Russian multicenter observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: a comparative analysis of the outcomes of stroke during mechanical ventilation

Annals of critical care, Journal Year: 2020, Volume and Issue: 4, P. 28 - 41

Published: Nov. 16, 2020

Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Objectives. To analyze patients with severe stroke requiring respiratory support, identify predictors death. Materials methods. A multicenter observational study “REspiratory Therapy Acute Stroke” (RETAS) was conducted under aegis “Federation Anaesthesiologists Reanimatologists” (FAR). The involved 14 centers included 1289 support. Results. We found that initial hypoxemia 28-day period associated (in 20 or more NIH scores) (p = 0.004). Risk factors lethal outcome: hyperventilation used to relieve intracranial hypertension 0.0336); volume-controlled ventilation (VC) versus pressure-controlled (PC) < 0.001); use methods monitoring ICP comparison instrumental ones 0.001). standard status scales (CPIS, LIS, etc.) decrease Conclusions. identified risk increase acute support: hypoxemia, lack according scales, hyperventilation, as well ventilation.

Language: Английский

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Russian multiple-center observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: aspects of mechanical ventilation

Russian Journal of Anesthesiology and Reanimatology, Journal Year: 2021, Volume and Issue: 6, P. 25 - 25

Published: Jan. 1, 2021

Language: Английский

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The treatment efficacy of disturbed swallowing function in patients with ischemic stroke and neurogenous dysfagia in the intensive care unit

S S Korsakov Journal of Neurology and Psychiatry, Journal Year: 2019, Volume and Issue: 119(7), P. 35 - 35

Published: Jan. 1, 2019

To evaluate the efficacy of training method rehabilitation patients with neurogenic dysphagia in ischemic stroke carried out use special nutrient mixtures as part combination therapy.The study included 65 (35 men and 30 women, aged 45 to 80 years) acute period stroke. Thirty were treated binding compounds a therapy. Thirty-five did not mixture. The dynamics recovery function swallowing using PAS (the Penetration-Aspiration Scale) FEDSS Fiberoptic Endoscopic Dysphagia Severity Scale), well transition from tube independent feeding studied.The help nutritional allows achieving significantly better indicators restoration assessed dysphagia. This trend is most pronounced group pseudobulbar syndrome. application leads feeding. Tracheal intubation mechanical ventilation are an additional factor aggravating disorders.Цель исследования. Оценить эффективность тренировочного метода реабилитации больных с нейрогенной дисфагией при ишемическом инсульте (ИИ), проводимого применением специальных питательных смесей в составе комбинированной терапии. Материал и методы. В исследование включены пациентов мужчин женщин возрасте от до лет) остром периоде ИИ. У применены специальные вяжущие смеси терапии, у 35 не применяли. Изучали динамику восстановления функции глотания использованием шкал (шкала пенетрации-аспирации) (федеральная эндоскопическая шкала оценки тяжести дисфагии), а также переход зондового питания на самостоятельное. Результаты заключение. Применение помощью ИИ позволяет достичь достоверно лучших показателей по шкалам FEDSS. Данная тенденция наиболее выражена группе псевдобульбарным синдромом. приводит к лучшему переходу самостоятельному. Интубация трахеи проведение искусственной вентиляции легких являются дополнительным фактором, усугубляющим нарушения глотания.

Language: Русский

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Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)»: a comparative analysis of the outcomes of stroke

S S Korsakov Journal of Neurology and Psychiatry, Journal Year: 2022, Volume and Issue: 122(3), P. 22 - 22

Published: Jan. 1, 2022

To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors death.A multicenter observational clinical study «REspiratory Therapy for Acute Stroke» (RETAS) was conducted under aegis «Federation Anaesthesiologists Reanimatologists» (FAR). The involved 14 centers included 1289 support.We found that initial hypoxemia in 28-day period associated higher mortality than absence (in 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors lethal outcome: hyperventilation used to relieve intracranial hypertension compared group who were not treated (79.55% 72.75%, p=0.0336); volume-controlled ventilation (VC) pressure-controlled (PC) (p<0.001); use methods monitoring ICP comparison instrumental ones (87.64% 62.33%, p<0.001). It has been proved nutritional insufficiency is a probability positive outcome (GOS 4 5) signs insufficiency, less points (p<0.001).A deterioration prognosis outcomes are undergoing identified: at start lack ICP, correct volume control (VC), as well presence insufficiency.Провести анализ результатов лечения пациентов с тяжелым церебральным инсультом, требующих проведения респираторной поддержки, и выявить предикторы летальных исходов.Под эгидой Федерации анестезиологов реаниматологов России проведено многоцентровое обсервационное клиническое исследование «Регистр терапии у ОНМК (RETAS)». В исследовании участвовало центров, включены ОНМК, которым проводили респираторную поддержку.Было доказано, что исходная гипоксемия ассоциируется более высокой летальностью в 28-дневный период, чем отсутствие гипоксемии (для группы тяжестью >20 баллов по NIHSS) (76,22% против 63,45%, p=0,004). Факторами, ассоциирующимися повышением летальности, являются также гипервентиляция, применяемая целью купирования внутричерепной гипертензии, сравнении группой пациентов, при лечении которых гипервентиляция не применялась (79,55% 72,75%, p=0,0336), стартовая вентиляция управлением объему со стартовой вентиляцией давлению (p<0,001), использование только клинических методов мониторинга внутричерепного давления (ВЧД) инструментальным мониторингом (87,64% 62,33%, p<0,001). Доказано, белково-энергетической недостаточности (БЭН) большей вероятностью позитивного исхода пациентами, имеющими признаки БЭН, для <14 (p<0,001).Выявлена группа факторов, связанных ухудшением прогноза исходов проводится ИВЛ: старте инструментального ВЧД, применение гипервентиляции коррекции ИВЛ а наличие БЭН.

Language: Русский

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Dysphagia Associated with Neurological Disorders

IntechOpen eBooks, Journal Year: 2021, Volume and Issue: unknown

Published: Feb. 19, 2021

Neurogenic dysphagia is characterized by problems with neural control of swallowing caused various neurological diseases: vascular diseases, traumatic neoplasms, infections, neuromuscular and others. In patients intensive care units after long-term intubation extubation may evolve “postextubation dysphagia”, the “learned non-use” phenomenon. a component bulbar or pseudobulbar palsy, depending on level lesion. Diagnoses neurogenic include clinical examination (water swallow test), videofluoroscopy, upper gastrointestinal tract endoscopy manometry, fiberoptic endoscopic evaluation swallowing, grade Penetration-Aspiration Scale, Fiberoptic Endoscopic Dysphagia Severity Scale. complications (malnutrition, dehydration, weight loss, aspiration, respiratory obstruction) associated bad functional recovery life prognosis, so need complex treatment: correct feeding pattern caloric value consistency, methods oral cavity mucosa sensitivity stimulation, process physiotherapeutic treatment (electrical stimulation larynx tongue root), logopedic exercises therapy, surgical correction, lifestyle Sometimes it for replacement therapy method nasogastric tube percutaneous gastrostomy, parenteral in several cases. patient rehabilitation includes “swallowing enhancement” optimal food consistency training preparation swallowing. requires technique contact safety efficient recovery.

Language: Английский

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Recent advances in the diagnosis and treatment of dysphagia in neurological diseases

INTERNATIONAL NEUROLOGICAL JOURNAL, Journal Year: 2024, Volume and Issue: 20(5), P. 253 - 264

Published: Sept. 29, 2024

Swallowing disorders are common in many neurological diseases, especially stroke, Parkinson’s disease, amyotrophic lateral sclerosis, dementia, and multiple sclerosis. Neurogenic dysphagia is associated with an increased risk of death serious complications, including aspiration pneumonia, dehydration, malnutrition, which points to the importance implementing recent advances diagnosis treatment swallowing into practice. If initial screening for positive, further workup includes a combination bedside tests ancillary investigations, such as comprehensive clinical, videofluoroscopic endoscopic evaluation. These measures allow determine type degree severity, necessary choosing optimal therapeutic strategy. Treatment patients neurogenic requires multidisciplinary approaches involving team specialists, neurologists, speech language therapists, gastroenterologists, dietitians. Therapeutic strategy should include providing adequate nutritional support by diet modification and/or enteral nutrition through nasogastric tube or gastrostomy, appropriate management underlying concomitant prevention complications well rehabilitation interventions. Future directions reduce diseases will probably comprise pharmacotherapy non-invasive stimulation/neuromodulation. Early detection effective crucial achieving better outcomes improving quality life diseases.

Language: Английский

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Artificial ventilation in patients with stroke: main results of the Russian multicenter observational clinical trial RETAS

S S Korsakov Journal of Neurology and Psychiatry, Journal Year: 2024, Volume and Issue: 124(8), P. 5 - 5

Published: Jan. 1, 2024

To analyze the relationship between characteristics of respiratory support (RS) for patients with stroke and clinical factors number structure complications, deaths, length stay in intensive care unit (ICU) duration artificial pulmonary ventilation (ALV).

Language: Английский

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Evaluation of aspiration risk by relatives of inpatients in the neurology service: A metaphor analysis

Health Expectations, Journal Year: 2023, Volume and Issue: 27(1)

Published: Oct. 2, 2023

Abstract Background The risk of aspiration is high in stroke patients due to dysphagia/loss swallowing. This problem can cause problems affecting the nutrition patients. Due possible during feeding, patient relatives are hesitant feed their Because this fear, malnutrition and hospital readmissions may increase. It important evaluate fear hospitalized neurology service. aim study determine views treated service about through metaphors. Method article analyzed metaphors patients' relatives' aspiration. analysis uses metaphor identification analysis. research sample consisted 31 First all, study, evaluation data was conducted by performing content analysis, as a result which it divided into conceptual categories, relevant field associated with text (event, thought, feelings, related speech or writing). In reporting research, Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist used. Results seen that produced different response statement ‘Aspiration like …, because …’ mostly compared concept ‘fear aspiration’ ‘fear’ ( n : 24). Conclusions described According result, have great increasing readmission malnutrition. shows informing will increase awareness allow them provide informed care. Patient Public Contribution Collaborated regarding contributed planning care

Language: Английский

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Effciency of a rehabilitation training method by means of special infant formulas in patients with ischemic stroke and neurogenic dysphagia as part of combined therapy

Neurology neuropsychiatry Psychosomatics, Journal Year: 2019, Volume and Issue: 11(2), P. 65 - 70

Published: June 16, 2019

Objective: to evaluate the efficiency of a training method using special infant formulas as part combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia. Patients methods . The investigation enrolled 55 (30 men 25 women) aged 45–80 years dysphagia during acute period stroke. Thirty used astringent therapy did not. investigators studied time course changes in restoration swallowing function, by Penetration-Aspiration Scale (PAS) Fiberoptic Endoscopic Dysphagia Severity (FEDSS), well transition from probe feeding independent one. Results discussion. best function was shown be achieved through different astringency. Stronger formulas, like solid foods, stimulate better pharyngeal receptor apparatus; most active dynamic stereotype occurs. gradual milder formula allows skill swallow thinner liquid foods. It takes 10 days achieve significant clinical effect patients, mainly those pseudobulbar disorders. Training may prolonged 2 weeks or more severe cases, bulbar dysfunctions. Conclusion. combination electrical stimulation achieving significantly indicators accordance PAS scale. application contributes

Language: Английский

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INFLUENCE OF RESPIRATORY SYSTEM PROTECTION ON THE TREATMENT OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

Pain anesthesia and intensive care, Journal Year: 2022, Volume and Issue: 1(98), P. 27 - 31

Published: April 1, 2022

Introduction. Craniocerebral trauma (CCT) results in disorders of pharyngeal reflex, deglutition, breathing rhythm and frequency. All the mentioned conditions cause development respiratory complications. Whereas they become independent factors negative therapeutic consequences such category patients. Aim a paper. The research aims at evaluating protection/treatment possibilities system concerning course craniocerebral injured Materials methods. We examined 237 patients with CCT who underwent urgent surgical interventions form decompressive cranial trepanation removal both subdural epidural hematomata. required prolonged mechanical ventilation lungs. were retrospectively divided into two groups, namely: first group (132 patients) – tracheostomy on 5th-6th days admission to clinics anesthesiology intensive care; second (105 1st-2nd hospitalization. Patients groups not differentiated by gender, severity general condition. In addition clinical biochemical blood markers, culturing secretion tube (at moment further every 3-4 days), urine performed all patients. Simultaneously we controlled leucocyte count peripheral blood, number immature forms, levels CRP procalcitonin. evaluation neurological status was carried out Glasgow Richmond Agitation-Sedation Scale (RASS). visualized help CT. Research results. Even frequency colonization tracheobronchial tree significantly higher compared one. Such tendency monitored stages as well. phenomena tracheobronchitis pneumonia detected more frequently postoperative period contrast period. Microorganisms Enterobacteriaceae extended spectrum ß-lactamase non-fermenting Gram-negative bacteria group. Conclusion. Early decrease positive secretions from reduction detection nosocomial pneumonia.

Language: Английский

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