Intensive care of acute hypovolemia in combination with chronic heart failure in patients with polytrauma without acute myocardial injury

Abstract

The impact effect assessment of ethylmethylhydroxypyridine succinate on the energy efficiency of blood circulation in patients with polytrauma without traumatic myocardial injury during chronic heart failure. The state of blood circulation was studied in 66 patients with polytrauma without myocardial injury on the background of CHF. Troponin I levels in all patients did not exceed 0.3 ng/ml, and NT-proBNP – was above 100 pg/ml, which confirmed the presence of chronic heart failure. Patients has been divided into 2 groups. Group S (n=33) – patients receiving standard intensive care, group E (n=33) – patients who were additionally injected with ethylmethylhydroxypyridine succinate 600 mg/day during a week. NT-proBNP, hemodynamics, oxygen and energy budget within the admission, on the 3rd and 7th day were investigated. The indicators of the energy budget, estimated by the circulatory reserve (CR), has been improved in all patients. Upon admission and on the 3rd day, it was not differ between groups, on the 7th day the CR in groups C and E was accordingly 286±94 and 392±173 mW/m2 (p<0.003). The level of NT-proBNP on the 7th day in groups C and E decreased to (109.1±8.5) and (65.8±23.3) pg/ml (p<0.001). Chronic heart failure aggravates the course of acute hypovolemia in patients with polytrauma without myocardial damage. The main cause of aggravation of circulatory failure during polytrauma without traumatic myocardial damage is energy deficiency in the myocardium. Ethylmethylhydroxypyridine succinate reduces the myocardial energy requirement. The effect of ethylmethylhydroxypyridine succinate begins to develop after 3 days, reaching a maximum on the 7th day. Keywords: polytrauma, heart failure, NT-proBNP, ethylmethylhydroxypyridine succinate, energy of blood circulation.