Central Hemodynamic Parameters Research Articles

Comparative analysis of hemodynamic monitoring with pulmonary artery catheter and transthoracic echocardiography in patients with cardiogenic shock

Aim. To compare main central hemodynamic parameters obtained by pulmonary artery catheterization and transthoracic echocardiography (TTE).Material and methods. This prospective study included 20 patients with acute myocardial infarction complicated by true cardiogenic shock. In all patients, number of central hemodynamic parameters was measured using a Swan-Ganz catheter and TTE. Comparison of both methods was carried out by Spearman correlation analysis and Bland-Altman plots using the STATISTICA 8.0 program.Results. We found quite a lot of agreement between the parameters measured by the two methods in the same patient at approximately the same time. Thus, the cardiac index (CI) is well measured by both methods. At the same time, the correlation coefficient was significantly higher when measuring CI using VTI (r=0,81 vs r=0,81) compared to LV volumes. Therefore, we consider the first method to be preferable. The values of total peripheral vascular resistance (TPVR), estimated by right atrial pressure, did not reveal agreement between methods. At the same time, there was agreement in case of central venous pressure. Measurement of pulmonary wedge pressure did not show agreement in me thods. We believe that this is due to the fact that diastolic function assessment in intensive care patients in the focal TTE mode may be difficult and not sufficiently correct.Conclusion. TTE can be used to monitor central hemodynamics in cases of satisfactory and moderately reduced cardiac imaging. Both the results of CI measurement using the Bernoulli formula and left ventricular volumes, as well as measuring TPVR using central venous pressure, are statistically consistent. Measurement of TPVR using right atrial pressure and measurement of pulmonary wedge pressure did not demonstrate agreement between the different techniques. We believe that TTE can be used to monitor CI and TPVR in patients with myocardial infarction complicated by true cardiogenic shock.

Relationship between central hemodynamic parameters and body composition and the functional state of neuro-autonomic regulation in young men

The aim of the study is to examine the relationship between central hemodynamic parameters and body composition by considering baseline functional state of neuro-autonomic regulation according to the index of regulatory system activity (IRSA) in young men. Material and methods. A total of 44 male participants were divided into three groups based on the IRSA level. The first group included 26 men with an optimal IRSA level. The second and third groups, each of 9 men, with moderate and high IRSA levels, respectively. The functional state of cardiovascular system was assessed using a device “REOKOM” (Kharkiv). The measurement of body composition was performed by weight-scale “TANITA BC-601” (Japan). The functional state of autonomic nervous system was assessed using a device “CARDIOLAB” (Kharkiv). Results. Our results have demonstrated higher hemodynamic parameters in men with moderate and high level of IRSA. Men with elevated level of sympathetic activity had the highest indices of the pumping function of the heart, and those with the balance between parasympathetic and sympathetic branches had the lowest indices of the pumping heart function. As for the indicators of total peripheral resistance and specific peripheral resistance, another trend was seen, namely, individuals with a balanced state of autonomic nervous regulation had the highest parameters, and those with a predominance of sympathetic tone had the lowest ones. Close correlations have been found between increased levels of regulatory mechanism tension and cardiohemodynamic parameters. An indicator analysis of the body component composition has revealed a significant increase in body mass index, total and visceral fat content in the examined groups with moderate and severe regulatory system tension. In addition, correlations have been found between IRSA and constituting components of body composition. Conclusions. The group assignment of the examined individuals according to IRSA has shown that a high tension of the regulatory mechanisms increased the load on the cardiovascular system, as indicated by higher indicators of central hemodynamics. In individuals with an optimal level of regulatory system functioning, the cardiovascular system activity is optimal and less energy consuming.

EARLY ACTIVATION PATHWAYS IN PATIENTS UNDERGOING OPEN HEART SURGERY WITH MULTICOMPONENT GENERAL ANESTHESIA COMBINED WITH HIGH THORACIC EPIDURAL ANESTHESIA

Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.

Effects of a medium cut-off dialyzer on inflammation and cardiac and vascular function in hemodialysis patients with heart failure.

Expanded hemodialysis (HDx) could provide clearance of larger middle-molecule uremic toxins. We compared the effect of hemodialysis with medium cut-off membranes and high-flux (HFHD) membranes regarding changes in inflammation and vascular and left ventricular function. This was a single-center, prospective, parallel-group comparative study. Patients were divided into two groups (HDx: 25 patients and HFHD: 26 patients). All measurements were performed at baseline and 12 weeks. Serum c-reactive protein, interkelukin-18, pentraxin-3, β-2 microglobulin, and brain natriuretic peptide were measured. We used pulse wave velocity and augmentation index to assess arterial stiffness and echocardiography to evaluate left and right ventricular function. We enrolled 51 patients. Although serum c-reactive protein, interkelukin-18, pentraxin 3, and β-2 microglobulin were significantly decreased in the HDx group (p = 0.02, p < 0.001, p = 0.002, and p = 0.02, respectively), there was no significant change in HFHD group at 12th week. Serum c-reactive protein and interkelukin-18were significantly lower in the HDx group compared to the HFHD group in the 12th week (p = 0.007 and p = 0.03, respectively). We observed a significant decrease in pulse wave velocity in the HDx group at the end of the study (p = 0.03). Although there was no significant change in pulse wave velocity in the HFHD group, pulse wave velocity was similar between the HDx and HFHD groups in the 12th week. We detected a significant decrease in the mean isovolumetric relaxation time in the HDx group (p = 0.006). However, there was no significant difference in isovolumetric relaxation time between the HDx and HFHD groups in the 12th week. HDx provides better clearance of middle molecular uremic toxins and inflammatory biomarkers, and it may be associated with better central hemodynamic parameters and diastolic functions.

Effect of Percutaneous Coronary Intervention on Central Hemodynamic Parameters in Elderly Patients

Effect of Percutaneous Coronary Intervention on Central Hemodynamic Parameters in Elderly Patients

Comparative assessment of the effect of anesthetics (propofol, sevoflurane, desflurane) on hemodynamics and gas exchange in the lungs during operations for acute pulmonary embolism

Introduction. To date, single studies have been published on the anesthesiological support of operations for acute pulmonary embolism. The issues of the influence of basic anesthetics on central hemodynamics and the functional state of lung tissue are not covered.The objective was to conduct a comparative assessment of the effect of anesthesia based on propofol, sevoflurane and desflurane on the parameters of central hemodynamics, myocardial contractility and functional state of the lungs during operations for acute pulmonary embolism.Materials and methods. The study included 75 patients (42 men and 33 women) aged 42.3 ± 14.3 years. All patients were operated for massive pulmonary embolism under cardiopulmonary bypass. The patients were randomized into three groups: in the first group (25 patients), propofol was used as the main anesthetic; in the secondgroup (25 patients) - sevoflurane; in the third group (25 patients) - desflurane. The indicators of central hemodynamics, myocardial contractile function and the functional state of the lungs during the operation were studied.Results. The comparative analysis of the anesthesia revealed that propofol had a more pronounced depressive effect on hemodynamics (a statistically significant decrease in blood pressure and EF LV), and desflurane had a moderate hyperdynamic effect (a statistically significant increase in heart rate). Anesthesia with propofol caused a statistically significant increase in the AAPO2 index (by 32.1%), a decrease in the PaO2/FiO2 index (by 24.1%) before cardiopulmonary bypass. After CPB, the oxygenation index decreased, intrapulmonary blood shunting increased, and pulmonary compliance decreased statistically significantly. The use of inhalation anesthetics (sevoflurane, desflurane) effectively preserved the functional parameters of the lungs: there were no statistically significant changes in the studied parameters.Conclusion. The inclusion of inhaled anesthetics (sevoflurane and desflurane) in the anesthesia regimen during surgery for acute pulmonary embolism ensures the stability of hemodynamic parameters and contractile function of the myocardium. The use of inhaled anesthetics maintains high lung function during surgery.

Arterial stiffness is associated with prehypertension in both non-hypertensives and treated hypertensives–A matched case control study

BackgroundPrehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls. MethodsThis is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each). ResultsPHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters. ConclusionPulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

Long-term exposure to ambient air pollution and measures of central hemodynamics and arterial stiffness among multiethnic Chicago residents

ObjectivesTo examine whether long-term air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters.MethodsWe assessed central hemodynamic parameters including central blood pressure, cardiac parameters, systemic vascular compliance and resistance, and brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter < 2.5 μm (PM2.5) and nitrogen dioxide (NO2) for the 3-year periods prior to enrollment were estimated at residential addresses using fine-scale intra-urban spatiotemporal models. Linear mixed models adjusted for potential confounders were used to examine associations between air pollution exposures and health outcomes.ResultsThe cross-sectional study included 2,387 Chicago residents (76% African Americans) enrolled in the ChicagO Multiethnic Prevention And Surveillance Study (COMPASS) during 2013–2018 with validated address information, PM2.5 or NO2, key covariates, and hemodynamics measurements. We observed long-term concentrations of PM2.5 and NO2 to be positively associated with central systolic, pulse pressure and BAR, and negatively associated with BAD, and BAC after adjusting for relevant covariates. A 1-µg/m3 increment in preceding 3-year exposures to PM2.5 was associated with 1.8 mmHg higher central systolic (95% CI: 0.98, 4.16), 1.0 mmHg higher central pulse pressure (95% CI: 0.42, 2.87), a 0.56%mmHg lower BAD (95% CI: -0.81, -0.30), and a 0.009 mL/mmHg lower BAC (95% CI: -0.01, -0.01).ConclusionThis population-based study provides evidence that long-term exposures to PM2.5 and NO2 is related to central BP and arterial stiffness parameters, especially among African Americans.

RELATIONSHIP OF PARAMETERS OF CENTRAL HEMODYNAMICS AND ARTERIAL STIFFNESS WITH COGNITIVE FUNCTIONS IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: To conduct a correlation analysis of central hemodynamics and arterial stiffness parameters with cognitive functions in patients with essential hypertension (EH). Design and method: The study included 111 male and female patients with grades I–III AH according to the classification (ESC/ESH, 2018). The average age of the patients was 54.6±10.8 years, the average duration of AH was 8.8±5.52 years. The state of arterial stiffness was assessed by applanation tonometry using the SphygmoCor apparatus (AtCor Medical, Australia). Cognitive functions were assessed using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproducing words) and the Montreal Cognitive Assessment Scale (MOCA). Results: The correlation analysis between the parameters of central hemodynamics and arterial stiffness revealed a negative correlation between the pulse wave velocity (PWV) and the severity of cognitive impairment, in particular, with the overall Mini-Cog score (R=-0.24, p=0.01), as well as central pulse pressure (CPP) with a total score on the Mini-Cog test (R=-0.27, p=0.007). Conclusions: Thus, an increase in pulse wave velocity and central pulse pressure correlates with the severity of cognitive impairment in EH patients.

SYSTEMIC DISEASES ARE A GROUP OF INFLAMMATORY ILLNESSES THAT CAN DAMAGE THE ARTERIAL WALL ASSESSED ACCORDING TO NON-INVASIVE ARTERIAL TONOMETRY

Objective: Objective: Hypertensive Cardiovascular Disease is a complex, multifactorial, and chronic illness, frequently beginning during childhood or adolescence, could develop functional and/or structural organ damage by the increase of arterial stiffness and the curve volume/pressure that in turn can raise the stress into the ventricular-arterial coupling and the appearance of arrhythmias. The aim of this study was to assess systemic inflammatory diseases according to non-invasive arterial tonometry and their possible complications. Design and method: Design &amp; Method: This cross-sectional study registered 339 patients, women 77%, both sexes, presented various systemic inflammatory diseases such as Psoriasis (123), Rheumatoid Arthritis (26), Celiac disease (13), Sjögren's disease (9), Crohn's disease (7), Ulcerative colitis (10), Endometriosis (10), Polycystic Ovary Syndrome (141). Anthropological data, Systolic/Diastolic Blood Pressure, and Heart Rate were measured. Central Hemodynamic Parameters (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure) and the difference between the maximum normal level and the observed value of the Augmentation Index (Diff-AIx), the surrogated value of arterial stiffness, were assessed with the SphygmoCor System-PVX, according to established protocols by sex and age. Results: Results: The mean age of women and men was 45-51 years. The mean of Systolic/Diastolic Blood Pressure among women and men was 132.5/81.6-135.2/85.9 mmHg, respectively. The Diff-AIx among women was 4.8 and among men was 5.4. The most important finding of the assessment of the systemic inflammatory diseases was the presence of hypertensive cardiovascular disease, considering the measurements of high systolic and diastolic blood pressure, and the abnormal Central hemodynamic parameters. The most important complication observed was the brief phases of atrial fibrillation during the 24-hour Holter monitoring (7.4%), the mean age of patients was 64.2 years, range of 44-88 years, and the highest percentage of each group were Ulcerative colitis (20.0%), Rheumatoid Arthritis (15.4%), and Crohn's disease (14.3%), Psoriasis (10.6%), Endometriosis (10.0%). Conclusions: Conclusions: The systemic diseases can damage the arterial wall and contribute to the development of Hypertensive Cardiovascular Disease. Cardiologists and clinical physicians, in the anamnesis, should include the search for inflammatory systemic diseases for a more complete clinical evaluation and therapeutic guidance.

GENDER DIFFERENCES IN ARTERIAL STIFFNESS IN YOUNG PATIENTS WITH PRIMARY HYPERTENSION

Objective: Influence of sex hormones on regulation of arterial stiffness (AS) include different mechanisms where changes in extracellular matrix, smooth and endothelial cells, and influence on oxidative stress and chronic inflammation are highlighted. In women after puberty AS decreases what confirm selective and fluctuating effect of sex hormones, primarly estrogen. In older men, hypogonadism is associated with incresed AS, while testosterone replacement reduce pulse wave velocity (PWV). Our aim was to analyze difference in central hemodynamic parameters between men and women with stage 1 hypertension. Design and method: This study included 154 patients with the primary hypertnsion (69.5% women, mean age 38.5). In all of them we collected different data and antroplogical paramaters using medical records. Parameters of AS were measured with the office tonometric system (SphygmoCor) and 24h ambulatory blood pressure monitoring system using Mobil-o-Graph and Arteriograph, but also estimated PWV was calculated using validated equation (ePWV). Results: There were no statistically significant gender differences in PWV values measured in the office oCor, measured during 24 hours (using Arteriograph and Mobil-O-Graph), and ePWV. There were no statistically significant gender differences in the values of 24 hours systolic and diastolic central aortic pressure (CAP) (Arteriograph or Mobil-O-Graph). Women had significant higher office CAP Men, on average, had statistically significantly higher amplified pulse pressure (APP) values than women (144.20 vs. 128.94, t = 3.275, p &lt; 0.01), while women had statistically significantly higher office augumentation index (AiX) values (t = -6.118, p &lt; 0.001), as well 24 hours (Mobil- O-Graph (t = -5.940, p &lt; 0.001;Arteriograph (t = -5.580, p &lt; 0.001). Conclusions: Possible explanation of no statistically significant differences in PWV values between men and women is average age of our group. A possible gender difference in AiX can be consequence of the increased reflection of pulse waves, which is increased in women. Longitudinal study should be conducted with monitoring of patients at longer time intervals in order to determine the further hormonal influence on structure of the arteries and for the assesment of total CV risk.

Association between speckle tracking echocardiography and pressure-volume loops during cardiogenic shock development

BackgroundThe relationship between speckle tracking assessed global longitudinal strain (GLS) and Doppler-based echocardiography with basic physiological markers of cardiac function derived from pressure-volume loops is poorly elucidated.ObjectiveWe aimed to describe...

Effects of Vitamin D Supplementation on Central Hemodynamic Parameters and Autonomic Nervous System in Obese or Overweight Individuals.

Previous studies have been inconsistent in demonstrating beneficial cardiovascular effects of vitamin D supplementation. To evaluate the effects of vitamin D3 supplementation on central hemodynamic parameters and autonomic activity in obese/overweight individuals with low vitamin D levels (<30ng/dl). Adults 40-65 years old with body mass index ≥25<40 kg/m2 were enrolled in this prospective, randomized, double-blind clinical trial (NCT05689632). Central hemodynamics was assessed using the oscillometric method (Mobil-O-Graph®), and heart rate variability using a Polar heart rate monitor (Kubios® software). Patients (n=53) received a placebo in the control group (CO, n=25) or vitamin D3 (VD, n=28) 7000 IU/day, and were evaluated before (W0) and after 8 weeks (W8) with a significance level of 0.05. The groups were homogeneous regarding age (51±6 vs 52±6 years, p=0.509) and vitamin D levels (22.8±4.9 vs 21.7±4.5ng/ml, p=0.590). At W8, the VD group had significantly higher levels of vitamin D (22.5 vs 35.6ng/ml, p<0.001). Only the VD group showed a significant reduction in systolic blood pressure (SBP; 123±15 vs 119±14mmHg, p=0.019) and alkaline phosphatase (213±55 vs 202±55mg/dl, p=0.012). The CO group showed an increase in augmentation pressure (AP: 9 vs 12 mmHg, p=0.028) and augmentation index (AIx: 26 vs 35%, p=0.020), which was not observed in the VD group (AP: 8 vs 8 mmHg, AIx: 26 vs 25%, p>0.05). VD group showed an increase in the parasympathetic nervous system index (PNSi) (-0.64±0.94 vs -0.16±1.10, p=0.028) and the R-R interval (866±138 vs 924±161 ms, p= 0.026). In this sample, eight weeks of daily vitamin D supplementation resulted in an improvement in blood pressure levels and autonomic balance.

ST-elevation myocardial infarction in patients with type 2 diabetes mellitus. Influence of the SGLT2 inhibitor dapagliflozin

Background. Patients with type 2 diabetes mellitus (T2DM) have a 2-fold higher risk of deve­loping coronary heart disease and mortality than those without carbohydrate metabolism disturbances. The reason for such negative trends is the occurrence of metabolic stress due to hyperglycemia and insulin resistance, which causes disturbance in energy metabolism and ischemic damage to cardiomyocytes. The purpose of the study is to improve the effectiveness of rehabilitation treatment and assess the dynamics of quality of life in patients with ST-elevation myocardial infarction (STEMI) and T2DM who are at high risk of develo­ping cardiac complications during the inpatient treatment by including the sodium-glucose transport protein 2 (SGLT2) inhibitor dapagliflozin in the comprehensive therapy. Materials and methods. The study group consisted of 38 patients with STEMI and T2DM who received dapagliflozin in addition to percutaneous coronary intervention (PCI). The control group included 37 patients with STEMI and T2DM who received only standard protocol treatment after PCI. In addition to general clinical examinations and assessment of quality of life using the EuroQol Group EQ-5D-5L questionnaire (1990), echocardiography was performed to determine general and local myocardial contractility by the Simpson method; plasma levels of glucose, insulin were evaluated, and insulin resistance was determined by the HOMA-IR. Results. Patients with STEMI and T2DM after PCI most often developed reperfusion syndrome with left ventricular failure and rhythm disturbances. Under the influence of standard medical treatment, a significant clinical and functional improvement was observed, but postinfarction remodeling progressed with impaired systolic and diastolic function and the development of heart failure syndrome, as well as treatment-resistant atrial and ventricular fibrillation paroxysms, supraventricular and ventricular extrasystoles, and bundle branch block. In patients of the study group with STEMI and T2DM on the comprehensive treatment with the SGLT2 inhibitor dapagliflozin, a significant decrease in the frequency of rhythm and conduction disturbances was noted on the se­cond day of observation, as well as a decrease in postinfarction left ventricular remodeling, which ultimately manifested in a statistically significant improvement of myocardial contractility (ejection fraction increased by 6.7 %) and a decrease in diastolic dysfunction. There was also a significant decrease in the frequency and severity of reperfusion arrhythmias, which was achieved due to the cardiometabolic effect of the SGLT2 inhibitor dapagliflozin. Conclusions. The inclusion of the SGLT2 inhibitor dapagliflozin in the comprehensive treatment led to a significant improvement in central cardiac hemodynamic parameters and a decrease in the frequency and severity of reperfusion arrhythmias and acute left ventricular failure, which contributed to the improvement in quality of life.

ПРИМЕНЕНИЕ МЕТОДА ЭКСТРАКОРПОРАЛЬНОЙ АУТОГЕМОМАГНИТОТЕРАПИИ С ЦЕЛЬЮ КОРРЕКЦИИ ГЕМОДИНАМИЧЕСКИХ НАРУШЕНИЙ В ИНТРАОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ ПРОВЕДЕНИИ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУCСТВЕННОГО КРОВООБРАЩЕНИЯ

Purpose of the study. To evaluate the effect of extracorporeal autohemomagnetic therapy on the parameters of central hemodynamics during surgical intervention for myocardial revascularization (aortocoronary and mammary coronary bypass surgery) under conditions of artificial circulation. Material and methods. The parameters of invasive hemodynamics of 100 patients who were treated in anesthesiology and intensive care units were studied. All patients were divided into 2 groups. Group 1 (50 people) received standard anesthesia (multicomponent balanced anesthesia) for coronary artery bypass grafting and mammary coronary artery bypass grafting under artificial circulation without the use of extracorporeal autohemomagnetic therapy. In group 2 (50 people), in addition to standard anesthesia autohemomagnetic therapy was used. Аfter catheterization of a. radialis dextra (sinistra) and v. jagularis interna dextra (sinistra), the invasive hemodynamics parameters were assessed using the Draeger Infinity Delta monitoring system (Germany): systolic blood pressure, diastolic blood pressure, mean arterial pressure, central venous pressure, heart rate. The parameters were studied at 2 stages of the surgical intervention: 10 minutes after induction of anesthesia, 10 minutes after administration of the calculated dose of protamine. Results. The use of autohemomagnetic therapy made it possible to increase the parameters of invasive central hemodynamics: systolic blood pressure, diastolic blood pressure, mean arterial pressure. The study of the parameters of heart rate and central venous pressure revealed no statistical differences. Conclusions. The use of extracorporeal autohemomagnetic therapy in the intraoperative period during myocardial revascularization can help correct hemodynamic disorders.

Development of an experimental technique for orthotopic left lung transplantation in a rabbit model

Objective: to develop, master and evaluate the efficiency of an isolated lung transplantation (LT) technique on a rabbit animal model using Perfadex Plus® solution for cold static storage. Materials and methods. Scottish Giant rabbits (n = 20) were used in this study and divided into two groups: donors and recipients. Donor lungs were preserved with Perfadex Plus® solution and stored for 6 hours at 4 °C. Recipient animals underwent unilateral orthotopic left LT. The postoperative follow-up period was 24 hours. Laboratory and instrumental control with assessment of blood gas composition, lactate level, ventilation parameters, and central hemodynamic parameters, was performed during the follow-up. Chest X-ray in direct projection was performed twice, and at the end of follow-up, material was taken for histologic examination. Results. We obtained a high oxygenation index in the post-transplant period (&gt;350 at p &lt; 0.023), as well as physiological indicators of lactate (3 ± 0.3 mmol/L at p &lt; 0.002) and peak inspiratory pressure (15 ± 1 cmH2O, p &lt; 0.001). Radiological examination showed no radiological signs of severe primary graft dysfunction in all cases (mean RALE score 1), which was confirmed by histological studies. Conclusion. Left LT in rabbits is possible, the LT technique on a biological rabbit model using Perfadex Plus® solution is valid and efficient with the achievement of satisfactory gas exchange, ventilation and metabolism parameters.

Clinical case of treatment of true drowning in fresh water

Drowning is the third leading cause of unintentional injury death worldwide. The largest number of victims of drowning falls on the young able- bodied population.Objective. There are no recent intensive care protocols for drowning, it is relevant to formulate guidelines for the treatment of drowning. Clinical observation. A 25-year-old female patient was taken by an ambulance team to the intensive care unit with a directional diagnosis ‘drowning in fresh water’ of three degree of severity. The patient had got on ventilator with closed aspiration system. Emergency bronchoscopy was performed during which 200 ml of fluid aspirated into the lungs was removed. Respiratory support was determined by stepwise increase of the PEEP level and decrease in FiO2 level taking into account respiratory index. Given the development of a pro-inflammatory mediator response, lactatacidosis, hemolysis, hyperhydration, a high risk of infectious complications, it was decided to start extracorporeal treatment early by continuous veno-venous hemodiafiltration and de-escalation of systemic antibacterial therapy with meropenem by prolonged infusion. Against the background of the ongoing treatment, we managed to achieve target respiratory parameters and stabilize central hemodynamic parameters by the end of the first day, prevent the development of renal damage, correct water-electrolyte and metabolic disorders, and avoid severe septic complications. Vasopressor support was discontinued on the 4th day, and on the 5th day the patient was switched to independent breathing. The patient`s stay in the intensive care unit was 6 days.Conclusions. Stepwise respiratory therapy using closed suction systems and urgent bronchoscopy prevent direct damage to the alveoli and ongoing translocation of fluid into the vascular bed. Prescribing broad-spectrum antibiotics prior to the growth of clinical and laboratory signs of infectious lung lesions allows to reduce the risk of severe septic complications with pulmonary destruction parenchyma. Early onset extracorporeal treatment by CVVHDF allows to correct homeostasis disorders, eliminate hypervolemia, prevent the development of acute renal damage as a result of hemolysis.

Control of Cardiac Biomarkers Concentrations, Central Hemodynamics and Their Correlation During Gastrointestinal Bleeding

We did not observe high values of cardiac markers and changes in central hemodynamic parameters in patients with acute gastrointestinal bleeding (AGIB) and a correlation between them, this led to the decision to conduct a study. Clinical materials of 457 patients diagnosed with GIB were analyzed. Cardiac pathology was detected in 150 patients. Dynamic changes in cardiac biomarkers and central hemodynamic indicators in patients were studied in 3 stages. Phase I, period included in ICU; Stage II - 24 hours after admission to the ICU; the third stage covers the next 48 hours. The concentration troponin, BNP, myoglobin and CK-Mb was studied in the patients and it was found that although the concentration of these biomarkers was high in the first stage, these concentrations decreased and reached normal levels in the later stages of the dynamics against the background of the treatment. Dynamic changes of central hemodynamic indicators (CHI): stroke volume, cardiac minute volume, peripheral vascular resistance and myocardial oxygen demand were studied in 3 stages. It was found that although SV was low, it dynamically increased in the later stages and did not reach the normal level. This is a clear example of continued hypovolemia. Peripheral vascular resistance (PVR) from blood loss from the gastrointestinal tract was greater than normal in all three phases. PVR remained high and was statistically honest because the volume of circulating blood was not fully corrected despite the treatments. Also, the correlation between central hemodynamic indicators and cardiac markers was studied, showing that in stage I, there is a strong contrast between CMV and CK-MB; Strong straight between PVR and BNP; In stage II, strong contrast between CMV and BNP; Strongly flat between PVR and CK-MB; In stage III, the average level is between CMV and myoglobin; We proved that there is a moderate inverse correlation between PVR and cTn and it is statistically honest. Thus, although CHI was slightly less than the norm in the initial period, it normalized in the later stages, but PVR remained high in all stages. This caused a sharp increase in PVR as a compensatory response to the decrease in circulating blood volume during acute GIB. Among the cardiac markers, we associate the rise of troponin during the bleeding period with damage to postanemic, hypoxic myocardial muscles. Among the cardiac markers, a sharp increase in BNP is an indicator of the development of left ventricular failure and is associated with a sharp increase in PVR, and we also proved that there is a strong direct relationship between them.

Use of hydrobalneotherapy in ambulatory rehabilitation of patients with post-COVID syndrome

BACKGROUND: Post-COVID syndrome ostcoid syndrome is a consequence of the multimodal systemic effect of the SARS-CoV-2 virus on the human body, and leads to a variety of clinical symptoms that require correction. In particular, there is an increase in the level of allostatic load and the risk of maladaptation. One of the means of effective non-drug effects on the separated consequences of COVID-19 is the use of hydrobalneotherapy methods as part of a rehabilitation course.&#x0D; AIM: To study the influence of various hydrobalneotherapy methods as part of comprehensive outpatient rehabilitation on the clinical-functional and psychoemotional status of patients with post-COVID syndrome.&#x0D; MATERIALS AND METHODS: 160 patients undergoing outpatient rehabilitation for manifestations of post-COVID syndrome, 74 men and 86 women, with a median age of 50 [43; 55.1] years, were comprehensively examined. Patients were randomized to 4 groups of 40, depending on the non-drug exposure method in the rehabilitation program: 1st group ― with the inclusion in the individual rehabilitation program of a course of chloride-sodium mineral baths in the amount of 10 procedures, 2nd group ― patients who were assigned a 10-day course of hot tubs, 3rd group ― 40 patients, along with exercise therapy, who underwent a 10-day course of general baths "Biolong", and 4th, control group of patients who did not undergo outpatient rehabilitation.&#x0D; RESULTS: The most frequent complaints were increased fatigue ― 88.8% of subjects, memory loss ― 46.9%, headache and dizziness ― 38.8%, dyspnea during physical activity ― 35.6%. The most frequent electrocardiogram parameters were sinus tachycardia (4.4%) and sinus bradycardia (8.1%). The mean allostatic load index of all patients was 3 [2; 3], which corresponds to the average allostatic overload. Against the background of rehabilitation measures with the inclusion of preformed physical factors, regression of the main complaints (weakness was detected in 24.2% of cases, memory decline ― in 20%, headache, dizziness ― in 17.5%, dyspnea ― in 15%, sleep disturbance ― in 10%, tachycardia and discomfort in the heart area ― in 7.5%) and improvement of electrocardiogram parameters were noted: sinus tachycardia and ventricular extrasystole were not noted, bradycardia was recorded in 2.5% of cases instead of 8.1%, repolarization process disorders ― in 2.5% instead of 8.1% before rehabilitation. In the group of patients who received whirlpool baths, improvement of external respiratory function parameters was noted: forced vital capacity of lungs increased by 12.1% (p 0.01), forced expiratory volume in the 1st second ― by 9.6% (р 0.05), the distance traveled according to the results of the test with 6-minute walking increased by 2.2% (р 0.05). In the group of those who received general baths with the preparation "Biolong", there was registered an increase in forced expiratory volume in the 1st second by 9.4% (р 0.05), an increase in the distance traveled during the 6-minute walk test by 8, 3% (р 0.05), decrease in norepinephrine level by 17.4% (р 0.05), adrenaline level by 13% (р 0.05) and cortisol level by 26.2% (р 0.01), glutathione peroxidase activity level by 13.6% (р 0.05). In the group of patients who received sodium chloride baths, there was a tendency to improvement of central hemodynamic parameters, reduction of adrenaline and noradrenaline parameters by 14.5% and 19.7% respectively (р 0.05). All rehabilitation groups showed a decrease in the Beck depression scale and Spielberger anxiety scale, K. Maslach questionnaire (emotional exhaustion and reduction of personal achievements), Bass–Perry aggression level questionnaire and Schulte table (mental stability), as well as a decrease in the level of allostatic load. In the control group, no dynamics of complaints and indicators was noted.&#x0D; CONCLUSION: In patients with post-COVID syndrome, a variety of complaints and a number of electrocardiogram disorders, clinical and functional parameters were identified. The study revealed positive dynamics against the background of the rehabilitation course with the inclusion of hydrobalneotherapy methods in the form of significant regression of complaints, clinical and functional disorders and changes in psychoemotional background and cognitive status. A decrease in allostatic load was noted after a course of non-drug rehabilitation.

Transcranial Electrostimulation as a Non-pharmacological Method of Treating Arterial Hypertension I Degree in young patients

Purpose: The authors determined the efficacy of transcranial electrostimulation (TES) in treating arterial hypertension I degree in young patients and compared it with electrically induced sleep therapy. Materials and Methods: The performed study is a prospective randomized controlled trial that enrolled 212 patients aged 18-20years with arterial hypertension I degree. Patients were divided into two groups. Group 1 consisted of 110 patients who underwent transcranial electrostimulationusing a method developed at the Institute of Physiology named after I. P. Pavlov, Russian Academy of Sciences in Saint Petersburg. Group 2 included 112 patients who underwent electrically induced sleep therapy procedures with the orbital-retro mastoidal technique of electrode application in a "sedative" mode. The control group included 45 patients with normal blood pressure. All patients underwent 24-hour ambulatory blood pressure monitoring, determination of central hemodynamic parameters, diurnal heart rate variability, and endothelial function parameters. Results: As a result of TES therapy in patients significantly decreased the average diurnal SBP and DBP values, pressure load, normalized the diurnal BP profile, AT, and EF values. As a result of electrosleep therapy, average diurnal SBP, and DBP values decreased unreliably, decreased pressure load, and signs of sympathicotonia, but AT and EF values did not change significantly. TES therapy's effectiveness for treating stage 1 hypertension in young patients is significantly higher by 1.9 times in comparison with electrosontherapy. Conclusion: This study has shown that the TES treatment is more effective than traditional non-pharmacological electrosleep therapyin a "sedative" mode. TES normalizes hemodynamics, BP levels, and EF indicators and can be recommended as one of the methods of antihypertensive therapy in young patients.