introduction. A recruitment maneuver (RM) may improve gas exchange in acute lung injury (ALI). The aim of our study was to assess the predictive value of a derecruitment test in relation to RM and to evaluate the efficacy of RM combined with surfactant instillation in patients with ALI.

Inhibitor of neuronal nitric oxide synthase improves gas exchange in ventilator-induced lung injury after pneumonectomy.

Background: Mechanical ventilation with high tidal volumes may cause ventilator-induced lung injury (VILI) and enhanced generation of nitric oxide (NO). We demonstrated in sheep that pneumonectomy followed by injurious ventilation promotes pulmonary edema. We wished both to test the hypothesis that neuronal NOS (nNOS), which is distributed in airway epithelial and neuronal tissues, could be involved in the pathogenesis of VILI and we also aimed at investigating the influence of an inhibitor of nNOS on the course of VILI after pneumonectomy.

Increased extravascular lung water reduces the efficacy of alveolar recruitment maneuver in acute respiratory distress syndrome.

Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients.

Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial.

Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group.

Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: a randomized, controlled study.

Background: Our aim was to assess the efficacy of thoracic epidural anesthesia (EA) followed by postoperative epidural infusion (EI) and patient-controlled epidural analgesia (PCEA) with ropivacaine/fentanyl in off-pump coronary artery bypass grafting (OPCAB).

Methods: In a prospective study, 93 patients were scheduled for OPCAB under propofol/fentanyl anesthesia and randomized to three postoperative analgesia regimens aiming at a visual analog scale (VAS) score < 30 mm at rest. The control group (n = 31) received intravenous fentanyl 10 μg/ml postoperatively 3-8 mL/h.

[Central venous blood oxygen saturation and venous to arterial PCO2 difference after combined heart valve surgery].

The aim of our study was to investigate the relationship between central venous oxygen saturation (ScvO2) and venous-to-arterial difference in PCO2 (Pv-aCO2) and their role in the assessment of balance between oxygen delivery and consumption after combined valve surgery. The prospective observation study included 38 adult patients with acquired valvular hear diseases, requiring surgical correction of two or more valves using cardiopulmonary bypass. All patients were divided into 2 groups according to the central value of central venous oxygen saturation (ScvO2): low ScvO2 (ScvO2 < 70%) and high ScvO2 (ScvO2 > 70%).

[Use of microstream capnography and alveolar recruitment during off-pump coronary artery bypass grafting].

The aim of the study was to investigate changes in EtCO2 and its correlation with PaCO2, and cardiac function during off-pump coronary artery bypass grafting (OPCAB) and to evaluate whether the recruitment maneuver was effective in improving gas exchange after OPCAB. Twenty adult patients scheduled for elective OPCAB were enrolled in a prospective randomized study. Anesthesia was maintained with midazolam, propofol, and fentanyl.

Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery.

Background: Off-pump coronary artery bypass grafting (OPCAB) requires thorough monitoring of hemodynamics and oxygen transport. Our aim was to find out whether therapeutic guidance during and after OPCAB, using an algorithm based on advanced monitoring, influences perioperative hemodynamic and fluid management as well as the length of post-operative ICU and hospital stay.

Methods: Patients were randomized into two groups of hemodynamic monitoring: the conventional monitoring (CM) group (n=20) and the advanced monitoring (AM) group (n=20).