Intensive Care for Eclampic Coma

Abstract

Objective: to enhance the efficiency of treatment of puerperas with eclampic coma, by substantiating, developing, and introducing new algorithms for correction of systemic hemodynamic, metabolic disturbances, and perfusion-metabolic changes in brain tissues. Subjects and methods. Studies were conducted in 18 puerperas with eclampic coma (Group 2) in whom the authors used a new treatment algorithm aimed at maintaining baseline cerebral perfusion pressure (CPP), restoring volemic levels at the expense of interstitial fluid. A control group (Group 1) included 30 patients who received conventional standard therapy. Regional cerebral circulation was measured by a non-invasive (inhalation) radioisotopic method, by applying the tracer 131Xe, as described by V. D. Obrist et al., on a modified КПРДИ-1 apparatus (USSR). The rate of brain oxygen uptake was determined from the oxygen content between the artery and the internal jugular vein. Central hemodynamic parameters were studied by the direct method of right heart catheterization using a flow-directed Swan-Ganz catheter. The volumes of total and extracellular fluids were estimated using 20% urea and mannitol solutions, respectively, at 0.2 g/kg weight by the procedure of V. M. Mogen. Circulating blood volume (CBV) was determined by a radioisotopic method using 131iodine albumin on an УPI-7 apparatus (USSR). Cerebral spinal fluid pressure was measured by an ИиНД apparatus. Studies were made in four steps: 1) on admission; 2) on days 2—3; 3) during emergence from coma; 4) before transition. Results. The use of the new algorithm for intensive care for eclampic coma, which is aimed at improving the perfusion metabolic provision of brain structures, with a reduction in mean blood pressure by 10—15% of the baseline level, by administering magnesium sulfate and nimodipine, and at compensating for CBV by high-molecular-weight hydroxyethylated starch (stabizol), ensured early emergence from a comatose state. Conclusion. The proposed intensive care could reduce mortality from 15.7 to 4.8%. Key words: eclampic coma, intensive care, cerebral blood flow.