Infusion therapies for Parkinson’s disease: where are we in 2025?

Background. D (definition): the daily fluid balance is the sum of all the amounts of consumed and excreted fluid. Assessment of fluid accumulation per day allows to detect fluid overload. At early stages (the first 1-3 hours) of infusion therapy (IT) targeted administration of necessary drugs should be carried out. The volume of infusion is 10-30 ml/kg of body weight. Subsequently, during the first week of treatment in the intensive care unit (ICU) it is necessary to achieve two consecutive days with a negative fluid balance. In the later stages of treatment, active fluid removal is performed with diuretics or renal replacement therapy. The concept of four D IT actually includes seven D: definitions, diagnosis, drug, dose, duration, de-escalation, discharge.
 Objective. To describe the basic principles of modern IT.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. The improvement and proper application of the existing IT techniques and drugs is an important step in improving treatment outcomes. Frequent mistakes include too long IT, wrong choice of drug or dose. Hypervolemia as a result of excessive infusions is even more dangerous than hypovolemia because it can lead to the interstitial edema. To address the issue of IT, it is advisable to focus on preload – the degree of stretching of a cardiomyocyte before contraction. Echocardiographic indicators of preload include end-diastolic volume and end-diastolic pressure of left ventricle. When choosing a solution for IT, it is necessary to take into account its tonicity and osmolality, as it depends on whether the solution will remain in the vessels or enter the intercellular space. Choosing an optimal IT, one should take into account the choice of solution or combination of solutions, the optimal time and duration of its introduction, the pathological condition of the patient. Thus, in case of trauma, blood and crystalloids are prescribed, in case of sepsis – crystalloids, and later albumin, in the perioperative period – hydroxyethyl starch (HES) and crystalloids. When choosing an antibiotic for IT, you should pay attention to the recent history of hospitalizations, length of stay in a medical institution (term >5 days increases the likelihood that the patient’s infection is nosocomial), comorbid conditions, history of steroid use, previous antibiotic therapy (ABT), duration of mechanical lung ventilation. Dose is another important aspect of IT. In ABT, too high dose can be toxic to the macroorganism, and too low dose can be ineffective and cause bacterial resistance. When selecting the dose of the antibiotic, attention should be paid to the distribution volume of the drug, the liver and kidney function and the peculiarities of the drug clearance, albumin level, ability to penetrate into tissues, minimal inhibitory concentration. In turn, when selecting the dose of solutions for IT, it is necessary to take into account the volume of distribution, type of solution, osmolality, tonicity, and the condition of renal function. In most cases, the maintenance volume of solutions is 1 ml/kg/h (25 ml/kg/day), and the volume required for resuscitation is 30 ml/kg in the first 3 hours, the fluid bolus is 4 ml/kg / 15 min. Some fluids (HES) are toxic for the kidneys (maximum dose is 30 ml/kg/h). However, lack of control over shock is also not beneficial for the kidneys, so the benefit/risk balance should always be assessed. Static surrogate parameters of preload (central venous pressure, average arterial pressure, urine volume, volumetric indicators) are often used for IT titration. However, it is more appropriate to use dynamic functional parameters of hemodynamics: pulse pressure variations, stroke volume variations, passive leg raise test. The duration of optimal IT has not yet been established, although there is evidence of a downward trend. After eliminating shock and normalizing blood lactate, it is advisable to stop IT. It is advisable to reduce the duration of ABT to a minimum and to remember that the goal is to treat the infection, not to treat fever, infiltrates or elevated C-reactive protein. Therefore, ABT should be discontinued when the signs and symptoms of active infection disappear. In future, biomarkers (procalcitonin or cystatin C, citrulline, respectively) will be used to determine the need to discontinue ABT or IT. Timely de-escalation of IT is no less important than its timely start. It is advisable to follow the ROSE concept (R – resuscitation; O – organ support; S – stabilization; E – evacuation).
 Conclusions. 1. The concept of four D IT includes definitions, diagnosis, drug, dose, duration, de-escalation, and discharge. 2. For IT titration it is reasonable to use dynamic functional parameters of hemodynamics: pulse pressure and shock volume variation, passive leg raise test. 3. It is advisable to follow the concept of ROSE.

Background. The choice of the infusion therapy regimen in the perioperative period remains a complex and controversial issue of modern anesthesiology. This is especially true for elderly patients with concomitant cardiovascular diseases, primarily coronary heart disease (CHD). Excessive fluid restriction in the perioperative period during the intervention can contribute to the development of arterial hypotension and hypoperfusion of vital organs. At the same time, excessive fluid intake in these patients is dangerous in terms of developing complications such as decompensation of heart activity, ischemic myocardial damage. There are many factors of the perioperative period that affect the processes of fluid metabolism in the body, the state of hemodynamics and other vital functions. Among them, the most significant factors are operational stress, features of the underlying disease and surgical intervention, the influence of anesthetics, the functional state of the cardiovascular system, kidneys, etc. One of the insufficiently considered factors that may influence the choice of infusion therapy, in our opinion, is the functional state of the hemostatic system in the preoperative period.
 Objective. To investigate the effect of perioperative infusion therapy on the functional state of the hemostatic system in patients with concomitant CHD.
 Materials and methods. A total of 92 patients who underwent abdominal surgery under combined general anesthesia with a ventilator were examined. The average age of patients was 61±12 years; risk on the ASA scale – II-III; risk of cardiac complications on the RCRI – 1-3; risk of thrombosis on the Caprini scale – 6.5±0.1. The functional state of platelets was assessed using the platelet aggregation analyzer AR 2110 (Belarus); the state of plasma hemostasis was assessed using standard coagulogram indicators.
 Results and discussion. When studying platelet aggregation in the initial state, significant fluctuations in the studied parameters were found from significant hypoaggregation to significant platelet hyperaggregation. For further analysis and differential correction, patients were divided into three groups depending on the degree of platelet aggregation. Group 1 included 22 patients with established hypoaggregation, 2nd group – 38 patients with established normal platelet aggregation, and 3rd group – 32 patients with platelet hyperaggregation. The coagulogram in the majority of patients in the initial state characterized normocoagulation or a tendency to hypercoagulation. Correction of changes in primary hemostasis was performed using infusion therapy, depending on the initial data of platelet aggregation. In the group with greegreece platelets was conducted infusion therapy with the liberal type – 5-10 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with hoareau for restrictive type an average of 3-5 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with normoergic the relatively restrictive type that was 5-7 ml/kg/h intraoperatively; 25 ml/kg/day after surgery. For specific correction of platelet-vascular hemostasis, etamzilate 12.5 % 4.0 ml was used in group 1 patients before surgery and later 4.0 ml three times a day; in group 3 patients, pentoxifylline 2 % 5.0 ml twice a day. Thromboprophylaxis with low-molecular-weight heparins in the perioperative period was performed in all patients according to current recommendations. As a result of this approach to the correction of established disorders of platelet-vascular hemostasis, a clear trend towards normalization of the studied parameters was established already at the intraoperative stage, this trend persisted a day after the operation. Thus, the indicators of platelet aggregation in group 1 patients at the intraoperative and early postoperative stages were 68.2 (59.5; 78.1) and 63.6 (60; 72.6); in group 3 patients – 79.7 (75.3; 94.2) and 74.6 (59.2; 83.4), respectively.
 Conclusions. Individualized infusion and pharmacological therapy allows correction of disorders of platelet-vascular hemostasis in patients with concomitant CHD, which may be useful for reducing the risk of thrombotic complications.

Background. Infusion therapy (IT) is a method of managing the functions of the organism by influencing purposefully the morphological composition and physiological properties of blood through parenteral administration of organic and inorganic solutions. The main feature of IT is that the drug completely enters the bloodstream.
 Objective. To describe the main characteristics of fluid and electrolyte balance and the IT principles.
 Materials and methods. Analysis of the literature sources on this topic.
 Results and discussion. Fluid comprises about 60 % of the human body (in children – 70-80 %, in adults – 60 %, in elderly – 50-55 %). Total fluid includes intracellular and extracellular. The latter, in turn, is divided into intravascular, interstitial and transcellular. Water balance involves the balance of fluid entering the body and the fluid being excreted. The main sources of water are beverages and food, however, about 300 ml per day is formed endogenously during oxidation processes. The main ways of the fluid excretion are its excretion in urine and stool, and perspiration losses. To calculate the physiological need of water for an adult, the body weight should be multiplied by the coefficient of 30 (up to 65 years), 25 (65-75 years) or 20 (more than 75 years). IT should also take into account the pathological losses of water from fever, vomiting, diarrhea, the presence of large wounds or burns, as well as reduction of the need in water in renal or heart failure. Thus, physiological needs, fluid deficiency, fluid volume as a result of pathological loss should be added, and the oral rehydration subtracted from this sum to calculate IT volume. There are 3 degrees of dehydration severity: I degree – deficiency of 1-2 liters, thirst, oliguria; II degree – deficiency of 4-5 liters, thirst, oliguria, dry skin, mucous membranes and tongue, general weakness; III degree – deficiency of 7-8 liters, consciousness disorders, decrease in arterial pressure, shock. The first degree can be overcome by oral rehydration, the second degree – by 50 % of oral rehydration and 50 % of IT, the third degree – by 70-100 % of IT. IT solutions are divided into crystalloids, colloids, polyatomic alcohols and special drugs. Preparations of polyatomic alcohols include, in particular, Reosorbilact, Sorbilact, Xylate (“Yuria-Pharm”). Complications of IT are divided into complications associated with the violation of the technique of entering the bloodstream (injuries of blood vessels and adjacent organs, hematomas, foreign bodies in the vessels and heart, the solution misplacement out of the vascular space); complications associated with the violation of the technique of drug administration (thromboembolism, air and fat embolism); complications associated with the wrong rate of solutions’ administration (heart overload, hypervolemia, pulmonary edema, cerebral edema); complications associated with the characteristics of infusion solutions (partial hemolysis of blood cells, acid-base imbalance, disorders of blood osmolarity, local cooling of the heart); complications associated with the IT method; complications due to individual intolerance; infectious complications in case of violation of asepsis and antiseptics; infectious diseases. Criteria for IT security include the knowledge of the drug composition and understanding of the instructions for its use; multicomponentity; use of the minimum effective doses; monitoring of the excreted urine and other fluids and infused solutions; strict control of fluid balance and blood circulation parameters.
 Conclusions. 1. IT is an important tool in treatment of many diseases, which performs a wide range of tasks. 2. The IT solution should be chosen depending on the individual needs of the patient. 3. Criteria for IT safety include the knowledge of drug composition and instructions for its use; multicomponentity; use of the minimum effective doses; monitoring of excreted urine and infused solutions; control of fluid balance and blood circulation parameters.

Objective – to establish the value of non-invasive monitoring of central hemodynamics during the acute period of polytrauma and its impact on systemic respiratory and circulatory parameters and intensive care treatment using the estimated Continuous Cardiac Output (esCCO), a non-invasive continuous measurement technique of central hemodynamics, which was integrated into the Life Scope monitor (Nihon Kohden, Japan). module.Materials and methods. The study included 170 patients with polytrauma who were treated in our intensive care unit. Patients with severe polytrauma (ISS 20–30 points) were included in the group 1 (n = 70), with an average age of (41.9 ± 2.4) years. The group 2 (n = 100) consisted of patients with moderate polytrauma (ISS 10–19 points), the average age of the patients in this group was (38.7 ± 2.5) years. In sub-groups 1А and 2А adequate circulating blood volume measurement and subsequent support was performed using the esCCO. In subgroups 1B and 2B, the analysis of systemic hemodynamics such as ECG and blood saturation was performed using standard multifunction monitors.Results. Hemodynamic disorders in the form of arterial hypotension < 70 mm Hg on admission occurred in 14.3 % of patients in group 1, and was not observed in patients within the group 2. The normalization of systemic hemodynamics was observed after 24 hours of intensive care therapy, in particular in subgroup 1А a marked increase in the systemic blood pressure and subsequent termination of tachycardia was observed. Normalization of cardiac output and cardiac index in subgroup 1А was observed after 3–6 h of infusion therapy (IT), in the subgroup 2А – after 12 h IT. In the subgroup 1А the infusion volume during the first day differed significantly, 8.9 % less if compared to the infusion volume used in subgroup 1B. In moderate-severity polytrauma, the infusion volume was significantly smaller than in severe polytrauma, and in the subgroup 2А it was significantly lower by 8.6 %, compared to the infusion volume used in the subgroup 2B. The confirmation of the effectiveness of the balanced IT was the normalization of the urine output. Namely: on day 2 in the subgroup 1А the diuresis increased significantly compared to day 1, and in the subgroup 1B it did not change significantly. Intergroup differences in mean daily diuresis in the group 2 were significant after 12 h of IT.Conclusions. Carrying out monitor-controlled infusion and respiratory therapy with the usage of the esCCO monitoring technique allowed to achieve an early normalization of central and systemic hemodynamics during the intensive care of polytrauma patients with a significantly smaller volume of infusion, contributed to the elimination of hypoxia, and was accompanied by a significant reduction, namely by 21.1 %, in the duration of mechanical ventilation in severe polytrauma.

Background. Infusion therapy (IT) is an integral part of the modern treatment process and the most common method of inpatient treatment. Indications for the IT use include dehydration, changes in blood properties, intoxication, the impossibility or inexpediency of the drug administration in other ways, the impossibility of oral nutrition, and impaired immunity.
 Objective. To describe the main complications of IT and their treatment.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Before conducting IT, you should take into account all the indications and contraindications and carefully read the instructions for use of drugs. It is advisable to use several drugs to reduce the number and severity of side effects. The rate of administration is important: in most cases, the safe rate is 20-30 drops per minute. Accidental needle injuries (ANI) and blood contact are potential IT risks for healthcare professionals. The National Union of Nurses of Private Practice has launched a survey of health workers to reduce the prevalence of these injuries. There are three components to injection safety: safe solution preparation, safe injection, and safe disposal. IT via the needle has a number of disadvantages: complications due to frequent punctures, limited ability to conduct long-term IT, increased risk of ANI. The installation of a permanent venous catheter reduces the likelihood of these defects. After catheter placement, before and after infusion, it should be flushed with 0.9 % NaCl, heparin or Soda-Bufer solution (“Yuria-Pharm”). However, as the number of catheterizations increases, the number of catheter-associated infections increases too, ranking third among nosocomial infections and first among the causes of bacteremia. In general, the frequency of complications of venous catheterization is 15 %. Mechanical complications occur in 5-19 % of patients, infectious – in 5-26 %, thrombotic – in 2-26 %. Complications of IT are classified into the complications due to violation of the rules of administration (hematoma, tissue damage, thrombophlebitis (septic, mechanical and chemical), embolism) or blood composition disorders (acidosis, blood thinning), as well as overdose, and specific complications (anaphylactic shock, pulmonary edema, hyperthermia). Anaphylaxis most often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc. The first line of treatment of anaphylactic shock involves drug discontinuation, intravenous adrenaline, 100 % oxygen, rapid intravenous infusion of crystalloids, in case of bronchospasm – 2-3 inhalations of salbutamol. Additionally, antihistamines and glucocorticoids may be prescribed.
 Conclusions. 1. IT is an integral part of the modern treatment process and the most common method of treatment in the hospital. 2. In IT, it is advisable to use several drugs, which reduces the number and severity of side effects. 3. Potential IT risks for healthcare professionals include ANI and blood contact. 4. Injection safety requires three components: safe solution preparation, safe injection, and safe disposal. 5. Complications of IT are divided into complications due to violations of the rules of installation or violation of blood composition, as well as overdose, and specific complications. 6. Anaphylaxis often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc.

Background. The goals of infusion therapy (IT) include the restoration of adequate tissue perfusion, maintaining the quantity and quality of the body fluid sectors, correction of homeostasis parameters. In addition, IT can be used for parenteral nutrition, reducing the risk of thrombosis and urinary tract infections.
 Objective. To identify key IT parameters of a cancer patient.
 Materials and methods. Analysis of the available literature on this topic.
 Results and discussion. Indications for IT include hypovolemia, cellular and protein deficiency of blood, nutrition disorders, intoxication, disorders of hemostasis, hemorheological properties, fluid and electrolyte balance, acid-base status. Cancer patients often have the listed syndromes. The appropriate infusion volume should not be exceeded, as the hypervolemia is accompanied by edema, multiorgan dysfunction and worsening of the prognosis. On the other hand, dehydration is the most common fluid and electrolyte balance disorder in the elderly. It is an independent predictor of mortality and high healthcare costs. At any IT administration it is necessary to assess the volemia condition, to determine the cause of the deficiency, to choose the optimal solution and infusion rate, to set and to monitor target values. Capillary filling time, heart rate, blood pressure, jugular veins’ condition, skin turgor, pulmonary and cardiac auscultation data, edema control, diuresis rate, and weight changes are used to assess volemia. Peculiarities of the elderly and debilitated patients, which should be taken into account when prescribing IT, include the loss of thirst feeling, deterioration of renal function and worsening of hormonal regulation of fluid and electrolyte balance. Anticancer therapy has a number of side effects, and some of them can be eliminated with the help of IT. The amount of fluid required should be calculated based on physiological needs (30-40 ml/kg/day), deficiency severity and pathological losses (fever, blood loss, polyuria, perspiration, drainage losses). Plasma replacement solutions can be divided into crystalloids (iso- and hypertonic saline, Ringera lactate) and colloids (albumin, solutions of gelatin, dextranes, hydroxyethyl starch). Crystalloids are recommended for short-term interventions, while long-term therapy requires colloids or balanced solutions, as the introduction of unbalanced solutions is accompanied by such risks as hyperchloremia, dilutive acidosis, acute kidney damage, and systemic vasoconstriction. In settings of the chronic inflammation, which often accompanies oncological diseases, the role of thirst as a means of controlling osmolarity changes. Hyperosmolarity may also accompany central diabetes mellitus and tumor metastases to the hypothalamus. Hyperosmolarity leads to the microcirculatory disorders, increased inflammation, cachexia development and multiple organ failure. Another feature of IT in oncology settings is the disruption of tissue energy supply due to nutritional deficiencies and changes in metabolism. Xylitol (Xylate, “Yuria-Pharm”) can be used to eliminate this problem. Xylitol is a five-atom alcohol, which is directly included into the pentose phosphate cycle. The benefits of xylitol include metabolism stabilization in people with diabetes, promotion of slow but stable energy production, antiketogenic properties, improved metabolism of B vitamins, cholekinetic action, and high safety. Xylitol is not used by the tumor cells as an energy substrate. The role of xylitol (Xylate) in IT is to increase the volume of circulating plasma, to reduce the interstitial edema, to decrease the production of ketone bodies, to activate the antioxidant systems, and to increase alkaline blood reserve. It has been reported that xylitol infusion has an oncosuppressive effect due to its antioxidant effect and inhibition of glucose utilization by tumor cells.
 Conclusions. 1. IT is an important component of cancer treatment; it should be based on the individual features of the patient. 2. Rational IT eliminates chronic inflammation, endothelial dysfunction and microcirculatory disorders. 3. Rational IT is based on the correct choice of solution, its timely introduction and frequent evaluation of the infusion response. 4. Xylate (“Yuria-Pharm”) has a multifunctional effect in oncology: eliminates dehydration, corrects energy deficiency, and has a direct oncosuppressive effect.

Background. Inadequate volume of perioperative infusion therapy (IT) is one of the predictors of postoperative complications. There are different types of infusion solutions on the pharmaceutical market: albumin, dextrans (Reopoliglukin), polyatomic alcohols (Reosorbilact, Sorbilact), hydroxyethyl starch preparations (Gekodez), modified gelatin (Volutenz), balanced colloid-hyperosmolar solution (Gekoton), etc (all listed solutions are produced by “Yuria-Pharm”).
 Objective. To describe the main features of perioperative IT.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. Inadequate IT can cause hypo- and hypervolemia, as well as slow the recovery after surgery, so the choice of infusion solution should be made very carefully. To eliminate endothelial dysfunction, which often accompanies the perioperative period, it is advisable to prescribe L-arginine (Tivortin, “Yuria-Pharm”), which acts as a substrate for the synthesis of nitric oxide. Tivortin has the following properties: membrane stabilizing, antioxidant, cytoprotective, detoxifying, endothelioprotective, anabolic, hepatoprotective, antihypoxic. L-arginine (Tivortin) also helps to correct acid-base balance, neutralizes and removes ammonia, promotes insulin synthesis and regulates blood glucose, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium. The position paper of the International Fluid Optimization Group (2015) states that in planned operations without blood loss, crystalloids can be prescribed (2 ml/kg/h for surgeries lasting >4 hours, up to 10 ml/kg/h for surgeries lasting up to 1 hour). However, the disadvantages of the most famous crystalloid (0.9 % saline) are the risk of hyperchloremic acidosis and the development of edema in case of overdose, so it is advisable to use ion-balanced solutions instead of 0.9 % NaCl. The ideal electrolyte solution should be isovolemic, isohydric, isooncotic, isoionic, and isotonic to the blood plasma. Elimination of the metabolic acidosis is an important task of perioperative IT. Soda-Bufer (“Yuria-Pharm”) can be used for this purpose, as the administration of sodium bicarbonate reduces mortality in patients with severe metabolic acidosis and acute kidney damage. To eliminate the intoxication syndrome, drugs of polyatomic alcohols (Reosorbilact) have been successfully used. Efficiency of Reosorbilact in the treatment of sepsis, peritonitis, pneumonia, burns, etc. was confirmed in the numerous studies. In addition to detoxification, Reosorbilact supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, stimulates diuresis, normalizes the rheological properties of blood, which makes it the main drug for low-volume IT in the perioperative period. In turn, Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation, corrects metabolic acidosis and has an osmodiuretic effect. In shock settings IT should be administered according to the ROSE concept (R (rescue) – aggressive IT; O (optimization) – support of tissue perfusion; S (stabilization) – supportive IT; E (evacuation) – deresuscitation, restoration of body functions).
 Conclusions. 1. Optimal IT improves the consequences of the surgery. 2. To eliminate endothelial dysfunction, it is advisable to prescribe L-arginine (Tivortin). 3. Reosorbilact is successfully used to eliminate the intoxication syndrome, which also supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, which makes it the main drug for low-volume IT in the perioperative period. 4. Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation. 5. In shock settings IT should be administered according to the ROSE concept (rescue, optimization, stabilization, evacuation).

As Parkinson's disease (PD) progresses, patients experience motor fluctuations, which may manifest as motor and/or non-motor wearing off symptoms, delayed "ON" time, and/or levodopa-related dyskinesia. Deep brain stimulation (DBS) is an effective therapy but may not be suitable for all patients due to factors such as premorbid conditions age, or accessibility. We review technology-based therapeutic innovations for PD: infusion therapies and novel non-invasive neuromodulation methods using the following databases: PubMed, Cochrane, and Science Direct. Infusion therapies such as percutaneous (LCIG, LECIG) and subcutaneous options (ND0612, foslevodopa-foscarbidopa, CSAI) demonstrate significant benefits in reducing OFF time and enhancing ON time without troublesome dyskinesias. However, vigilance is required for procedural and skin adverse events. Neuromodulation approaches such as auricular, vagus nerve, and galvanic vestibular stimulation, as well as whole-body vibration, showed promising benefits in freezing of gait (FOG) and tremor. Infusion and non-invasive neuromodulation therapies provide additional treatment options for patients with refractory motor and non-motor symptoms and may be an alternative for those who experience limitations of traditional dopaminergic therapies and are not candidates for neurosurgical interventions.

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.

Background. The goal of infusion therapy (IT) is to maintain central euvolemia without excess sodium and water. The term “restrictive IT”, which allows hypovolemia, should be replaced by the term “IT with a zero balance”. Individualized targeted IT involves monitoring cardiac output, optimizing stroke volume, and preventing episodes of hypovolemia. Less stringent restrictions on preoperative nutrition contribute to better control of hemodynamic parameters.
 Objective. To describe the role of hyperosmolar solutions in the physician’s practice.
 Materials and methods. Analysis of literature sources on this issue.
 Results and discussion. Support of perioperative euvolemia is the basis of the concept of enhanced recovery and improvement of the surgery outcomes. Clinical indices of tissue perfusion adequacy include mean blood pressure, central and abdominal perfusion pressure, diuresis, consciousness level, skin perfusion, lactate and blood pH, etc. Each patient with suspected hypovolemia should be physically examined with an emphasis on searching for bleeding, dehydration, and other causes of hypovolemia. Fluid deficiency should be compensated before surgery. Hyperhydration must also be detected and eliminated timely, as the diagnosis and prediction of pulmonary edema are difficult. There are 4 phases in IT of shock: rescue (achieving blood pressure and cardiac output required for survival), optimization (ensuring sufficient oxygen delivery and lactate control), stabilization (preventing organ dysfunction after achieving hemodynamic stability), and de-escalation (ensuring negative fluid balance). In resuscitation of patients with sepsis and septic shock, the use of hydroxyethyl starch (HES) is not recommended; crystalloids should be preferred over gelatin. If HES were still prescribed, their introduction should be stopped if there are signs of kidney damage or signs of coagulopathy. It is also proposed not to administer hyperoncotic solutions to critically ill patients outside of clinical trials. New colloidal solutions should be introduced into clinical practice only after the establishment of safety for the patient. Following an appeal by HES-manufacturing companies, the Pharmacovigilance and Risk Assessment Committee of the European Medicines Agency stated that HES could be used for massive bleeding at the discretion of the chief physician. Continued use of HES in the postoperative period should be further investigated, including monitoring of renal function for 90 days. In general, the use of HES in clinical practice remains relevant in conditions such as massive bleeding or penetrating trauma, as well as for preloading before regional anesthesia and IT of critical conditions without the risk of bleeding. Modern HES should be used and the dose should not exceed 30 ml/kg. The benefits of preoperative targeted preload optimization using HES are beyond doubt, while recommendations for the overall hazard of these solutions are debatable and inconclusive. The volume of injected solutions should be monitored during IT, as infusion of large volumes of crystalloids may cause pulmonary edema and large volumes of 0.9 % NaCl may lead to the development of hyperchloremic metabolic acidosis. Hypertonic solutions have been shown to be effective in reducing the number of abdominal complications of pancreatoduodenectomy, reducing the length of stay on mechanical ventilation in patients with hemorrhagic shock, and in a number of other interventions. Fluid resuscitation with a small volume of hypertonic saline after damage control operations significantly reduces the length of stay in the intensive care unit, decreases the likelihood of acute respiratory distress syndrome, sepsis and multiple organ failure, reduces 30-day mortality. In patients with brain injuries, hypertonic solutions reduce intracranial pressure and help to balance the fibrinolysis system by reducing secondary brain damage. Unfortunately, most (60 %) of the solutions on the market are unbalanced (Hohn R., 2014). The reasons for this include lower cost of the latter, the lack of understanding of the benefits of alternatives by doctors, the lack of awareness of the seriousness of these solutions’ disadvantages. Due to the risk of acidosis on the background of unbalanced solutions, chloride-restrictive IT should be followed. Hyperosmolar balanced solution Reosorbilact (“Yuria-Pharm”) helps to activate the sympathetic nervous system, which leads to increased blood pressure, decreased diuresis, adrenaline release and increase of circulating blood volume by contracting the spleen. Reosorbilact quickly normalizes hemodynamic parameters, microcirculation, laboratory and biochemical parameters, stabilizes and normalizes the function of external respiration and blood circulation. The use of osmotic drugs Reosorbilact and Xylate (“Yuria-Pharm”) is indicated for plasma volume replacement in hypovolemia of various origins.
 Conclusions. 1. Perioperative euvolemia is the main principle of perioperative IT. 2. It is not recommended to use HES in intensive care. 3. HES remain relevant in acute hypovolemia and blood loss. 4. Balanced hyperosmolar solutions (Reosorbilact) are an alternative to HES in the treatment of patients with multiple organ failure in intensive care units.

Background. Infusion therapy (IT) has a number of features that both doctors and nurses need to know. IT can be performed via a needle, a peripheral intravenous catheter (PIC), and an implanted system for long-term infusions (ISLI).
 Objective. To describe the features of short-term and long-term IT.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. First of all, every healthcare worker should remember that the patient should be identified before any manipulation and then the procedure may start. IT via the needle has a number of disadvantages: complications due to the frequent punctures and prolonged stay of needle in the vein; limited possibility of long-term IT; increased risk of needle injuries among medical staff. The advantages of PIC above needle include the lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, easy use of IT and parenteral nutrition, and the ability to monitor central venous pressure. PIC are classified by the presence of an additional injection port, by the material from which they are made, by the shape of the needle tip sharpening, by the visibility on X-ray and size. Venoport Plus (“Yuria-Pharm”) is an elastic teflon catheter with a low coefficient of surface friction, X-ray contrast strips and the possibility of a long stay in a vein (up to 72 hours). The advantages of the Venoport Plus PIC are the adaptive shape of the cap, the optimal inclination angle and SMART SLOT – a hole near the tip of the needle, which allows you to visualize the blood between the catheter and the needle without waiting for it to appear in the indicator chamber. The most suitable for the PIC placement veins are located on the outside of the hand and on the inner surface of the forearm. It is recommended to use the ulnar vein only for laboratory blood sampling and emergency medical care. When choosing PIC one should take into account the vein diameter, necessary speed of infusion, potential time of stay of a catheter in a vein, and features of the infused solution. After installing PIC, it is advisable to use special transparent aseptic bandages. Bandage replacement is performed as needed; daily replacement is not required. After PIC installation and after infusion, PIC should be washed with 0.9 % NaCl, heparin (1:100 dilution), or Soda-Bufer solution (“Yuria-Pharm”). If the catheter is not used, washing should be performed once a day. ISLI Yu-Port (“Yuria-Pharm”) provides long-term venous access and can be used if the patient needs multiple administrations of drugs during a long course of therapy.
 Conclusions. 1. IT can be conducted via a needle, PIC, or ISLI. 2. The advantages of PIC over the needle injection are lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, facilitated use of IT and parenteral nutrition, and the ability to monitor central venous pressure. 3. PIC Venoport Plus (“Yuria-Pharm”) is an elastic teflon catheter with an adaptive shape of the cap and the optimal angle. 4. When choosing PIC one should take into account the vein diameter, the required speed of infusion, the potential time of stay of a catheter in a vein, and the features of the infused solution. 5. ISLI Yu-Port provides long-term venous access and can be used if necessary for the multiple administrations of drugs during a long course of therapy.

BACKGROUND. Intensive care with adequate, balanced, accurately calculated and safe infusion therapy (IT) is one of the methods of solving problems that are encountered by neurologists and neurosurgeons. The role of IT in the treatment of the patient, its volume and composition depend on a wide variety of circumstances: the patient’s general baseline a lack of information on IT for doctors in various specialties. OBJECTIVE. To highlight the emergence of updated current IT recommendations in neurology and neurosurgery. RESULTS AND DISCUSSION. In the beginning of 2020 the guide-book “Infusion Therapy in Neurology and Neurosurgery” (authors: M.E. Polishchuk, O.A. Halushko, M.I. Gumeniuk, M.A. Trishchynska) was published. The pages of the manual contain information on pathophysiological prerequisites and principles of IT in neurological practice, rules and technical support for IT, gives a general description of the main infusion tools in the arsenal of the neurologist and neurosurgeon. The manual describes in detail the pathogenesis, clinic and intensive care of acute and chronic conditions in neurology and neurosurgery, in which one of the main methods of treatment is IT. The criteria of treatment effectiveness and the typical errors observed in clinical practice when using various IT programs of these conditions are highlighted. CONCLUSIONS. The new handbook “Infusion Therapy in Neurology and Neurosurgery” (authors: M.E. Polishchuk, O.A. Halushko, M.I. Gumeniuk, M.A. Trishchynska) will be a useful source of information for neurologists, neurosurgeons, anesthesiologists, doctors of intensive care units, as well as specialists of related specialties involved in the treatment of patients with a neurological profile.

Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance.
 Objective. To describe modern IT.
 Materials and methods. Analysis of the literature sources on this topic.
 Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions.
 Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.

Background. Bleeding accounts for 34 % of maternal mortality. Every 7 minutes 1 woman dies from bleeding during the labour. Retrospective analysis of medical records shows that in 60-80 % of cases, fatal consequences can be avoided. Criteria for defining the concept of “massive blood loss” are the loss of 100 % of circulating blood volume (CBV) within 24 hours or 50 % of CBV within 3 hours, loss of 150 ml/min, of 2 % of body weight within 3 hours, reduction of hematocrit by 10 % in combination with hemodynamic disturbances, one-time blood loss more than 1500-2000 ml or 25-35 % CBV, the need for transfusion of >10 doses of erythromass for 24 hours. The main causes of bleeding in obstetrics include uterine atony, premature placental abruption, uterine rupture, placental abruption, hereditary blood diseases, coagulopathy, sepsis, amniotic fluid embolism.
 Objective. To describe infusion therapy (IT) for obstetric bleeding.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Strategies for the treatment of obstetric hemorrhage include restriction of the traditional massive crystalloid-based IT, applying the principle of antihypertensive resuscitation, using of adequate doses of tranexamic acid, fibrinogen concentrate and prothrombin complex concentrate, early informed use of blood components, and low-volume IT. Routine use of unbalanced crystalloid solutions in critically severe patients is dangerous. Infusion of large amounts of 0.9 % NaCl may cause metabolic hyperchloremic acidosis. Therefore, except in cases of hypochloremia, it is advisable to replace saline with balanced solutions. Reosorbilact (“Yuria-Pharm”) is the most suitable solution for this purpose. It mobilizes the own fluid of the organism, helping it to move from the intercellular space into the vessels. Hypotensive resuscitation involves the introduction of limited amounts of fluid in the early stages of treatment of hemorrhagic shock (until the bleeding stops). Low-volume IT program is a part of hypotensive resuscitation. In this case, the following solutions can be used: Reosorbilact, Sorbilact, Gekoton (“Yuria-Pharm”), 130/0.4 hydroxyethyl starch (HES), hypertonic NaCl solutions (including combined solutions with colloids), polyhydric alcohols. It should be noted that the new generation of HEC has less effect on coagulation than older drugs. Due to the risk of kidney damage, HEC solutions should be used in the lowest effective dose for as shortest period of time as possible. HEC infusion should be stopped as soon as hemodynamic targets are reached. Solutions containing polyhydric alcohols (Reosorbilact, Sorbilact, Xylate) occupy an important position in IT of critically ill patients. Due to their high osmolarity, Reosorbilact and Sorbilact cause fluid to move from the intercellular space into the vascular bed, improving microcirculation and tissue perfusion. The polyhydric alcohol sorbitol contained in these solutions creates increased osmotic pressure in the renal tubules, which provides a diuretic effect. In case of the blood loss volume of I-II functional class up to 1500 ml and stopped bleeding, IT is performed in a limited mode. The volume of intravenous infusion together with blood components should not exceed 200 % of the blood loss volume. Reosorbilact (10-15 ml/kg) is an initial solution in combination with 0.9 % NaCl (20-30 ml/kg). In case of unstable hemodynamics HEC may be added (up to 1,5 L). Blood components are used only in case of confirmed coagulopathy and continued bleeding. In case of massive critical blood loss >1500-2000 ml, it is advisable to use the protocol of massive blood transfusion 1:1:1:1. In order to reduce the pathological response of the endothelium to IT, it is advisable to use a substrate for the nitric oxide synthesis, namely, Tivortin (“Yuria-Pharm”). To stop life-threatening obstetric bleeding, CBV must be refilled using the protocol of massive blood transfusion and automatic blood reinfusion, oxytocin and prostaglandin analogues for the correction of uterine tone, uterine massage, correction of coagulopathy, balloon tamponade of the uterus.
 Conclusions. 1. Emergency care for massive bleeding in obstetrics is one of the priorities in reducing maternal morbidity and mortality. 2. Intensive therapy of blood loss should be based on modern recommendations and the use of modern drugs. 3. The indications for transfusion of blood components should be clearly applied.

Background. In the pathogenesis of many intra- and postoperative complications, the composition, volume and rate of infusion therapy (IT) play a significant role. This problem is especially relevant for patients with concomitant chronic pathology of the cardiovascular, respiratory systems and kidneys. Informative indicators for assessing the correctness of IT and early diagnosis of intraoperative complications associated with errors in its implementation are complex monitoring of functional indicators of the cardiovascular and respiratory systems. Purpose – of the study is to investigate changes in biochemical markers of heart failure and ultrasound signs of venous stasis in two modes of infusion therapy (restrictive and liberal), on the basis of a comparative study, to determine the optimal mode of perioperative IT in patients undergoing elective surgery for diseases of the abdominal cavity and have comorbid pathology in the form of coronary heart disease (CHD) and heart failure (HF). Materials and Methods. 86 patients were included in a single-center, prospective, randomized study. All patients were randomly divided into two groups depending on the mode of intraoperative IT: in the first group (n = 44) – a restrictive mode of 5–8 ml/kg/hour was applied, in the second (n = 42) – a liberal mode. Echocardiography was performed at the stages of the study. Heart contractility, central hemodynamics, and ejection fraction were evaluated. An ultrasound scan of the inferior vena cava (IVC) was performed during breathing as a non-invasive method of assessing the intravascular blood volume. The diameter of the vein during inhalation and exhalation was evaluated. Based on the respiratory change in the diameter of the IVC, the caval index is calculated, which is expressed as a percentage. An index approaching 100% indicates near-complete collapse and probable volume depletion, while an index close to 0% indicates minimal collapse and intravascular overflow. Ultrasound of the lungs was performed according to the BLUE protocol with a convex sensor in 8 zones along the front chest wall. The severity of pulmonary congestion was assessed based on the sum of B-lines: 5 and less – no congestion, 6 to 15 – slight congestion, 15 to 29 – moderate, 30 and more – significant. Results. The conducted study shows the advantage of the restrictive regimen of IT in patients with concomitant coronary artery disease and minimal signs of congestive heart failure during abdominal surgical operations. The regime with restriction of intravenous fluid administration was better, as it reduces venous congestion, reduces the amount of fluid in the interstitial space of the lungs, causes a smaller compensatory reaction of the cardiovascular system to infusion with normal values of NT-proBNP. The task of the anesthesiologist in this case is careful control of daily and cumulative water balance, adequate monitoring of indicators of the cardiovascular system, use of modern ultrasound technologies and protocols for controlling volemic status, assessment of the dynamics of biomarkers of heart failure, which will allow complex abdominal operations to be safely performed in patients with reduced cardiac reserve. Conclusions. As a result of the conducted research, it was established that: the use of a liberal regimen of infusion therapy in the perioperative period in patients with coronary heart disease and HF I, I-II FC compared to a restrictive regimen leads to a statistically significant increase in biomarkers of heart failure and ultrasound signs of volemic overload. The restrictive regimen of IT in a dose of 5–8 ml/kg/hour, in comparison with a liberal one in a dose of 12–15 ml/kg/hour, can be recognized as optimal and safe in patients with coronary heart disease and HF I, I-II FC during surgery on the organs of the abdominal cavity. The use and widespread implementation in practice of complex determination of the level of the amino-terminal prohormone of brain natriuretic peptide (NT-proBNP) NT-proBNP, non-invasive methods of ultrasound of the heart – echocardiography, ultrasound of the lungs and central vessels – assessment of the dynamic filling of the inferior vena cava (IVC) allows significantly supplement clinical information on volemic status, venous stasis, contractility of the heart and fluid retention in the interstitial space of the lungs and may be key in the prevention of cardiac complications in this category of patients.