Hypertonic Sodium Chloride Solution Research Articles

Effect of hypernatremia on protein reabsorption in renal proximal tubules of the lake frog <I>Pelophylax ridibundus</I>

Protein reabsorption in the kidney proximal tubules occurs simultaneously with the transport of ions and water, but little is known about the dependence of receptor-mediated protein endocytosis on water-salt balance changes. The aim of the study was to investigate tubular reabsorption and intracellular vesicular transport of various proteins in a model of hypernatremia in lake frogs (Pelophylax ridibundus). Frogs were injected with hypertonic sodium chloride solution (0.75 M NaCl) 1 hour before injection of green or yellow fluorescent proteins (GFP or YFP), as well as lysozyme. The method of fluorescent immunohistochemistry was used for detection of lysozyme and endocytic receptor megalin in kidney sections. Specimens were investigated using laser scanning confocal microscopy. The intensity of fluorescent signals of proteins and megalin in proximal tubular cells was determined on the images obtained. To study the dynamics of endocytosis, an automated method for quantifying colocalized protein and megalin signals was used. A statistically significant decrease in the reabsorption of GFP, YFP and lysozyme in the proximal tubules after 0.75 M of NaCl injection was found. The accumulation of proteins in the early endocytic compartment and decrease in their entry into late endosomes and lysosomes are shown, that is considered as evidence of a delay in intracellular vesicular transport in hypernatremia. The data obtained were analyzed in connection with changes in blood parameters and kidney activity during osmoregulation, and also with the role of chloride channels in receptor-mediated protein endocytosis. It can be assumed that increased ion transport in the proximal tubules cells in hypernatremia leads to decreased reabsorption capacity of epitheliocytes and delayed intracellular transport of proteins.

New diagnostic criterion for a 3% hypertonic saline infusion test for the differential diagnosis of diabetes insipidus and primary polydipsia

AIM: To determine the value of urine osmolality when conducting a test with 3% hypertonic sodium chloride solution, which allows for the differential diagnosis of diabetes insipidus (DI) and primary polydipsia (PP).METHODS: An interventional cross-sectional study was conducted at the (Endocrinology Research Center. The study included 90 patients with polyuria-polydipsia syndrome from September 2021 to September 2023. All patients underwent sequential two tests with osmotic stimulation: 3% hypertonic saline infusion test and a water deprivation test. The final diagnosis was established based on the results of a fluid deprivation test, the patient’s anamnestic data (previous operations, diseases of the hypothalamic-pituitary region, the presence of mental illnesses), MRI data (the presence of a hyperintense signal from the posterior pituitary on T1-weighted images, a detected tumor or infiltrative formation of the hypothalamic-pituitary area, presence of Rathke’s pouch cyst).RESULTS: 48 patients with a final diagnosis of DI and 42 with a final diagnosis of PP were analysed. A cut-off point for urine osmolality during infusion test with 3% hypertonic saline was found: values less than or equal to 377 mOsm/kg support the diagnosis of DI, and values higher than 377 mOsm/kg support the diagnosis of PP. The sensitivity of the criterion is 89%, 95% CI (77%; 97%), specificity — 98% (87%; 100%), PPV — 98% (88%; 100%), NPV — 89% (76%; 96%), accuracy 93% (86%; 98%).CONCLUSION: The proposed criterion for differential diagnosis has comparable diagnostic accuracy in relation to the differential diagnosis of DI and PP, while the safety of the test may be higher.

Assessment of pharmacotherapy efficacy for the treatment of exacerbations of chronic obstructive pulmonary disease associated with viral infection

Justification. Knowledge of the differences in response to therapy between phenotypes of exacerbations of chronic obstructive pulmonary disease (COPD) is necessary to improve treatment outcomes. Objective: to determine the most effective additional pharmacological methods for virus-associated exacerbations of COPD. Material and methods. The study included patients hospitalized with exacerbations of COPD with viral (n = 60) and viral-bacterial (n = 60) infections, and a comparison group with exacerbations of COPD with bacterial infection (n = 60). The diagnosis of COPD was based on spirometric criteria, viral infection — according to the results of PCR-RV of sputum for RNA of respiratory viruses. Treatment was carried out in real clinical practice. The groups were comparable in the use of systemic glucocorticoids, short-acting bronchodilators. Dyspnea was assessed using the TDI index (primary endpoint), lung function (spirometry, diffusion capacity for carbon monoxide), exercise tolerance (6-minute walk test), length of hospital stay (secondary endpoints). The сorrelations were determined with the use of Cox proportional hazards model. Results. In the groups with virus-associated and viral-bacterial exacerbations, unlike bacterial exacerbations, the following types of treatment were associated with achieving TDI +1 (odds ratio — OR, 95 % confidence interval — CI): fixed triple combination (OR 2.69; 95 % CI 1.48–4.90; p = 0.010 and OR 2.74; 95 % CI 1.29–3.80; p = 0.031), inhalation of 3 % sodium chloride solution (OR 3.64; 95 % CI 1.45–5.42; p = 0.001 and OR 3.23; 95 % CI 2.15–5.43;\ p = 0.042), antiviral drugs (OR 2.91; 95 % CI 1.15–3.62; p = 0.009 and OR 2.76; 95 % CI 1.31–3.90; p = 0.008). As a result of treatment, an increase in DLco/Va, SpO2 after a 6-minute walk, and a decrease in the length of hospital stay were observed. Conclusion. Detection of virus-associated infections is a promising marker for determining indications for prescribing long-acting anticholinergic drugs and beta-adrenomimetics, inhaled corticosteroids, inhalations of hypertonic sodium chloride solution, and antiviral drugs for exacerbations of COPD.

Pharmacotherapeutic justification of the hypertonic saline solution usage for the treatment of calves with diarrhea

Among the mass distribution of gastrointestinal diseases in calves with signs of diarrhea, a significant share is occupied by infectious diseases. In the farm, the largest number of sick calves had polyetiological disorders of the gastrointestinal tract, which were caused by causative agents of rotavirus, corona virus infection, and Escherichia Coli K99. The complex etiological nature of the disease with the symptom of diarrhea, the variety of pathogenetic links involves all body systems in the pathological process and requires complex treatment. Treatment should include restoration of hydration and concentration of electrolytes, correction of metabolic acidemia, fight against opportunistic and pathogenic microorganisms, intoxication, and restoration of digestive functions. Treatment of the experimental group of sick calves with diarrhea included antibiotic therapy using Colistin orally at a dose of 0.5 g/50 kg of body weight, twice a day, for 5 days; drinking colostrum in a dose of 30 ml once a day for 3 days; rehydration therapy by drinking energy electrolyte solution "Regidrobust" once a day for 3 days and infusion of 7.5% sodium chloride solution at a dose of 4 ml/kg of body weight, once. Calves of the control group did not receive an infusion of 7.5% sodium chloride solution. The research results showed that in the calves of the research group, complex therapy using a hypertonic 7.5% sodium chloride solution had a stronger therapeutic effect, positively changed the biochemical and morphological indicators of the blood, led to the normalization of metabolic processes, body functions as a whole, and restoration of calf activity. The calves of the experimental group on the 2nd day of treatment showed much more active interest in feed and consumed it and generally had a satisfactory general condition. This did not happen in the calves of the control group, whose condition remained depressed. Disappearance of the symptom of diarrhea in calves of the experimental group was noted on average on the 3rd day of treatment, in calves of the control group on 4-5 days. The proposed treatment scheme contributed to the reduction of the calf disease period by 1,5 times. Key words: diarrhea, gastrointestinal disorders, calves, hypertonic sodium chloride solution, hypertonic saline solution, treatment, rota virus infection, corona virus infection, colibacteriosis.

Reprofiling Hydrogen Peroxide from Antiseptics to Pyolytics: A Narrative Overview of the History of Inventions in Russia

Pyolytics are drugs that dissolve thick pus when applied topically. This group of drugs was discovered in early 21st century in Russia as a result of successful repurposing of antiseptics hydrogen peroxide, sodium bicarbonate and sodium chloride from antiseptics to pyolytics. Prior to this watershed event in pharmacy, the problem of effective treatment of purulent diseases had not been solved. The fact is that before that in the treatment of various purulent diseases mainly antiseptics and disinfectants solutions were used, of which hypertonic sodium chloride solution and 3 - 6% hydrogen peroxide solutions took the leading role as "antipurulent" drugs. However, the use of the known antiseptics and disinfectants solutions provided disinfection of the treated surface, but not dissolution of thick pus masses, as the solutions had no effective pyolytic action. Pyolytic activity, i.e. activity of dissolution of thick pus masses, was fantastically increased in hydrogen peroxide solutions only after the possibility of transformation of "old" drugs into "new" drugs by means of artificial changes in physical and chemical properties of their dosage forms was discovered. The greatest (explosive) effect was achieved by developing warm alkaline hydrogen peroxide solutions enriched with oxygen gas under increased pressure. In chronological order, an overview is given of Russian inventions, which formed the basis for the physicochemical repurposing of hydrogen peroxide solutions into pyolytics as well as the basis of temperature and physicochemical pharmacology and pharmaceutics.

Severe acute bronchiolitis in children: etiology, therapy, effectiveness of 3% hypertonic saline containing sodium hyaluronate

Introduction. Acute bronchiolitis (АB) is a common infection in children under the age of 2 years. In modern clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison with therapy without the inclusion of this drug.Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy of 3% HSCS with HS AB was conducted in comparison with historical control.Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the age younger than 3 months (40.7%). The presence of risk factors for severe course of acute respiratory failure had an impact on the average bed-day and on the need for respiratory support (p = 0.04), in addition to which patients often received drug therapy. There were no statistically significant differences in the terms of hospitalization, the duration of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma by the 2nd day of the disease.Conclusion. AB in ICU patients most often has RSV etiology, developing in the presence of risk factors for severe course. The influence of modern guidelines for the treatment of AB in the ICU remains controversial. The addition of 3% HSCS with HS can improve the flow of AB.

Safety of Administration of Hypertonic Sodium Chloride Solution Through Peripheral IV in Neuroscience Intensive Care Unit, KAMC, Makkah

Background: Infusions of 3% sodium chloride are routinely recommended to be given through central venous catheters, not peripheral IV lines. In addition, no data are available on the proper site for administration of a continuous intravenous infusion of 3% sodium chloride solution in adults. Some recent studies have illustrated that this theory may not be relevant, and that 3% sodium chloride may be safe for administration in peripheral IV lines. Aims and Objectives: To evaluate the incidence of infusion-related reactions in neuro intensive care patients treated with continuous intravenous infusion of hypertonic sodium chloride up to 3% solution via peripheral IV catheter. Methods: Data on patients treated with continuous intravenous infusion of hypertonic sodium chloride up to 3% solution through peripheral IV cannula for at least 24 hours at neuroscience intensive care unit were evaluated by using prospective observational design to determine the complications in administration site such as phlebitis, infiltration, extravasation, thrombosis and line infection. Results: Out of 43 patients with peripheral hypertonic saline infusion (up to 3%), no incidence of complications were reported after 24 hours of continuous infusion. Out of 34 patients who continued their infusion to second day, one incidence of phlebitis and 2 incidences of extravasation were reported. 20 patients were on continuous infusion towards day 3, where also one incidence of phlebitis and 2incidencese of extravasation were reported. Overall complications reported in all 97 peripheral hypertonic saline infusion days were 2 incidence of phlebitis and 4incidences of extravasation. Conclusion: Current recommendations that a central catheter is required for continuous intravenous infusion of hypertonic sodium chloride up to 3% should be reconsidered. Only a few patients who had peripheral infusions had infusion-related complications. Peripheral intravenous administration of hypertonic saline can be used safely and effectively in patients without a central line.

Вибір оптимальної стратегії муколітичної терапії при захворюваннях органів дихання

Abstract. Lung health mostly depends on effective mucociliary clearance. Many lung diseases have a classic pathogenetic triad (hypercrinia, dyscrinia, mucostasis) – when thick and viscous mucus is difficult to secrete and this can lead to an infection, progressive inflammation, as well as impaired airway patency. Today, the arsenal of drugs that reduce the density of sputum, improve mucociliary clearance and promote sputum release has significantly increased. Thus, medical professionals face the issue of choosing the optimal drug or their combination, as well as the way of drug management, in acute and chronic respiratory diseases, taking into account the characteristics of the course of the disease and the presence of concomitant pathology. Wider implementation of nebulizer therapy in clinical practice is also relevant. This will significantly increase the effectiveness of mucolytic therapy, which is especially important for patients with chronic bronchopulmonary diseases. Inhalation of a hypertonic solution of sodium chloride in combination with hyaluronic acid provides a direct mucolytic effect – it reduces viscosity and improves the biophysical characteristics of mucus, subsequently improving its transport and excretion.

Development of concepts on sodium regulation in XX century

The 20th century is the time of the birth of many scientific areas, including the physiology of the kidneys and water-salt metabolism. This article is devoted to the history of the development of one of its directions - the issue of regulation of sodium homeostasis in the body. This article is the first attempt in the Russianspeaking space to summarize the achievements in the study of sodium regulation. For many decades, scientists from different countries have studied the influence of various factors on sodium excretion: blood pressure, atrial peptides, hormones of the neurohypophysis and adrenal glands, renal nerves, infusion of various substances, etc. It was found that sodium excretion does not directly depend on changes in blood pressure and glomerular filtration rate. Atrial peptides causing natriuresis were discovered, their structure and mechanism of action were described in detail. The role of the hormones of the neurohypophysis - vasopressin and oxytocin - in the excretion of sodium, as well as the role of aldosterone and angiotensin II in the reabsorption of this cation was shown. It has been shown that the administration of hypertonic solutions of sodium chloride causes a greater natriuretic response than the administration of other substances (sodium sulfate and acetate, glucose, mannitol, etc.), and the idea of the existence of sodium-s ensitive receptors has also been put forward.

Bronchial reactivity to inhaled hypertonic saline solutions in children with cystic fibrosis

Background. Inhaled hypertonic saline solutions (IHSS) are included in the list of mandatory prescriptions in the treatment of cystic fibrosis (CF). However, some patients with CF may develop bronchial hyperreactivity (BHR), which may be the cause of violation of the treatment protocol. The purpose is to study the state of bronchial reactivity to IHSS and its dependence on the clinical, functional and microbiological features of CF course in children. Materials and methods. Forty children with CF were examined. All of them underwent general clinical, molecular genetic, laboratory and microbiological examination. Instrumental methods included spirometry, measurement of fractional exhaled nitric oxide, X-ray and computer tomography of the chest. To determine the individual tolerance of inhalations of hypertonic sodium chloride solution (HSCS), the research protocol proposed by E.P. Dellon et al. was used. Results. According to the results of the research protocol, 17 (42.5 %) patients with CF had BHR to HSCS. The highest frequency of BHR was found in children with a severe CF course. There was no dependence of BHR in CF patients on allergic pathology and a burdened allergic history. Assessment of the tolerance of HSCS before prescribing basic therapy is important. Early functional signs of BHR, which may require the preventive administration of short-acting β2-agonists when using HSCS in children with CF, are as follows: reduction in forced expiratory volume in 1 second by 7 % and maximal expiratory flow at 25 % by 6 % when using 3% HSCS. Conclusions. The presence of BHR in patients with CF may interfere with adequate basic therapy by inhalation. The prescription of IHSS to patients with CF should be personalized with the determination of individual sensitivity of a person to predict a positive therapeutic effect.

Determination of the effectiveness of short-term nebulizer therapy in bronchiectasis

BACKGROUND. While the incidence of bronchiectasis is increasing every year, the treatment of this category of patients today is a real challenge for practical medicine, as the only existing guideline contain only low and medium quality data.
 OBJECTIVE. To determine the effectiveness of short-term differentiated inhalation therapy with salbutamol (Nebutamol®, “Yuria-Pharm”), hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) and decametoxinum (Decasan®, “Yuria-Pharm”) in patients with bronchiectasis, which was separated the for four different subgroups depending on the presence of sputum colonization by pathogens and airways obstruction.
 MATERIALS AND METHODS. 99 adult patients with confirmed clinically significant bronchiectasis in a stable condition were included in a single-center prospective study lasting 12 months. The number of exacerbations in the previous year and the year after treatment, subjective assessment of the severity of cough and sputum, amount of daily sputum, serum C-reactive protein level, microbiological examination of sputum, and spirometry were performed.
 RESULTS AND DISCUSSION. Short-term personalized inhalation therapy with bronchodilators, mucolytics and antiseptics in the subgroup of patients with airway obstruction and colonization reduced the severity of the main symptoms and reduced the total bacterial load by 45.9 %, and in the subgroup of patients with airway colonization without airway obstruction reduced the severity of cough and the total bacterial load in 76.2 % of cases. Prescribed therapy was effective in statistically significant reduction in the number of exacerbations by 43 %.

Experience of inhaled hypertonic saline use in pediatric pulmonology

Impaired secretion and removal of mucus from the respiratory tract are important pathophysiological links in the development of several pulmonary pathologies: chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, cystic pulmonary fibrosis, etc. In the article, modern approaches to the use of inhaled hypertonic (3-7%) sodium chloride solutions in children with various recurrent and chronic bronchopulmonary pathologies are analysed. The combination of hypertonic sodium chloride solution and hyaluronic acid can minimize the unpleasant effects of hypertonic solution, such as irritating cough caused by the effect of salt on the cough receptors of the upper respiratory tract. At the same time, hyaluronic acid has unique water-retaining properties, therefore it plays an important role in regulating the fluid balance in the lung interstitium, moistens the airways, reduces bronchial hyperresponsiveness, decreases inflammation and destroys the biofilm associated with chronic infection. The use of nebulizer inhalations with a combination drug containing hypertonic sodium chloride solution and hyaluronic acid has proved to be successful in pulmonological pediatric practice. The authors have learned first-hand that this combination is highly efficient. The described clinical cases demonstrate the positive experience of inhaled use of the domestic combination drug of 3% hypertonic sodium chloride solution and hyaluronic acid in the treatment of preschool patients (5 years old) with the following diagnoses: recurrent bronchitis, primary ciliary dyskinesia (Kartagener's syndrome). This inhalation therapy helped not only to improve the rheological properties of sputum, quickly restore the bronchi to health, reduce signs of inflammation of the respiratory tract, but also generally improve the patients' breathing and quality of life.

INFLAMATOMETRIC FEATURES OF BRONCHIAL ASTHMA WITH DIFFERENT ACTIVITY DEGREE OF EOSINOPHILIC AIRWAY INFLAMMATION

The aim of the study – to investigate the clinical signifi cance of eosinophilic cationic proteinconcentration in sputum and its diagnostic role in the disease management for optimizationof the personalized anti-infl ammatory therapy of patients with bronchial asthma.
 Materials and methods. There have been examined 66 school-aged children with persistentbronchial asthma who had been under anti-infl ammatory control therapy for at least thelast three months, but still needed treatment correction. Sputum has been collected in allpatients during post-attack period of disease by the method of sputum induction usingan inhalation of hypertonic solutions (3%,5%,7%) of sodium chloride. Quantitative andqualitative cytological composition of the sputum precipitate has been determined, inthe supernatant liquid fraction, obtained after sputum centrifugation, the concentrationsof eosinophilic cationic protein (ECP) and endothelial vascular growth factor (VEGF)have been studied by ELISA method. In the general cohort of examined patients, theaverage ECP concentration was 2.28±2.2 ng/ml (minimum value 0, maximum – 9.2 ng/ml). Depending on the ECP content in the sputum, children have been divided into 2clinical groups: The fi rst (I) clinical group was formed by 29 children with a content ofECP in the sputum greater than the average cohort value, and the second (II) clinicalgroup included remaining 47 patients with the level of ECP<2 ng/ml). According to themain clinical characteristics (age, gender, place of residence, duration of the disease)the clinical groups have been comparable. All patients underwent a biochemical studyof exhaled breath condensate (EBC), which involved the content determination of totalprotein, catalase activity; concentrations of nitrogen monoxide metabolites and markers
 of proteolytic activity. The results of the study were analyzed by parametric and non-parametric calculation methods, and estimation of the tests’ diagnostic value were carried
 out from the position of clinical epidemiology taking into account their sensitivity (Se)and specifi city (Sp), as well as attributive (AR) and relative (RR) risks, and the odd ratio(OR) of the event, taking into consideration their 95% confi dence intervals (95% CI).Results. The analysis of the obtained data has showed that in the comparison groups theclinical level of asthma control (18.3 ± 1.5 vs. 18.6 ± 1.3 points, P> 0.05), and sputumcell composition (in particular by the number of eosinophilic granulocytes: 9,24±2.3vs. 9,28±2.2%, P> 0.05) did not diff er much. In addition to that, VEGF concentrationin sputum, which refl ects the bronchial remodeling processes, was 1.25 times higherin representatives of the I group (145.43 ± 19.71 pg/ml) compared with patients of theII group (115.93 ± 15, 7 pg/ml; P> 0.05). In EBC, the content of nitrogen monoxidemetabolites was higher in patients of the II group: 44.4 ± 5.74 μmol/l in comparison withrepresenatives of I group (55.8 ± 9.8 μmol/l; P> 0.05). At the same time, in patients ofclinical I group in EBC higher proteolytic activity of azocol, as well as a higher catalaseactivity was noted (68.4 ± 22.6 μmol/min x mg of protein compared to 49.6 ± 10.3 μmol/min x mg of protein in the II group of comparison; P> 0, 05). In contrast, in the II group,the infl ammatory process has been associated with the lysis of low molecular weightproteins.Conclusion. In children with bronchial asthma, increased degranulation of sputumeosinophils (according to the ECP concentration) is associated with a more pronouncedairway infl ammation, as evidenced by the increased intensity of oxidative modifi cation ofproteins (OR=3,6) and proteolytic activity of high molecular weight proteins; togetherwith high catalase activity and elevated concentration of such marker of bronchialremodeling as VEGF, along with decreased content of nitrogen monoxide metabolites inthe exhaled breath condensate.

Evaluation of the efficacy and safety of the 7% hypertonic solution with hyaluronic acid in patients with COVID-19 in the outpatient phase

Introduction. Since 2020, the pandemic caused by the SARS-CoV-2 virus poses a serious threat to health systems in many countries around the world. Finding inexpensive and affordable, effective and safe medications that can promote rapid recovery and reduce the risk of a severe course of COVID-19 is an important challenge for the health care system of any country. It has long been known that 7% hypertonic sodium chloride solution has nonspecific antiviral, antibacterial and antifungal properties. A 2020 study shows the effectiveness of hypertonic NaCl solutions in blocking SARS-CoV-2 replication in Vero cells. These data suggest that hypertonic solutions can be used as a prophylactic and alternative comprehensive treatment for patients with COVID-19.Aim. We study the efficacy and safety of hypertonic solution with hyaluronic acid in patients undergoing outpatient treatment with mild to moderate COVID-19.Materials and methods. We conducted an open prospective study of the use of hyaluronic acid (HA) solution 7% (Ingasalin® forte 7%) in outpatients with confirmed SARS-CoV-2 infection who had 1 or more risk factors for a severe course of the disease. Patients were divided into 2 groups of 30 patients each. The main group received, in addition to standard therapy (according to the interim guidelines in effect at the time of treatment, version 14 dated 12/27/21), inhalation of 7% HG with HA in the morning and evening for 10 days; patients in the control group received standard therapy according to the interim guidelines.Results and discussion. Patients of the study group who received hyaluronic acid solution 7% had statistically significant decrease of dyspnea and normalization of saturation values already on the 5th day of therapy compared to patients of the control group. One patient in the study group was hospitalized, and 4 patients in the control group were hospitalized. There were no side effects associated with the administration of hyaluronic acid solution 7%. Also, there was no development of cough or its intensification against the background of inhalation in patients of the main group.Conclusion. It is reasonable to use hyaluronic acid solution 7% in outpatients with mild to moderate COVID-19 and with one or more risk factors of severe disease course as part of complex therapy.

A teaspoon of sugar and a pinch of salt: Reviewing hyperosmolar therapy.

The traditional hyperosmolar agents used to treat patients with elevated intracranial pressure are mannitol and hypertonic sodium chloride solution. This article focuses on some of the pros and cons of these treatments for managing cerebral edema.

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

INTRODUCTION. The literature has accumulated enough data on the treatment of children with acute bronchiolitis (OB). However, this information is formed mainly on the general population of patients with OB and is often not applicable to patients with a severe course of the disease. From the standpoint of evidence-based medicine, routine use of medications is not recommended in modern consent documents, and there are also no clear recommendations on respiratory support and certain aspects of intensive care in children with OB. OBJECTIVES. To analyze approaches to therapy in children with severe acute course in need of intensive care, and to assess the validity, effectiveness and safety of the use of the analyzed groups of drugs and respiratory strategies. MATERIALS AND METHODS. The analysis of publications in the electronic databases PubMed and the Russian Scientific Citation Index on the keywords “bronchiolitis”, “intensive care units”, “critical care”, “fluid therapy”, “respiratory therapy”, “ventilation”, “co-morbidity”; “respiratory syncytial virus”; “hypertonic saline” was carried out, “corticosteroids”; “epinephrine”; “high-flow oxygen therapy”, “inhalation”, “infant”, “bronchiolitis in children”. The date of the last search is January 15, 2022. RESULTS. This systematic review provides information on the etiology and risk factors of severe acute respiratory syndrome in children, from the standpoint of evidence-based medicine, studies on the treatment of severe acute respiratory syndrome are characterized, including in the intensive care unit with glucocorticosteroids, inhalations of bronchodilators, epinephrine, 3 % hypertonic sodium chloride solution, respiratory support, high-flow oxygenation, noninvasive ventilation, artificial ventilation, antibiotics, air-helium mixture. CONCLUSIONS. Currently, there is more information that infants with OB show a high degree of heterogeneity, while the main uncertainty lies in a misunderstanding of the processes, which patients will benefit most from a particular treatment method. Further research is needed to fill the research deficit in children with a severe course of OB.

Липосомальная форма дексаметазона в коррекции экспериментального острого повреждения легких

Objective. To investigate the possibility of pharmacological correction of acute lung injury of aspiration genesis with a liposomal form of dexamethasone in experiment. Materials and methods. For the experiment, simple liposomes were prepared from phosphatidylcholine and cholesterol with an average size of 320±50 nm and a dexamethasone concentration of 2.98±0.02 mg/ml. The study used outbred white rats, divided into four groups of 16 animals. 1st group Control (without experimental therapy), 2nd group - Experiment 1, where a solution of dexamethasone was injected intravenously at a dose of 6 mg/kg, 3rd group - Experiment 2, where an intravenous combination of dexamethasone solution (6 mg/kg) and hypertonic (7.5%) NaCl solution was administered once, and group 4 - Experiment 3, where liposomes with dexamethasone (6 mg/kg) were injected intravenously once in hypertensive (7.5%) NaCl solution. The main functional parameters of the animals (heart rate, blood pressure, saturation of hemoglobin with oxygen, partial pressure of blood oxygen and respiration rate) were subject to analysis. Functional parameters were analyzed before modeling acute lung injury and after 5 min, 1, 4, 24 hours, and 6 days. At the end of the experiment (day 6) the degree of pulmonary edema and histological signs of acute lung injury were assessed. Morphology was assessed quantitatively in each group. Results. The study found that liposomal dexamethasone in hypertonic NaCl solution, when administered intravenously, was more effective than aqueous dexamethasone solution in correcting functional impairment in acute lung injury. The combination of hypertonic sodium chloride solution with dexamethasone more markedly increases blood pressure and reduces the degree of pulmonary oedema. In acidine pepsin aspiration, liposomal dexamethasone in hypertonic NaCl solution most effectively increased animal survival. Conclusion. Compared with dexamethasone in hypertonic NaCl solution, liposomal dexamethasone is more effective in increasing animal survival and protecting lung tissue from aspiration damage by acidine pepsin.

Physiology of magnesium metabolism and the use of magnesium in intensive care (part 2)

In the second part of the review, aspects of changes in magnesium metabolism under conditions of severe stress, mechanisms of anti-stress protection of the body with the participation of magnesium, features of magnesium participation in water-electrolyte metabolism at the cellular level, the anti-inflammatory effect of magnesium and the role of magnesium in the processes of detoxification of the body in acute poisoning with certain poisons are consi-dered. The main mechanisms of the body’s magnesium defence are to suppress the mechanisms of oxidative stress by limiting the production of stress hormones, the intake of ionized calcium and sodium into cells with a decrease in the severity of transmineralization and sodium retention in the body, suppressing the action of factors that initiate the development of inflammation and reducing the production of pro-inflammatory mediators, in blocking and protecting glutamate receptors. Magnesium therapy can help keep effective energy production in the body in critical conditions by maintaining the functioning of the Na+/K+-ATPase, the work of the Na+/H+-exchanger, helping reduce the severity of cellular acidosis. The mechanisms of functioning and the prescription of the sodium-magnesium antiporter are discussed. Hypertonic solutions of magnesium sulfate are being injected at a high rate to create the effect of rapid low-volume fluid resuscitation, thereby eliminating the dangerous effects of severe hyperchloremia and hypernatremia that occur when using hypertonic sodium chloride solutions. In toxico-logy, magnesium preparations are used to protect the body when exposed to heavy metals, organophosphorus compounds. They also help reduce the severity of oxidative stress caused by heavy metals, inhibit excess production of endogenous carbon monoxide, and limit free radical damage in its pathological effect. During detoxification, magnesium prevents depletion of the antioxidant system by helping maintain sufficient levels of glutathione and other antioxidants in cells.

A survey of emergency and critical care veterinarians regarding IV fluid bolus therapy and monitoring practices in small animals.

To determine how veterinary emergency and critical care clinicians define IV fluid bolus therapy (FBT) and what constitutes a positive response to a fluid bolus. Online survey of 222 emergency and critical care veterinarians between December 17, 2018, and March 1, 2019. An online survey was provided to diplomates of the American College of Veterinary Emergency and Critical Care (ACVECC), residents of ACVECC-approved training programs, as well as house officers and emergency clinicians of a corporate multicenter emergency and specialty care veterinary hospital. The survey investigated the administration of various crystalloid, colloid, and blood products for FBT, as well as expected physiological responses. The majority of respondents considered balanced isotonic crystalloids appropriate for FBT (220/222 [99.1%]). Respondents showed greater variability in acceptance of 0.9% sodium chloride (105/222 [47.30%]), hypertonic (3-7%) sodium chloride (131/222 [59.01%]), and hydroxyethyl starch solutions (90/222 [40.54%]). Most respondents did not consider physiological plasma (44/222 [19.82%]) an appropriate choice. The most commonly used parameters for monitoring FBT responses were heart rate (220/222 [99.10%]), blood pressure (217/222 [97.75%]), capillary refill time (192/222 [86.49%]), lactate (181/222 [81.53%]), pulse pressure (151/222 [68.02%]), and rectal temperature (145/222 [65.32%]). The majority of respondents perceived that 0-20% (165/222 [74.32%]) of hypotensive patients are nonresponsive to FBT. Small animal emergency and critical care clinicians favored balanced isotonic electrolyte solutions and hypertonic sodium chloride solutions for FBT over other options. When monitoring responses to FBT, heart rate, blood pressure, capillary refill time, and plasma lactate were among the most commonly monitored parameters, and there was a lack of familiarity with others. Despite the widespread use of FBT, these findings outline the need for further prospective clinical trials regarding the ideal fluid type and rate, as well as the appropriate responses to FBT.

EFFICIENT COMPREHENSIVE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION AND POSTCOVIDAL SYNDROME IN ELDERLY PATIENTS.

The aim: The purpose of the study is to increase the efficacy of сomprehensive treatment in elderly patients with COPD , who have suffered of coronavirus disease-COVID-19 in the last 3-6 months, by using nebulizer therapy with N-acetylcysteine and 3% hypertonic sodium chloride solution (Flu-Acyl broncho) and the drug glycine, to correct psychosomatic disorders. Materials and methods: Under our supervision there were 60 elderly patients with COPD gr D, who underwent Covid 19 in the last 3-6 months, were under observation. The average age was 66.3±2.1 years. Рatients of the main and control groups were prescribed complex basic therapy. However, mucolytic therapy was administered to patients in the main group using combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution through a 5.0 №10 nebulizer. For the treatment of astheno-neurotic disorders of postcovidal syndrome was prescribed glycine 100 mg 2 times a day for 10 days. Subsequently, Flu-Acyl broncho through a nebulizer at 5.0 No.10, and glycised was used in courses once a day for 10 days per month. Patients in the control group were prescribed acetylcysteine 200 mg 3 times a day N10. Results: The results of observation for 6 months showed that in patients of the main group, recurrence of the disease was not observed. whereas in patients of the control group in 6 patients (20%). Conclusions: Comprehensive treatment of elderly patients with comorbid pathology - COPD group D and postcovidal syndrome, with the additional use of nebulizer delivery of the combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution in combination with the sedative drug glycine, promotes improving the quality of life in patients, reducing the duration of treatment, prevents recurrence and progression of COPD.